Meta Analysis And Qualitative Study Of Wenyang Huayin Method In The Treatment Of Malignant Pleural Effusion

[Objective]Warming yang and resolving fluid retention is one of the commonly used therapeutic principle in clinical treatment of Malignant pleural effusion(MPE).The purpose of the first clinical study was to analyze the clinical effects of warming yang for resolving fluid retention on MPE by summarizing previously published literatures through Meta analysis.And the second was to through the collation and analysis of the qualitative interview data,it is expected to clearly explore the non-specific efficacy of acupuncture in the treatment of MPE.[Methods]The method of first linical study was to retrieve CNKI,Wanfang Data,VIP,PubMed,The Cochrane database from 2007 to March 2019 about randomized Controlled Trials of warming yang for resolving fluid retentionthis for MPE.According to the pre-set inclusion and exclusion criteria,two quality personnel independently screened and extracted relevant data,and Rve Man5.3 software was used for Meta analysis.The method of second linical study was used the principles of"dynamic sampling" and"information saturation" for sampling.After receiving the treatment of acupuncture,semi-structured interviews were conducted with the interviewees,and the qualitative interview data were transcribed and sorted out and analysed by Colaizzi's seven-step method.[Results]Clinical study I:eleven clinical studies on the treatment of MPE with warming yang for resolving fluid retention were finally included,including 449 cases in the experimental group and 423 cases in the control group.The results showed that,compared with the treatment of western medicine alone,the combined warming yang for resolving fluid retention method could significantly improve the clinical efficiency(RR=1.46,95%CI[1.30,1.66],P<0.00001),and the difference was statistically significant.Meta analysis on quality of life of 7 studies showed that RR=1.72,95%CI[1.38,2.14],P<0.00001),and the difference was statistically significant.In the occurrence of adverse reactions,gastrointestinal reactions(RR=0.36,95%CI[0.25,0.53],P<0.00001),malignant vomiting(RR=0.53,95%CI[0.30,0.94],P=0.03<0.05),anorexia(RR=0.48,95%CI[0.28,0.80],P=0.005),leukopenia(RR=0.28,95%CI[0.11,0.70],P=0.006),fever(RR=0.16,95%CI[0.03,0.94],P=0.03<0.05)were statistically significant compared with the control group.However,there was no significant difference between the two groups in terms of adverse reactions such as diarrhea(RR=0.61,95%CI[0.32,1.16],P=0.13>0.05),thrombocytopenia(RR=0.13,95%CI[0.02,0.97],P=0.05),dizziness and headache(RR=0.64,95%CI[0.17,2.32],P=0.49>0.05),chest pain(RR=0.33,95%CI[0.04,3.08],P=0.33>0.05).Clinical study ?:6 patients were eventually included in the interview,and 7 subjects were finally extracted through the transcription,sorting and analysis of qualitative data:Cognition;Choice;Curative effect;Change;Good doctor-patient relationship;Confidence;Satisfaction.[Conclusions]Clinical study I:combined warming yang for resolving fluid retention method can effectively improve the short-term clinical efficacy of patients,improve the quality of life,and reduce the incidence of nausea and vomiting,appetite loss,bone marrow suppression,fever and other adverse reactions.There was no significant difference in the incidence of adverse reactions such as diarrhea,dizziness,headache,chest pain,fatigue,liver and kidney function damage between the two groups,which may be related to the small sample size.The included literatures are generally of low quality,and there is a risk of publication bias,which has a certain impact on the reliability of the analysis results of this study.Therefore,it is expected that this result will be verified by higher-quality RCTS in the future.Clinical study ? through qualitative interview,it was found that patients receiving acupuncture not only improved their clinical symptoms,but also greatly improved their life style,mental state,mental health and confidence in their future life,with certain non-specific efficacy.The analysis also found that a good doctor-patient relationship also played a key role in the overall efficacy,the method of acupuncture treatment of MPE still needs further clinical promotion.