| ObjectiveTo examine the effect value of acupuncture in complex interventions for post-stroke cognitive impairment(PSCI)patients and the additional benefit of acupuncture through a component network metaanalysis.The optimal combination of treatments was ranked to optimize the acupuncture treatment combinations.The findings of the CNMA will be confirmed by exploratory prospective clinical observation.Methods(1)Literature research: Pub Med,Embase,Cochrane Library,CNKI,and CBM were searched for literature published from the database set up to 31 December 2020 to include randomized controlled trials of acupuncture interventions for ischemic PSCI.literature data were extracted and included.Literature quality assessment was based on the risk of bias assessment tool in the Cochrane Handbook version 5.2.Overall cognitive function improvement efficiency was used as the outcome indicator,RR values and their95% confidence intervals were calculated.Standard network meta-analysis and CNMA were performed using R x64 version 4.0.5 software.(2)Clinical research: Patients with ischemic PSCI admitted to the Department of Neurology,West China Hospital of Sichuan University from September 2020 to December 2020 were selected to form natural observation groups according to the treatment.While the western medicine group was treated with routine western medicine,the acupuncture group was treated with regular acupuncture or electroacupuncture on this basis.MoCA and MMSE scores and treatment-related adverse events were recorded before and 1 month after treatment.Results(1)Literature research: 50 RCTs with a total of 3825 patients were included for qualitative analysis.4,37,and 9 studies rated as high,moderate,or low risk of bias respectively.24 RCTs with a total of 1828 patients were included for quantitative analysis,with cognitive training being the most effective treatment component(RR=2.03,95% CI [1.40,2.94]),followed by general acupuncture(RR=1.26,95% CI [1.19,1.34])and electroacupuncture(RR=1.16,95% CI [1.04,1.28]),which are superior to western conventional treatment.General acupuncture + routine western treatment + cognitive training was the most effective treatment combination(RR=2.56,95% CI [1.78,3.68])and was superior to routine western treatment plus cognitive training and routine western treatment alone.(2)Clinical research: A total of 31 patients(13 in the acupuncture group and 18 in the western medicine group)completed the observation and follow-up.The differences in MoCA scores and MMSE scores in the acupuncture group 1 month after treatment were statistically significant compared with those before treatment(P<0.01),while their differences in the western medicine group before treatment and 1 month after treatment were not statistically significant compared with those in the western medicine group(P >0.05).There was also no statistically significant difference in MoCA and MMSE scores between groups in the acupuncture group and the western medicine group(P>0.05).No serious adverse events occurred in either group.Conclusions(1)In complex treatment combinations to improve cognitive function in patients with ischemic PSCI,cognitive function training is the most effective component,followed by general acupuncture and electroacupuncture,which are superior to routine western treatment,with routine rehabilitation being ineffective.(2)For improving cognitive function in patients with ischemic PSCI,general acupuncture + routine western treatment + cognitive function training is the most effective treatment combination.(3)Compared to acupuncture alone,acupuncture exerts a greater therapeutic effect when combined with other therapies,and has a synergistic and additive effect on the routine western treatment and cognitive function training.(4)Acupuncture is safe for ischemic PSCI.(5)The results of exploratory clinical observation showed that acupuncture,as an adjunctive treatment of conventional western medicine,partly showed a beneficial tendency to improve cognitive function of patients with ischemic PSCI,but the sample size is too small and the duration of acupuncture sessions is insufficient to draw definite conclusions.And the quality of the literature included in the CNMA is poor,so definite results need to be confirmed by further randomized controlled clinical trials. |
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