| 引用本文:靳英辉1，魏洪悦2，王云云3，李紫梦1，许良燕1，韩蕙安1，杨柳1，商洪才4.中医非药物治疗老年性痴呆的证据总结与评价[J].世界中医药,2017,(06):. |
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| 中医非药物治疗老年性痴呆的证据总结与评价 |
| Summary and Evaluation of Evidences of Non-pharmacological Intervention of Traditional Chinese Medicine in Alzheimer’s Disease |
| 投稿时间：2017-05-10 |
| DOI：10.3969/j.issn.1673-7202.2017.06.007 |
| 中文关键词: 中医非药物；证据评价；AMSTAR工具 GRADE系统 AGREE II工具；指南构建 |
| English Keywords:Non-pharmacological intervention in Traditional Chinese Medicine Evidence evaluation AMSTAR tool GRADE approach AGREE II Guideline development |
| 基金项目:国家自然科学基金青年项目（编号：81603496）——中西医调摄护理多源证据体构建及整合评价 |
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| 中文摘要: |
| 目的：评价中医非药物治疗老年性痴呆的证据，为老年性痴呆非药物管理指南提供证据支持；方法：检索各大指南数据库获得与中医非药物管理有关的推荐意见，检索CNKI、万方、维普、Pubmed、Medline、Cochrane library、Embase，PsycINFO，CINAHL，ACP Journal Club（www.acpjc.org）等数据库获得相关系统评价。分别采用指南评定采用指南评价工具AGREE II。纳入系评价/Meta分析的方法学质量和证据质量分别采用AMSTAR量表和GRADE系统进行评价；结果：检索到针刺治疗AD系统评价若干篇，香薰治疗AD患者系统评价一篇，非药物管理AD患者系统评价一篇，内含按摩操作文献四篇，其中一篇为穴位按摩。针刺有效性系统评价，AMASTA等级评分从6.5分到11不等，GRADE证据质量分级大多为Low及Moderate。一篇系统评价分析综合了感官刺激干预对痴呆患者的干预效果，按摩方法中一篇为穴位按摩，结果显示穴位按摩组和蒙台梭利教育组相对于空白组均明显减低了激越行为，身体其他非激越行为，语言激越行为，AMSTAR:8.5。检索到一篇含“香薰疗法”相关推荐意见的指南，不推荐使用芳香疗法减轻AD患者激越行为。芳香疗法较安慰剂对痴呆患者的激越症状和行为症状的影响呈现不一致的结果［AMSTAR：8.5;GRADE：very low］。结论：但本研究显示对已经发生AD的患者的中医非药物的研究仍然不足，尤其是中医护理技术对AD患者的应用研究非常缺乏，故其对AD非药物管理指南的支持作用仍较小。中医调摄研究者们应继续进行高质量的原始研究，并及时进行证据总结和评价，以促进中医调摄护理技术的循证转化。 |
| English Summary: |
| To summarize and evaluate the evidence of non-pharmacological intervention of Traditional Chinese Medical in Alzheimer’s disease （AD） and provide supports. Methods:A systematic literature search was performed. CNKI, Wanfang, Pubmed, Medline, Cochrane library, Embase, PsycINFO, CINAHL, CQVIP, ACP Journal Club（www.acpjc.org ） were searched for related systematic reviews. The methodological quality and the quality of the evidences were evaluated using the Assessment of Multiple Systematic Reviews （AMSTAR） and Grading of Recommendations Assessment, Development and Evaluation （GRADE） approaches. The guideline was evaluated using AGREE II.Results:Seven systematic reviews and meta-analyses of acupuncture for AD were included, one of aromatherapy and one of non-pharmacological intervention for AD, four of massage （included one article of acu-point massage）. The compliance with AMSTAR checklist items regarding to acupuncture systematic reviews ranged from 6.5 to 11. The quality of the bodies of evidence of acupuncture we assessed ranged from very low to moderate, and no high quality bodies of evidence were found. The effectiveness of aromatherapy for agitation or behavior symptom of AD remained inconclusive. Acu-point massage revealed positive effective in controlling psychological or behavior symptoms.Conclusion:There is still expectations for more researches including primary and secondary literature about non-pharmacological intervention of TCM for AD. The overall quality of the evidence remains sub-optimal which raises concerns regarding their roles in clinical practice. Thus, the conclusions in reviews must be treated with caution and their roles in clinical practice should be limited. |
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