背景:产后无乳(PH)在哺乳期很突出,可能对母亲或婴儿的健康产生负面影响。针灸被广泛用于增加产妇的母乳产量。然而,针刺对PH的影响尚不清楚。因此,这篇综述旨在评估针灸在PH患者中的疗效和安全性。
方法:从PubMed检索了从数据库开始到2023年10月发表的关于针灸治疗PH的潜在合格随机对照试验(RCT)的文章,WebofScience,科克伦图书馆,EMBASE,EBSCO,Scopus,中国国家知识基础设施,中国生物医学文献数据库,万方,VIP数据库。两名审稿人独立筛选记录,提取的基本信息,并使用修订后的Cochrane偏倚风险(RoB)工具评估RCT的方法学质量。主要结果是治疗前后血清催乳素(PRL)水平的变化。次要结果包括乳汁分泌量(MSV),总有效率(TER),乳房丰满度(MFD),纯母乳喂养率(EBR)。使用RevManv5.4进行Meta分析。最后,使用建议分级评估证据质量,评估,发展,和评估工具。
结果:本研究包括19项RCT,涉及2,400名参与者。纳入的研究被归类为具有不明确的至高的RoB。我们的研究结果表明,总的来说,针刺在增加血清PRL水平方面具有显着作用(标准化平均差[SMD]=1.09,95%置信区间[CI]:0.50,1.68),MSV(SMD=1.69,95%CI:0.53,2.86),TER(相对风险[RR]=1.25,95%CI:1.10,1.42),与对照组相比,EBR(RR=2.01,95%CI:1.07,3.78);但是,MFD无差异(SMD=1.17,95%CI:-0.09,2.42)。在亚组分析中,针刺结合中药或常规治疗在提高血清PRL水平方面显着更有效,MSV,和TER比中药或常规治疗单独。此外,与中草药相比,单纯针刺导致血清PRL水平明显更高;然而,对于TER和MFD没有观察到这种益处.证据质量极低。
结论:针刺可有效增加PH女性的乳汁分泌。然而,由于证据质量低,我们需要进一步严格设计的研究来证实我们的发现.
BACKGROUND: Postpartum hypogalactia (PH) is prominent during
lactation and may negatively impact the mother\'s or infant\'s health. Acupuncture is widely used to increase maternal breast milk production. However, the effects of acupuncture on PH remain unclear. Therefore, this
review aimed to evaluate the efficacy and safety of acupuncture in individuals with PH.
METHODS: Articles on potentially eligible randomized controlled trials (RCTs) on acupuncture for PH published from database inception to October 2023 were retrieved from the PubMed, Web of Science, Cochrane Library, EMBASE, EBSCO, Scopus, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, WanFang, and VIP databases. Two reviewers independently screened the records, extracted essential information, and evaluated the methodological quality of the RCTs using the revised Cochrane risk-of-bias (RoB) tool. The primary outcome was a change in serum prolactin (PRL) levels before and after treatment. Secondary outcomes included milk secretion volume (MSV), total effective rate (TER), mammary fullness degree (MFD), and exclusive breastfeeding rate (EBR). Meta-analyses were performed using RevMan v5.4. Finally, the quality of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation tool.
RESULTS: This study included 19 RCTs involving 2,400 participants. The included studies were classified as having an unclear to high RoB. Our findings indicated that, overall, acupuncture showed a significant effect in increasing serum PRL levels (standardized mean differences [SMDs] = 1.09, 95% confidence interval [CI]: 0.50, 1.68), MSV (SMD = 1.69, 95% CI: 0.53, 2.86), TER (relative risk [RR] = 1.25, 95% CI: 1.10, 1.42), and EBR (RR = 2.01, 95% CI: 1.07, 3.78) compared to that in the control group; however, no difference in MFD (SMD = 1.17, 95% CI: -0.09, 2.42) was observed. In the subgroup analysis, acupuncture combined with Chinese herbs or conventional treatment was significantly more effective in increasing serum PRL levels, MSV, and TER than did Chinese herbs or conventional treatment alone. Moreover, acupuncture alone resulted in significantly higher serum PRL levels compared to Chinese herbs; however, this benefit was not observed for TER and MFD. The quality of evidence was critically low.
CONCLUSIONS: Acupuncture may effectively increase milk secretion in women with PH. However, owing to the low quality of evidence, further rigorously designed studies are warranted to confirm our findings.