中国针灸

目的：系统评价耳针治疗失眠的临床疗效及安全性。方法：计算机检索Pub Med、EMbase、Cochrane Library、Web of Science、中国期刊全文数据库（CNKI）、万方数据知识服务平台（Wanfang）、维普资讯中文期刊服务平台（VIP）、中国生物医学文献数据库（Sino Med）中耳针治疗失眠的随机对照试验（RCT）文献，检索时间从建库至2021年4月30日。采用Rev Man5.3软件进行Meta分析。结果：共纳入38篇文献，共3 707例患者。Meta分析结果表明：(1)耳针治疗失眠的有效率优于单用安眠西药（RR=1.26,95%CI:1.15～1.39,Z=4.77,P<0.000 01）、常规针刺治疗（RR=1.10,95%CI:1.05～1.16,Z=3.83,P=0.000 1）、中药治疗（RR=1.41,95%CI:1.23～1.63,Z=4.80,P<0.000 01）;(2)耳针治疗在降低PSQI总评分方面优于单用安眠西药治疗（MD=-1.61,95%CI:-2.61～-0.60,Z=3.14,P=0.002）、中成药治疗（MD=-3.76,95%CI:-4.84～-2.68,Z=6.84,P<0.000 01），与常规针刺组比较差异无统计学意义（MD=-1.02,95%CI:-2.11～0.08,Z=1.82,P=0.07）;(3)耳穴选择：迷走神经分布区耳穴为主治疗在降低PSQI总评分方面优于其他耳区穴位为主治疗（MD=-3.21,95%CI:-4.45～-1.96,Z=5.03,P<0.000 01）;(4)刺激物选择：使用不同刺激物（磁珠、王不留行籽、微针）治疗有效率比较差异无统计学意义（MD=1.62,95%CI:0.71～3.73,Z=1.14,P=0.25）;(5)刺激频率：高频次刺激与低频次刺激耳穴在有效率、降低PSQI总评分方面比较差异无统计意义（P>0.05），但根据敏感性分析，结果需要谨慎对待；(6)不良反应：耳针（耳穴贴压）治疗较西药不良反应例数少（MD=0.15,95%CI:0.06～0.35,Z=4.38,P<0.000 1）。结论：耳针治疗失眠较中西药治疗和常规针刺治疗有一定的疗效优势，可以改善失眠的相关症状，且不良反应少，但尚需更多高质量的随机对照试验进一步验证。

Objective To review the effectiveness and safety of auriculotherapy in treatment of insomnia. Methods The articles were collated by computer retrieval from 8 databases from the initiation to April 30, 2021, i.e. Pub Med, EMbase, the Cochrane Library, the Web of Science, CNKI, Wanfang database, VIP and Chinese biomedical literature database(Sino Med). Meta-analysis was conducted with Rev Man5.3 software. Results A total of 38 articles were included, with 3 707 cases involved. The results showed:(1)The effective rate of auriculotherapy was better than that of single application of western medication with sleeping pills(RR=1.26, 95%CI:1.15 to 1.39, Z=4.77, P<0.000 01), conventional acupuncture(RR=1.10, 95%CI: 1.05 to 1.16, Z=3.83, P=0.000 1) and Chinese herbal medicine(RR=1.41, 95%CI: 1.23 to 1.63, Z=4.80, P<0.000 01), respectively.(2) The total score of PSQI was reduced remarkably under the auriculotherapy when compared with the single application of western medication(MD=-1.61, 95%CI:-2.61 to-0.60, Z=3.14, P=0.002) and Chinese herbal medicine(MD=-3.76, 95%CI:-4.84 to-2.68, Z=6.84, P<0.000 01). But the difference was not significant when compared with conventional acupuncture(MD=-1.02, 95%CI:-2.11 to 0.08, Z=1.82, P=0.07).(3)Auricular point selection: the auricular points distributed in the areas of vagus nerve were more advantageous in reducing PSQI score(MD=-3.21, 95%CI:-4.45 to-1.96, Z=5.03, P<0.000 01) compared with the points in other areas.(4)Stimulant selection: the difference in the effective rate was not significant among different stimulants(magnetic beads,the seeds of Vaccaria segetalis, micro-needles)(MD=1.62, 95%CI: 0.71 to 3.73, Z=1.14, P=0.25).(5)Stimulation frequency: there was no significant difference between high-frequency stimulation and low-frequency stimulation of auricular point sticking in improving the effective rate and reducing PSQI score(P>0.05). But the result should be considered cautiously in terms of the sensitivity analysis.(6)Adverse reactions: the case numbers of adverse reactions of auriculotherapy(auricular point sticking) were less than those of western medication(MD=0.15, 95%CI: 0.06 to 0.35, Z=4.38, P<0.000 1). Conclusion Auriculotherapy has certain curative advantages in treatment of insomnia compared with western and Chinese medications as well as conventional acupuncture. This therapy may relieve the symptoms of insomnia and has less adverse effects. But those outcomes need to be further verified with more high-quality randomized controlled trials.