针刺联合疗法治疗动眼神经麻痹的文献研究

Literature Research on the Acupuncture Combined Therapy for Oculomotor Nerve Paralysis

摘要: 目的：系统评价针刺联合疗法治疗动眼神经麻痹(ONP)的临床疗效，为优化治疗方案提供循证依据。方法：计算机检索中英文数据库(建库至2025年2月)，纳入11项随机对照试验(RCTs，共688例患者)。试验组采用针刺联合电针、推拿、穴位注射等疗法，对照组采用单纯针刺。使用RevMan 5.4软件进行Meta分析，评估临床有效率、眼球活动度、瞳孔直径、复视像距离及眼裂大小等指标。结果：临床有效率(OR = 4.80, 95%CI [2.95, 7.82], P < 0.05)，异质性低(I² = 0%)，眼球活动度(MD = 1.48, 95%CI [−0.05, 3.01])，异质性较高(I² = 95%)，瞳孔直径(MD = −0.31, 95%CI [−0.64, −0.02])，异质性较高(I² = 77%)，复视像距离(MD = −10.25, 95%CI [−10.58, −9.93])，异质性低(I² = 0%)，眼裂大小(MD = 1.69, 95%CI [1.52, 1.86])，异质性低(I² = 33%)，试验组优于对照组。亚组分析表明眼球活动度与治疗方法有关，疗程对瞳孔直径影响较大，且疗程长疗效越好，对眼裂大小进行敏感性分析，病因可能影响ONP的治疗效果。结论：针刺联合疗法可有效改善ONP症状，且疗程4周效果更佳。未来需规范联合方案以进一步提升疗效。

Abstract: Objective: To systematically evaluate the clinical efficacy of the acupuncture combined therapy in the treatment of oculomotor nerve paralysis (ONP), and to provide an evidence-based basis for optimizing the treatment plan. Methods: Computer retrieval of Chinese and English databases (from the establishment of the database to February 2025) was carried out, and 11 randomized controlled trials (RCTs, a total of 688 patients) were included. The experimental group adopted therapies such as acupuncture combined with electro-acupuncture, tuina, and acupoint injection, while the control group adopted simple acupuncture. The RevMan 5.4 software was used for Meta-analysis to evaluate indicators such as clinical effective rate, eye movement, pupil diameter, diplopia image distance, and palpebral fissure size. Results: For the clinical effective rate (OR = 4.80, 95% CI [2.95, 7.82], P < 0.05), the heterogeneity was low (I² = 0%); for the eye movement (MD = 1.48, 95% CI [−0.05, 3.01]), the heterogeneity was high (I² = 95%); for the pupil diameter (MD = −0.31, 95% CI [−0.64, −0.02]), the heterogeneity was high (I² = 77%); for the diplopia image distance (MD = −10.25, 95% CI [−10.58, −9.93]), the heterogeneity was low (I² = 0%); for the palpebral fissure size (MD = 1.69, 95% CI [1.52, 1.86]), the heterogeneity was low (I² = 33%). The experimental group was superior to the control group. Subgroup analysis showed that the eye movement was related to the treatment method, the course of treatment had a greater impact on the pupil diameter, and the longer the course of treatment, the better the curative effect. Sensitivity analysis of the palpebral fissure size indicated that the cause of the disease might affect the treatment effect of ONP. Conclusion: The acupuncture combined therapy can effectively improve the symptoms of ONP, and the effect is better when the course of treatment is 4 weeks. In the future, it is necessary to standardize the combined program to further improve the curative effect.