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Efficacy and safety of acupuncture for septic gastrointestinal dysfunction: a systematic review and meta-analysis of
Jian Xu1,2, Jiahua Li3, DingWei Deng1
1The Second Clinical School of Medicine, Guangzhou University of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.
Background:
Septic gastrointestinal dysfunction (S-GID) lacks effective therapeutic approaches. Acupuncture has been widely used to treat S-GID; however, its efficacy and safety lack high-quality evidence-based support, particularly from randomized controlled trials (RCTs).
Methods:
A comprehensive search of PubMed, Embase, The Cochrane Library, and four other Chinese databases was conducted for all years up to September 2023 of acupuncture for S-GID. Additionally, research progress was reviewed in the Chinese Clinical Trials Registry and ClinicalTrials.gov. The analysis was conducted using RevMan5.3 and STAT13.1. Continuous data were evaluated by the mean difference (MD)/the standard mean difference (SMD) and 95% confidence intervals (CIs). Dichotomous data were used to calculate the relative risk (RR)/the odds ratio (OR) with 95% CI. The quality of the data was assessed using the Risk of Bias Tool 2 and the GRADEpro GDT tool.
Results:
Thirteen RCTs with 865 patients were included for the analysis. Compared with the group of the standard treatment, the combination of acupuncture and the standard treatment for S-GID effectively reduced the intra-abdominal pressure (IAP; SMD = -0.71; 95% CI: -1.01, -0.41, p < 0.001), the acute gastrointestinal injury grade (AGI; MD = -0.44; 95% CI: -0.65 to -0.23; p < 0.001), the Acute Physiology and Chronic Health Evaluation-II score (APACHE II; MD = -1.99; 95% CI: -3.04, -0.95, p < 0.001), and abdominal perimeter (AP; MD = -2.24; 95% CI: -3.49 to -1.00; p < 0.001), and increased the frequency of borborygmus per minute (FOB; MD = 0.85; 95% CI: 0.52-1.18; p < 0.001). No significant difference was found between these two groups in both mortality at day 28 (RR = -0.74; 95% CI: 0.49-1.11; p = 0.14) and the incidence of adverse events (OR = 1.01; 95% CI: 0.22-4.58; p = 0.99).
Conclusion:
This study indicated that, in S-GID patients, combining conventional treatment with acupuncture may reduce IAP, AP value, and AGI grade, increase FOB values, and lower the APACHE II score with good safety. However, the 28-day mortality data showed no significant difference, likely due to insufficient sample size. A multicenter, randomized, double-blind controlled study is required for further confirmation.
Systematic Review Registration:
https://www.crd.york.ac.uk/PROSPERO/view/CRD42022375480, identifier PROSPERO (CRD42022375480).