Table 1_Comparative effectiveness of multiple different non-pharmacologic interventions for post-stroke constipation: a Bayesian network meta-analysis.docx

BackgroundPost-stroke constipation (PSC) is a common complication among stroke patients, with a positive correlation to stroke severity. Straining during defecation in constipated patients can increase intracranial pressure, posing a high risk for secondary strokes, negatively impacting prognosis, disease progression, and contributing to the development of depression and anxiety. Non-pharmacological interventions (NPIs), including traditional Chinese medicine (TCM) and rehabilitation approaches, have been explored due to challenges in advancing Western medical treatments. However, the optimal treatment remains unclear, necessitating guidance for clinical practice. This research employs Bayesian network meta-analysis (NMA) to identify the most effective NPIs for improving clinical outcomes and alleviating constipation in post-stroke patients.
MethodsWe conducted a NMA of randomized controlled trials to evaluate the relative efficacy of eight NPIs for PSC: acupuncture therapy (AT), acupoint catgut embedding (ACE), auricular therapy (ART), moxibustion (MT), abdominal massage (AM), point application (PA), physiotherapy (PT), and cognitive behavioral therapy (CBT). The primary outcome was the clinical effective rate (CER), and the secondary outcome was the Constipation Scoring System (CCS). To establish a comparative hierarchy of interventions, surface under the cumulative ranking curve (SUCRA) values were calculated, representing the probability of relative efficacy across treatments.
ResultsA comprehensive literature review identified 53 clinical studies with 5,813 participants to evaluate the relative efficacy of eight NPIs. ACE ranked highest for both CER and CCS (SUCRA = 94.7, 97.8%), followed by PT (88.4, 81.7%). In contrast, ART and AM ranked lower, indicating relatively less efficacy compared with other interventions.
ConclusionAcupoint catgut-embedding (ACE) may represent a potentially superior non-pharmacological intervention for improving clinical outcomes and reducing constipation severity in post-stroke patients. Physiotherapy (PT) also demonstrated favorable efficacy, ranking second in both clinical outcomes. However, further high-quality, multicenter clinical trials are needed to validate and refine these findings.

研究背景：脑卒中后便秘（Post-stroke constipation, PSC）是脑卒中患者常见并发症，且与卒中严重程度呈正相关。便秘患者排便时用力可升高颅内压，大幅增加继发性卒中风险，对预后、疾病进程产生负面影响，并诱发抑郁与焦虑症状。由于西医治疗脑卒中后便秘面临诸多推进难点，非药物干预（Non-pharmacological interventions, NPIs）涵盖传统中医学（traditional Chinese medicine, TCM）及康复疗法，已被诸多研究探索。然而目前最优治疗方案仍不明确，亟需临床实践指导依据。本研究采用贝叶斯网络meta分析（Bayesian network meta-analysis, NMA），旨在筛选出可改善脑卒中后患者临床结局、缓解便秘症状的最优非药物干预措施。

研究方法：本研究针对脑卒中后便秘的8项非药物干预措施开展随机对照试验的网络meta分析，以评估其相对疗效，包括针刺疗法（acupuncture therapy, AT）、穴位埋线（acupoint catgut embedding, ACE）、耳穴疗法（auricular therapy, ART）、艾灸疗法（moxibustion, MT）、腹部按摩（abdominal massage, AM）、穴位贴敷（point application, PA）、物理疗法（physiotherapy, PT）及认知行为疗法（cognitive behavioral therapy, CBT）。本研究的主要结局指标为临床有效率（clinical effective rate, CER），次要结局指标为便秘评分系统（Constipation Scoring System, CCS）。为构建干预措施的相对疗效等级体系，本研究计算了累积排序曲线下面积（surface under the cumulative ranking curve, SUCRA）值，该值可反映各治疗方案的相对疗效概率。

研究结果：经全面文献检索，共纳入53项临床研究，涉及5813名受试者，用于评估8项非药物干预措施的相对疗效。在临床有效率与便秘评分系统两项指标中，穴位埋线均位列首位（SUCRA值分别为94.7、97.8%），其次为物理疗法（SUCRA值分别为88.4、81.7%）。与之相反，耳穴疗法与腹部按摩排名相对靠后，提示其疗效弱于其他干预措施。

研究结论：穴位埋线（ACE）或可作为改善脑卒中后患者临床结局、减轻便秘严重程度的最优非药物干预方案。物理疗法（PT）同样展现出良好疗效，在两项结局指标中均位列第二。但本研究结论仍需开展高质量多中心临床试验予以验证与完善。