正念冥想治疗创伤后应激障碍有效性及安全性的系统评价再评价

doi:10.12114/j.issn.1007-9572.2021.00.456

摘要/Abstract

摘要： 背景　由于干预场所易获得、成本低，干预方法简便，易于大范围实施、具有更少的交谈暴露，正念冥想在创伤后应激障碍（PTSD）的治疗中得到广泛应用，但临床上关于其治疗PTSD的有效性及安全性评价不一。目的　评价正念冥想治疗PTSD有效性和安全性的系统评价/Meta分析的方法学及结局指标质量。方法　通过计算机检索中国知网（CNKI）、万方数据知识服务平台（Wanfang Data）、维普网（VIP）、中国生物医学文献数据库（CBM）、PubMed、Web of Science、EMBase、ScienceDirect、Wiley Oline Library、OVID LWW、Cochrane Library、JBI Database，筛选正念冥想治疗PTSD有效性及安全性的系统评价和Meta分析，检索时间为建库至2019-11-28。2名研究员按照文献纳入和排除标准筛选文献，提取资料，应用AMSTAR 2量表评价纳入研究的方法学质量，采用GRADE分级系统评价纳入研究的结局指标。结果　共纳入11篇系统评价/Meta分析，其中仅1篇方法学质量为高，7篇方法学质量为低，3篇方法学质量为极低，主要缺陷为缺乏前期设计方案、纳入的研究设计描述不详、未解释研究资金来源等。11篇系统评价/Meta分析包含7个结局指标，共28个证据体；GRADE分级结果显示：4个为中等质量，20个为低等质量，4个为极低等质量。结论　正念冥想对于缓解PTSD患者的症状、改善睡眠、提升正念水平均有一定效果，且效果稳定，较少出现不良反应，但仍需进一步研究创伤敏感正念。正念冥想治疗PTSD有效性及安全性的系统评价/Meta分析的方法学质量及结局指标可靠程度大多为低质量。建议完善研究设计，获得更高质量的临床证据，并严格按照程序进行系统评价，规范报告研究结果。

关键词: 应激障碍, 创伤后；正念；冥想；系统评价再评价

Abstract: Background　Mindfulness meditation has been widely used in the treatment of post-traumatic stress disorder（PTSD） due to easy availability，low cost，simplicity，wide popularization，and less conversational exposure.However，clinical evaluations of its effectiveness and safety vary.Objective　To evaluate the quality of methodological and outcome indicators in studies included in systematic reviews/Meta-analyses of the efficacy and safety of mindfulness meditation in the treatment of PTSD.Methods　CNKI，Wanfang Data，VIP，CBM，PubMed，Web of Science，EMBase，ScienceDirect，Wiley Online Library，OVID LWW，JBI Database，and Cochrane Library were searched from inception to November 28，2019，and the systematic reviews /Meta-analyses of the efficacy and safety of mindfulness meditation on PTSD were collected.Two researchers screened the literature and extracted data independently.AMSTAR 2 was applied to evaluate the methodological quality.GRADE system was used to evaluate the outcome indicators.Results　Totally 11 systematic reviews /Meta-analyses were included，thereinto only 1 of which was of high methodological quality，7 were low，and 3 were very low.The major methodological flaws were lack of a preliminary design plan，poor description of the included study design，and lack of explanation of the research funding sources.GRADE system evaluation results showed that there were 7 outcome indicators altogether，with a total of 28 evidence bodies：4 were of moderate quality，20 were of low quality，and 4 were of very low quality.Conclusion　Mindfulness meditation has a partially stable effect on alleviating the symptoms，improving sleep quality，and raising the level of mindfulness of PTSD patients，with fewer adverse reactions.But further research on trauma-sensitive mindfulness is needed.However，the methodological quality and reliability of outcome indicators for the systematic reviews/Meta-analyses of the efficacy and safety of mindfulness meditation on PTSD are mostly low.It is recommended to improve the study design，use higher quality clinical evidence，and conduct systematic evaluation studies strictly following the procedures and standardize the reporting of study results.

Key words: Stress disorders, post-traumatic；Mindfulness；Meditation；Overview of systematic reviews

谭香艺,杨祎玲,赵久波,等. 正念冥想治疗创伤后应激障碍有效性及安全性的系统评价再评价[J]. 中国全科医学, 2021, 24(21): 2721-2728. DOI: 10.12114/j.issn.1007-9572.2021.00.456.
TAN Xiangyi,YANG Yiling,ZHAO Jiubo, et al. Overview of Systematic Reviews on Efficacy and Safety of Mindfulness Meditation on Post-traumatic Stress Disorder　[J]. Chinese General Practice, 2021, 24(21): 2721-2728. DOI: 10.12114/j.issn.1007-9572.2021.00.456.

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