耳穴貼壓對血液透析患者口乾症狀的改善成效：系統性文獻回顧與統合分析

Efficacy of auricular acupressure in alleviating xerostomia symptoms among patients undergoing hemodialysis: a systematic review and meta-analysis

目標：口乾為血液透析患者常見的困擾症狀，也是患者無法確實遵行體液限制，從而導致透析期間體重增加（IDWG, interdialytic weight gain）的主因。高IDWG與心血管死亡風險有關，因此，本研究旨在透過系統性文獻探討耳穴貼壓介入改善血液透析患者口乾之成效，以作為日後實施減輕口乾相關照護策略的實證基礎。方法：本文以P: renal dialysis, hemodialysis、I: auricular acupressure、O: Xerostomia等關鍵字並運用MeSH及布林邏輯，搜尋2025年3月31日前之CEPS、PubMed、Cochrane Library、EmBase、台灣碩博士論文、CNKI等文章，搜尋12篇，再依納入及排出條件篩選，最後納入5篇研究，以Cochrane系統之ROB 2.0及ROBINS-I進行評讀。結果：因異質性高，無法全部執行統合分析。但多數研究顯示耳穴貼壓能改善口乾或口渴；4週後IDWG的統合分析也達成效（Z=3.25, p=0.001）。結論：耳穴貼壓介入4週後，對口乾、口渴、唾液流速及IDWG有較好的改善效果；但由於統合分析文獻數量較少且異質性大，應謹慎看待結果。此外，考慮到一些研究的年代和方法學限制，建議未來投入大樣本的雙盲或三盲的隨機對照試驗，以利於日後提供更為精準的依據。（台灣衛誌2025；44（3）：243-256）

Objectives: Xerostomia is a common symptom among patients undergoing hemodialysis, often hindering adherence to fluid restrictions and leading to increased interdialytic weight gain (IDWG). Elevated IDWG is associated with an increased risk of cardiovascular mortality. This study systematically reviewed the efficacy of auricular acupressure in alleviating xerostomia and provided an evidence-based foundation for future management strategies. Methods: Using the keywords“renal dialysis,”“hemodialysis,”“auricular acupressure,”and“xerostomia,”along with MeSH terms and Boolean logic, we searched CEPS, PubMed, Cochrane Library, EmBase, Taiwan Thesis and Dissertation Database, and CNKI for articles published before March 31 2025. Twelve articles met the criteria. After screening for inclusion and exclusion criteria, we identified five eligible clinical trials for quality assessment. Research quality was appraised using the Cochrane risk of bias tool, ROB 2.0, and the Risk of Bias in Non-randomized Studies of Interventions. Results: Because of the high heterogeneity among the studies, a comprehensive meta-analysis was not feasible. However, most studies have indicated that auricular acupressure effectively alleviates xerostomia. Additionally, a meta-analysis conducted after four weeks demonstrated a significant reduction in IDWG (Z=3.25, p=0.001). Conclusions: Auricular acupressure was effective for xerostomia, thirst, salivary flow rate, and IDWG in patients undergoing hemodialysis after four weeks. However, owing to the small number of meta-analyses and heterogeneity, the results should be cautiously viewed. Considering the age and methodological limitations of some studies, further large-scale double- or triple-blind randomized controlled trials are recommended to establish more robust evidence for this intervention. (Taiwan J Public Health. 2025;44(3):243-256)