中国循证医学杂志

中国循证医学杂志

重复经颅磁刺激对脑卒中患者单侧忽略康复疗效的系统评价

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目的 系统评价重复经颅磁刺激对脑卒中患者单侧忽略的康复疗效。 方法 计算机检索 PubMed、The Cochrane Library、PEDro、EMbase、CNKI、WanFang Data 和 VIP 数据库,搜集应用重复经颅磁刺激治疗脑卒中患者单侧忽略的随机对照试验(RCT),检索时限均为建库至 2017 年 3 月。由 2 位评价者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用 RevMan 5.3 软件进行 Meta 分析。 结果 共纳入 12 个 RCT,包括 303 例患者。Meta 分析结果显示:刺激组在改善患者二等分线段测试分值[MD=–5.54,95%CI(–6.79,–4.29),P<0.000 01]、线段划销测试分值[MD=–3.75,95%CI(–4.60,–2.90),P<0.000 1]和星星划销测试分值[MD=–22.94,95%CI(–26.52,–19.35),P<0.000 01]方面均优于对照组,差异有统计学意义。但两组在改良 Barthel 指数分值方面差异无统计学意义[MD=3.91,95%CI(–9.52,17.34),P=0.57]。 结论 重复经颅磁刺激能改善脑卒中患者单侧忽略患者的忽略症状。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。

Objectives To systematically review the efficacy of repetitive transcranial magnetic stimulation (rTMS) on rehabilitation of unilateral neglect in stroke patients. Methods PubMed, The Cochrane Library, PEDro, EMbase, CNKI, WanFang Data and VIP databases were searched online for randomized controlled trials (RCTs) of rTMS on rehabilitation of unilateral neglect in stroke patients from inception to March 2017. Two reviewers independently screened literature, extracted data and assessed the quality of included studies. Meta-analysis was then performed by using RevMan 5.3 software. Results A total of 12 RCTs involving 303 patients were included. The results of meta-analysis showed that: the stimulate group was superior to the control group in line bisection test (MD=–5.54, 95%CI –6.79 to –4.29, P<0.000 01), line cancellation test (MD=–3.75, 95%CI –4.60 to –2.90,P<0.000 1) and star cancellation test (MD=–22.94, 95%CI –26.52 to –19.35,P<0.000 01). However, there was no significant difference in the score of the modified Barthel index between two groups (MD=3.91, 95%CI–9.52 to 17.34,P=0.57). Conclusions rTMS appears to improve the symptoms of unilateral neglect in stroke patients. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify above conclusions.

关键词: 经颅磁刺激; 单侧忽略; 脑卒中; 系统评价; Meta 分析; 随机对照试验

Key words: Transcranial magnetic stimulation; Unilateral neglect; Stroke; Systematic review; Meta-analysis; Randomized controlled trial

引用本文: 张庆, 肖洪奇, 余佳丹, 许阳, 杨永红, 王朴. 重复经颅磁刺激对脑卒中患者单侧忽略康复疗效的系统评价. 中国循证医学杂志, 2018, 18(2): 163-171. doi: 10.7507/1672-2531.201705048 复制

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