摘要
目的系统评价肉毒毒素结合康复训练治疗脑卒中后上肢痉挛的临床疗效。方法计算机检索中国知网数据库、中国生物医学文献数据库、维普中文科技期刊数据库、万方数据库、PubMed、EMbase、Wiley、SpringerLink,关于肉毒毒素结合康复训练治疗脑卒中后上肢痉挛的随机对照试验,检索时间从建库至2019年6月,按照循证医学系统评价的方法,运用RevMan 5.2软件进行Meta分析。结果共纳入20项随机对照试验,涉及1509例病人。Meta分析结果显示:肉毒素联合康复的治疗组Fugl-Meyer运动评分量表(FMA)评分[12周:MD=8.50,95%CI(6.03,10.98),P<0.00001;4周:MD=4.71,95%CI(1.35,8.06),P=0.006]、痉挛评价量表(MAS)评分[12周:MD=-0.60,95%CI(-0.83,-0.37),P<0.00001;4周:MD=-0.75,95%CI(-1.04,-0.47),P<0.00001]、Barthel指数量表(BI)评分[12周:MD=10.82,95%CI(3.34,18.30),P=0.005]、视觉模拟量表(VAS)评分[MD=-2.22,95%CI(-2.84,-1.59),P<0.00001]均优于对照组。结论现有证据表明:肉毒毒素结合康复训练能有效改善脑卒中后病人上肢痉挛功能障碍,较单纯干预降低患肢肌张力维持时间更长,作用时间更久。
Objective To systematically evaluate the effect of botulinum toxin combined with rehabilitation training in the treatment of upper limb spasticity after stroke.Methods Randomized controlled trials in the treatment of upper limb spasticity after stroke by botulinum toxin combined with rehabilitation training were searched from China Journal Full-Text Database,Chinese Biomedical Literature,Chinese science and technology periodical database,Wanfang database,PubMed,EMbase,Wiley,and SpringerLink from the establishment to June 2019.According to the method of evidence-based medicine system evaluation,and RevMan 5.2 software was used for Meta-analysis.Results A total of 20 literatures were included,involving 1509 patients.The results of Meta-analysis showed that Fugl-Meyer Assessment(FMA)score[12 weeks:MD=8.50,95%CI(6.03,10.98),P<0.00001;4 weeks:MD=4.71,95%CI(1.35,8.06),P=0.006],Modified Ashworth Scale(MAS)score[12 weeks:MD=-0.60,95%CI(-0.83,-0.37),P<0.00001;4 weeks:MD=-0.75,95%CI(-1.04,-0.47),P<0.00001],Barthel Index(BI)score[12 weeks:MD=10.82,95%CI(3.34,18.30),P=0.005]and Visual Analogue Scale(VAS)score[MD=-2.22,95%CI(-2.84,-1.59),P<0.00001]in the treatment group were better than those in the control group.Conclusion Current evidence showed that botulinum toxin combined with rehabilitation training could effectively improve the upper limb spasticity dysfunction after stroke.Compared with the single intervention,botulinum toxin combined with rehabilitation training could maintain the muscle tension of the affected limb for a longer time after stroke.
作者
陈纳纳
王远朝
全小红
张新涛
欧海宁
CHEN Nana;WANG Yuanzhao;QUAN Xiaohong;ZHANG Xintao;OU Haining(Peking University Shenzhen Hospital,Shenzhen 518035,Guangdong,China)
出处
《中西医结合心脑血管病杂志》
2021年第20期3468-3474,共7页
Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease
关键词
脑卒中
上肢痉挛
肉毒毒素
康复
META分析
stroke
upper limb spasticity
botulinum toxin
rehabilitation
Meta-analysis
