摘要
背景上肢运动功能障碍是脑卒中后常见的后遗症之一,严重影响患者日常生活能力。重复经颅磁刺激(rTMS)作为常见的神经电生理技术对治疗脑卒中后上肢运动功能障碍有较好的疗效,但临床对不同rTMS干预模式的选择仍缺乏循证依据。目的采用网状Meta分析方法比较rTMS的4种模式对脑卒中后上肢运动功能障碍患者的临床疗效。方法计算机检索PubMed、Embase、Cochrane Library、Web of Science、中国生物医学文献数据库、中国知网、万方数据知识服务平台、维普网中有关rTMS治疗脑卒中后上肢运动功能障碍的随机对照试验,并通过追溯Meta分析的参考文献作为补充。检索时间均为建库至2022年2月,采用主题词和自由词结合方式进行。2名研究者进行文献筛选、资料提取及质量评价。采用RevMan 5.0软件和Stata 16.0软件进行统计学分析。结果最终纳入17篇文献,790例患者,共涉及6种干预措施:高频rTMS(HF-rTMS)、低频rTMS(LF-rTMS)、间断性theta节律刺激(iTBS)、连续性theta节律刺激(cTBS)、假刺激、常规疗法。网状Meta分析结果显示,HF-rTMS、LF-rTMS提高脑卒中后上肢功能障碍患者Fugl-Meyer运动评分量表上肢部分(FMA-UE)评分均高于假刺激、常规疗法(P<0.05),cTBS提高脑卒中后上肢功能障碍患者FMA-UE评分高于常规疗法(P<0.05),LF-rTMS提高脑卒中后上肢功能障碍患者改良Barther指数(MBI)和Barther指数(BI)评分均高于假刺激、常规疗法(P<0.05),HF-rTMS、LF-rTMS缩短脑卒中后上肢功能障碍患者运动诱发电位(MEP)潜伏期高于假刺激(P<0.05)。不同措施提高脑卒中后上肢运动功能障碍患者FMA-UE评分的累积排序概率曲线下面积(SUCRA)排序结果显示,LF-rTMS(79.9%)>cTBS(75.3%)>HF-rTMS(71.1%)>iTBS(45.8%)>假刺激(20.2%)>常规疗法(7.7%),降低改良Ashworth量表(MAS)评分的SUCRA排序结果显示,iTBS(77.0%)>LF-rTMS(64.1%)>cTBS(61.0%)>HF-rTMS(38.0%)>假刺激(30.6%)>常规疗法(
Background Upper limb motor dysfunction is a common complication after stroke that seriously affects daily living skills of patients.As a common neuroelectrohysiological technique,repetitive transcranial magnetic stimulation(rTMS)has a good effect on post-stroke upper limb motor dysfunction.However,there is still no practice-based evidence on the selection of modalities of rTMS.Objective To evaluate the clinical efficacy of four rTMS modalities in post-stroke upper limb motor dysfunction by a network meta-analysis.Methods Randomized controlled trials(RCTs)about rTMS for treating upper limb motor dysfunction after stroke were searched with subject words combined with free words as searching terms in PubMed,Embase,Cochrane Library,Web of Science,CBM,CNKI,Wanfang Data,and VIP from inception to February 2022,supplemented by references from retrospective meta-analysis.Two researchers performed literature screening,data extraction,and quality evaluation separately.RevMan 5.0 and Stata 16.0 were used for statistical analysis.Results A total of 17 RCTs with 790 cases were included.Six interventions were involved:high frequency-rTMS(HF-rTMS),low frequency-rTMS(LF-rTMS),intermittent theta burst stimulation(iTBS),continuous theta burst stimulation(cTBS),sham stimulation and conventional therapy.Network meta-analysis results showed that HF-rTMS and LF-rTMS had better effects on increasing the FMA-UE score than sham stimulation and conventional therapy(P<0.05).cTBS increased the FMA-UE score more significantly than conventional therapy(P<0.05).LF-rTMS increased the MBI and BI scores more notably than sham stimulation and conventional therapy(P<0.05).HF-rTMS and LF-rTMS reduced the MEP latency more significantly than sham stimulation(P<0.05).The SUCRA ranking of the six interventions in terms of increasing the FMA-UE score showed the following:LF-rTMS(79.9%)>cTBS(75.3%)>HF-rTMS(71.1%)>iTBS(45.8%)>sham stimulation(20.2%)>conventional therapy(7.7%).The SUCRA ranking of decreasing the MAS score revealed the following:iTBS(77.0%)>
作者
熊丹
谢海花
李浩
张泓
谭洁
赵宁
XIONG Dan;XIE Haihua;LI Hao;ZHANG Hong;TAN Jie;ZHAO Ning(College of Acupuncture&Tuina and Rehabilitation,Hunan University of Traditional Chinese Medicine,Changsha 410208,China;Rehabilitation Medicine Department,Huazhong University of Science and Technology Union Shenzhen Hospital,Shenzhen 518052,China)
出处
《中国全科医学》
CAS
北大核心
2023年第8期997-1007,1014,共12页
Chinese General Practice
基金
国家自然科学基金资助项目(81874499)
深南科南山区卫生科技计划项目(2020004)。
关键词
卒中
重复经颅磁刺激
theta节律刺激
上肢运动功能
网状Meta分析
随机对照试验
Stroke
Repetitive transcranial magnetic stimulation
Theta burst stimulation
Upper limb motor dysfunction
Network meta-analysis
Randomized controlled trials
