摘要
背景肩手综合征是脑卒中患者致残的主要因素之一,严重影响患者身心健康及生活质量。目前,治疗脑卒中后肩手综合征的非药物干预方式众多,但临床上优选何种非药物治疗方式尚有一定困扰。目的使用网状Meta分析评价7种非药物治疗方式改善脑卒中后肩手综合征疗效、疼痛视觉模拟评分(VAS)及简式肢体运动功能量表(FMA)评分的差异,为临床决策提供循证支持。方法计算机检索中国知网、万方数据知识服务平台、维普网、中国生物医学文献服务系统、PubMed、Embase、CochraneLibrary数据库中有关非药物治疗脑卒中后肩手综合征的随机对照试验,检索时间设定为建库至2023年6月。由2名研究员根据研究设计独立筛查文献与数据提取,使用RevMan 5.3、Stata 15.0软件进行网状Meta分析。结果共纳入62项研究,共5090例患者,干预措施包含针灸疗法、中药熏蒸疗法、体外冲击波疗法、艾灸疗法、热敷疗法、电刺激疗法、中药泡洗疗法。网状Meta分析结果显示:7种非药物治疗方式在改善肩手综合征患者总有效率、FMA评分方面均优于对照组(P<0.05);除艾灸疗法外,6种非药物治疗方式在改善肩手综合征患者VAS评分方面均优于对照组(P<0.05)。7种非药物治疗方式改善总有效率的累积排序概率图下面积(SUCRA)依次为:针灸疗法(86.1%)>中药泡洗疗法(77.1%)>中药熏蒸疗法(54.7%)>体外冲击波疗法(53.1%)>热敷疗法(49.0%)>电刺激疗法(48.4%)>艾灸疗法(31.1%)>常规对照治疗(0.4%)。7种非药物治疗方式改善VAS评分的SUCRA依次为:热敷疗法(81.3%)>中药泡洗疗法(78.4%)>针灸疗法(76.7%)>电刺激疗法(58.4%)>中药熏蒸疗法(52.7%)>体外冲击波疗法(32.9%)>艾灸疗法(18.1%)>常规对照治疗(1.5%)。7种非药物治疗改善FMA评分的SUCRA依次为:中药泡洗疗法(90.6%)>针灸疗法(83.5%)>中药熏蒸疗法(59.9%)>电刺激疗法(59.8%)>体外冲击波疗法(42.3%)>艾灸疗�
Background Shoulder-hand syndrome is one of the major disabling factors for stroke patients,which seriously affects their physical and psychological health as well as their quality of life.Currently,there are many non-pharmacologic treatments used to treat post-stroke shoulder-hand syndrome,but there is still some confusion about which non-pharmacologic treatment modality is more effective in clinical practice.Objective To provide evidence-based support for clinical decision-making,this network meta-analysis evaluates the efficacy of seven non-pharmacological treatments in improving outcomes for post-stroke shoulder-hand syndrome,pain as measured by the Visual Analogue Scale(VAS),and scores on the simplified Fugl-Meyer Assessment(FMA).Methods A computerized search of databases including CNKI,Wanfang Data,VIP,China Biomedical Literature Service System,PubMed,Embase,and Cochrane Library was conducted for randomized controlled trials on non-pharmacological treatments for post-stroke shoulder-hand syndrome up to June 2023.Two researchers independently screened the literature and extracted data,performing the network meta-analysis using RevMan 5.3 and Stata 15.0.Results The analysis included 62 studies involving 5090 patients,assessing interventions such as acupuncture,herbal fumigation,extracorporeal shockwave therapy,moxibustion,herbal hot compress,electrical stimulation,and herbal soak.Results showed that all seven non-pharmacological treatments were superior to the control group in improving overall effectiveness,and FMA scores(P<0.05).Except for moxibustion,the six non-pharmacological treatments were superior to the control group in improving VAS scores in patients with shoulder hand syndrome(P<0.05).In terms of improving overall effectiveness,the cumulative ranking probability area(SUCRA)scores for the treatments were:acupuncture(86.1%),herbal soak(77.1%),herbal fumigation(54.7%),extracorporeal shockwave(53.1%),hot compress(49.0%),electrical stimulation(48.4%),and moxibustion(31.1%),with conventional control tre
作者
黄腾佳
曹曦
陈蕾
李子滢
秦莉花
HUANG Tengjia;CAO Xi;CHEN Lei;LI Ziying;QIN Lihua(School of Nursing,Hunan University of Chinese Medicine,Changsha 410208,China;Hunan Key Laboratory of Integrated Chinese and Western Medicine for Prevention and Treatment of Heart and Brain Diseases of Hunan University of Chinese Medicine,Changsha 410208,China)
出处
《中国全科医学》
CAS
北大核心
2024年第23期2921-2930,共10页
Chinese General Practice
基金
国家自然科学基金资助项目(81904180)
湖南省自然科学基金资助项目(2023JJ50035,2024JJ8124)
湖南省卫生健康委科研计划课题(B202319018677)
湖南省中医药科研计划项目(A2024001)
湖南省社会科学成果评审委员会课题成果(XSP2023FXC066,XSP24YBC413)。
关键词
肩手综合征
非药物治疗
脑卒中
随机对照试验
网状Meta分析
Shoulder-hand syndrome
Non-pharmacological treatment
Stroke
Randomized controlled trial
Network meta-analysis
