重复经颅磁刺激治疗卒中后吞咽功能障碍的系统文献回顾  

Repetitive transcranial magnetic stimulation for post-stroke dysphagia: a systematic review of the literature

作　　者：刘玲[1] 刘海波[2] 王晓玲[3] 孔丽[1] 顾永盛 陈光辉[1] 杨昉[1] 

机构地区：[1]南京军区南京总医院神经内科,南京210002 [2]南京军区南京总医院神经内科皮肤科,南京210002 [3]南京军区南京总医院神经内科干部保健科,南京210002 [4]总装备部新乡干休所

出　　处：《中国脑血管病杂志》2014年第5期250-255,269,共7页Chinese Journal of Cerebrovascular Diseases

基　　金：国家自然科学基金(81070923,81100870)

摘　　要：目的系统评价重复经颅磁刺激(rTMS)治疗卒中后吞咽功能障碍的有效性及安全性。方法采用计算机检索Pubmed、EMbase、MEDLINE、Cochrane图书馆、中文期刊全文数据库、中国生物医学文献数据库、万方数据库中关于rTMS治疗卒中后吞咽功能障碍的临床研究,截止日期为2013年12月。由2名研究者按纳入和排除标准选择文献、提取资料、交叉核对,而后进行分析。结果共纳入7篇研究(228例,其中rTMS 136例,对照92例),对4篇随机对照试验(RCT)进行Meta分析(rTMS组54例,对照组42例),另外3篇非RCT进行系统综述。(1)Meta分析表明,rTMS治疗后吞咽功能评分的改善优于对照组(SMD=1.73,95%CI:0.45~3.01,P=0.008)。(2)高频rTMS(>1 Hz)治疗后吞咽功能评分的改善与对照组比较,差异有统计学意义(SMD=1.60,95%CI:0.10~3.11,P=0.04);低频rTMS(1 Hz)与对照组相比,在一些吞咽功能评分的改善方面差异亦有统计学意义,提示低频治疗潜在的优势。(3)rTMS治疗后,卒中患者Barthel指数的改善与对照组相比差异有统计学意义(MD=-21.60,95%CI:-36.21^-7.00,P=0.004)。(4)在不良反应方面,7篇研究均未报道有头痛、耳鸣或癫痫等任何不良事件发作。结论对卒中后存在吞咽功能障碍的患者,采用rTMS治疗可显著促进患者吞咽功能的恢复,并且安全、有效。Objective To systematically review the efficacy and safety of repetitive transcranial magnetic stimulation （rTMS）for post-stroke dysphagia. Methods The clinical trials about rTMS for post-stroke dysphagia were searched on Pubmed,EMbase,MEDLINE,Cochrane library,China National Knowledge Infrastructure （CNKI）,Chinese BioMedical Literature Database on disc （CBMdisc）,and Wanfang database with computers. Two independent reviewers selected the literatures by the inclusion and exclusion criteria,data extraction and cross-checking,and then conducted the analysis. Results A total of seven trails （228 patients,136 of them in a rTMS group and 92 in a control group）were included. Four randomized controlled trials （RCTs）were used for Meta-analysis （54 patients in the rTMS group,42 in the control group）. The other three non-RCTs were only reviewed systematically. （1）Meta-analysis showed that the improvement of swallowing function score after rTMS was better than that of the control group （SMD=1. 73,95%CI 0. 45 to 3. 01;P=0. 008）. （2）After high-frequency rTMS （＆gt;1 Hz）,there was significant difference in the improvement of swallowing function score between the two groups （SMD=1. 60,95%CI＆amp;nbsp;0. 10 to 3. 11;P=0. 04）. Compared to the control group,there were also significant differences in the improvement of some swallowing function scores in low-frequency rTMS （1 Hz）,suggesting the potential advantages of low-frequency therapy. （3）After rTMS,there was no significant difference in the improvement of Barthel index in patients with stroke compared with the control group （MD= -21. 60,95%CI-36. 21 to-7. 00;P=0. 004）. （4）In terms of adverse reactions,seven trials did not report any adverse events, such as headache,tinnitus or epilepsy,etc. Conclusion Using rTMS may significantly promote the recovery of swallowing function for patients with post-stroke dysphagia,and it is both safe and effective.

关 键 词：卒中 吞咽障碍 经颅磁刺激 Meta分析 系统文献回顾 

分 类 号：R743.3[医药卫生—神经病学与精神病学]