13种干预方案治疗脑卒中吞咽困难效果的网状Meta分析  

A network Meta⁃analysis of the effect of 13 interventions on dysphagia in stroke patients

作　　者：韩春彦 赵存 王兴蕾[2] 姚丽 田金徽[3] 张丽红[1] 豆欣蔓 HAN Chunyan;ZHAO Cun;WANG Xinglei;YAO Li;TIAN Jinhui;ZHANG Lihong;DOU Xinman(School of Nursing,Lanzhou University,Gansu 730000 China)

机构地区：[1]兰州大学护理学院,甘肃730000 [2]兰州大学第二医院 [3]兰州大学循证医学中心

出　　处：《护理研究》2020年第11期1869-1877,共9页Chinese Nursing Research

基　　金：2018年甘肃省陇原青年创新创业人才(团队)项目;兰州市城关区科技计划项目,编号:2019SHFZ0019。

摘　　要：[目的]评价13种干预方案在脑卒中吞咽困难病人中的应用效果。[方法]计算机检索PubMed、Cochrane Library、Web of Science、EMbase、中国生物医学文献数据库(CBM)、中国知网(CNKI)、万方数据库(WanFang Data)中有关脑卒中吞咽困难病人康复治疗的随机对照试验,由2名研究员独立筛选文献、提取资料、质量评价,对符合质量标准的研究采用GeMTC统计软件和Stata软件进行数据分析。[结果]共纳入46项研究,涉及13种干预方案,在有效率和电视透视吞咽功能检查(videofluroscopic swallowing study,VFSS)评分方面均显示吞咽训练、神经肌肉电刺激联合吞咽训练、神经肌肉电刺激、电针联合吞咽康复训练、肌电生物反馈疗法联合吞咽训练、针灸与常规护理比较差异有统计学意义(P<0.05)。脑卒中吞咽困难康复的有效率指标中,电针联合吞咽训练效果最好;在VFSS评分方面,神经肌肉电刺激联合吞咽训练的效果最好。[结论]现有证据表明,根据有效率和VFSS评分两个指标排序概率结果,电针联合吞咽训练或神经肌肉电刺激联合吞咽训练成为最好的干预方案的可能性最大,由于电针联合吞咽训练更为经济,推荐使用,同时也要结合病人病情特点选择适宜的干预方案。Objective:To evaluate the application effect of 13 interventions in stroke patients with dysphagia by using network Meta⁃analysis.Methods:Randomized controlled trials on rehabilitation treatment of stroke⁃associated dysphagia were retrieved from the PubMed,Cochrane Library,Web of Science,EMbase,China Biomedical Medicine Database,CNKI and WanFang Data.The screening of literature,extraction of data,and evaluation of the quality of included studies were carried out by two researchers independently.Then network Meta⁃analysis was conducted for studies meeting quality standard using software GeMTC and Stata.Results:A total of 46 studies were included,involving 13 interventions.In terms of total effective rate and videofluroscopic swallowing study score(VFSS),there were statistically significant differences between swallowing training,neuromuscular electrical stimulation combined swallowing training,neuromuscular electrical stimulation,electroacupuncture combined with swallowing rehabilitation training,electromyography biofeedback therapy combined swallowing training,acupuncture and conventional nursing(P<0.05).Among the indicators of rehabilitation efficiency rate of stroke-associated dysphagia,the treatment effect of electroacupuncture combined with swallowing training was the best.As for VFSS score,the treatment effect of neuromuscular electrical stimulation combined with swallowing training was the best.Conclusion:Current evidence showed that,from the aspects of the efficiency and VFSS scores,the comprehensive analysis,electro⁃acupuncture combined with swallowing training or neuromuscular electrical stimulation combined swallowing training is most likely to become the best intervention program.Because electroacupuncture combined with swallowing training is more economical,it is recommended to use during period of rehabilitation.At same time it should be suggested to choose the appropriate intervention program according to the characteristics of the patient's condition.

关 键 词：脑卒中 吞咽困难 干预方案 网状Meta分析 有效率 VFSS评分 

分 类 号：R47[医药卫生—护理学]