针刺联合康复训练治疗缺血性脑卒中上肢运动功能障碍的Meta分析  

Meta-analysis of Acupuncture Combined with Rehabilitation Training in the Treatment of Upper Limb Motor Dysfunction after Ischemic Stroke

作　　者：冯子桐 林润 罗菁[2] 许明珠 唐纯志 崔韶阳[2] FENG Zi-Tong;LIN Run;LUO Jing;XU Ming-Zhu;TANG Chun-Zhi;CUI Shao-Yang(Clinical Medical School of Acupuncture,Moxibustion and Rehabilitation,Guangzhou University of Chinese Medicine,Guangzhou 510006 Guangdong,China;Shenzhen Hospital of Guangzhou University of Chinese Medicine,Shenzhen 518034 Guangdong,China;Shenzhen Hospital,Southern Medical University,Shenzhen 518000 Guangdong,China)

机构地区：[1]广州中医药大学针灸康复临床医学院,广东广州510006 [2]广州中医药大学深圳医院,广东深圳518034 [3]南方医科大学深圳医院,广东深圳518000

出　　处：《广州中医药大学学报》2022年第3期703-711,共9页Journal of Guangzhou University of Traditional Chinese Medicine

基　　金：深圳市卫生三名工程资助项目(编号:SZSM201502044);广东省中医药局科研资助项目(编号:20201240);深圳市卫生计生系统科研资助项目(编号:SZXJ2017070)。

摘　　要：【目的】系统评价针刺联合康复训练治疗缺血性脑卒中患者上肢运动功能障碍的改善情况。【方法】计算机检索中国知网(CNKI)、万方数据库(WanFang Data)、重庆维普数据库(VIP)、中国生物医学文献数据库、美国医学在线(PubMed)、国际循证医学图书馆(Cochrane Library)、荷兰医学文献数据库(Embase)六大数据库中关于针刺联合康复训练对比康复训练治疗缺血性脑卒中患者上肢运动功能障碍的随机对照试验或临床对照试验。筛选文献、提取数据并评价文献质量后,使用RevMan 5.3进行Meta分析,并用Stata 12.0进行Egger检验以评价发表偏倚。【结果】共纳入9项研究,合计660例患者。Meta分析结果显示,与对照组相比,试验组可有效地改善患者的Fugl-Meyer运动评分(WMD=21.09,P<0.00001)、Fugl-Meyer运动评分量表的上肢评分部分(WMD=9.17,P=0.0005)、改良版Barthel指数量表(WMD=21.38,P=0.009)、腕背伸主动关节活动范围(WMD=3.13,P=0.01)和简易上肢功能评分(WMD=8.91,P<0.00001),且2组间的差异均存在统计学意义。对Fugl-Meyer运动评分量表、Fugl-Meyer运动评分量表的上肢评分部分和改良版Barthel指数量表进行发表偏倚分析,Egger’s test提示2组间研究没有明显的发表偏倚。【结论】针刺联合康复训练可改善缺血性脑卒中患者的上肢运动功能及生活质量,但由于纳入的部分文献质量较低、部分结果异质性较高,期望今后更多大样本、多中心的随机对照试验加以验证。Objective To systematically evaluate the improvement of upper limb motor dysfunction in patients with ischemic stroke treated by acupuncture combined with rehabilitation training.Methods Randomized controlled trials or clinical controlled trials on acupuncture combined with rehabilitation training compared with rehabilitation training in the treatment of upper limb motor dysfunction in patients with ischemic stroke,were searched by computer through CNKI,WanFang Data,VIP,Chinese Biomedical literature Database,PubMed and Cochrane Library and Embase.After literature screening,data extraction and literature quality evaluation,RevMan 5.3 was used for Meta analysis and Egger’s test was performed with Stata 12.0 to evaluate publication bias.Results A total of 660 patients were included in 9 studies.Meta-analysis showed that compared with the control group,the trial group could effectively improve the Fugl-Meyer assessment of motor recovery of upper-limb(WMD=21.09,P<0.00001),the upper limb score of Fugl-Meyer assessment of motor recovery of upper-limb(WMD=9.17,P=0.0005),modified Barthel index scale(WMD=21.38,P=0.009),wrist dorsiflexion active joint range of motion(WMD=3.13,P=0.01)and simple upper limb function score(WMD=8.91,P<0.00001),and the differences between the two groups were statistically significant.Publication bias analysis of Fugl-Meyer motor score scale,the upper limb score of Fugl-Meyer motor score scale and the modified Barthel index scale was carried out.Egger’s test indicated that there was no obvious publication bias between the two groups.Conclusion Acupuncture combined with rehabilitation training has effect in improving upper limb motor function and quality of life in patients with ischemic stroke.However,due to the low quality of partial included literatures and high heterogeneity of partial results,it is expected to be verified by more large-sample,multi-center randomized controlled trials in the future.

关 键 词：缺血性脑卒中 上肢运动功能障碍 针刺 康复训练 META分析 

分 类 号：R246.9[医药卫生—针灸推拿学]