针刺联合经颅磁刺激治疗脑卒中后认知障碍的系统评价与Meta分析  

Systematic Evaluation and Meta-analysis of Acupuncture Combined withTranscranial Magnetic Stimulation for the Treatment of Post-strokeCognitive Impairment

作　　者：赖丽婷 林润 彭志华 许明珠 唐纯志 崔韶阳 LAI Li-Ting;LIN Run;PENG Zhi-Hua;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 518110 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(福田),广东深圳518034 [3]南方医科大学深圳医院,广东深圳518110

出　　处：《广州中医药大学学报》2023年第7期1838-1846,共9页Journal of Guangzhou University of Traditional Chinese Medicine

基　　金：深圳市中医重点专科建设项目(编号:ZYTS019);深圳市科创委面上项目(编号:JCY20190801182730737)。

摘　　要：【目的】对针刺联合经颅磁刺激(TMS)治疗脑卒中后认知障碍进行Meta分析和系统评价。【方法】通过计算机检索中国知网期刊全文数据库(CNKI)、万方学术期刊全文数据库(Wanfang)、重庆维普中文科技期刊数据库(VIP)、中国生物医学数据库(CBM)、美国生物医学信息检索系统(PubMed)、荷兰医学文摘(Embase)、国际循证医学图书馆(Cochrane Library)等各大数据库有关针刺联合TMS治疗脑卒中后认知障碍的随机对照试验(RCT)文献。检索语言为中文和英文。检索时间为各数据库自建库以来至2022年4月。由2名评价者分别完成文献筛选、数据提取和方法学质量评价过程后,相互讨论达成意见统一。采用RevMan 5.3软件进行Meta分析。【结果】共纳入12项研究。Meta分析结果显示,与对照组相比较,针灸联合TMS可有效改善脑卒中后认知障碍患者认知能力,MMSE量表评分[MD=2.69,95%CI(1.93,3.44),P<0.00001],MoCA量表评分[MD=2.53,95%CI(2.07,2.99),P<0.00001],同时,可提高脑卒中患者日常生活能力,ADL量表评分[MD=15.33,95%CI(10.06,20.61),P<0.00001],且差异均具有统计学意义。【结论】针刺联合TMS可有效改善脑卒中后认知障碍患者认知能力及日常生活能力,但由于纳入文献较少,部分文献质量较低,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 clinical efficacy of acupuncture combined with transcranial magnetic stimulation(TMS)in the treatment of post-stroke cognitive impairment(PSCI)based on Meta-analysis.Methods The CNKI,Wanfang,VIP,CBM,PubMed,Dutch Medical Abstracts Embase,Cochrane Library and other major databases on randomized controlled trials(RCTs)of acupuncture combined with TMS for poststroke cognitive impairment were screened.The search language was Chinese and English.The search period was from the time of each database since its creation to April 2022.The process of literature screening,data extraction and methodological quality evaluation was completed by 2 evaluators respectively,followed by mutual discussion to reach a unified opinion.Meta-analysis was performed using RevMan 5.3 software.Results(1)The total effective rate of the observation group was 93.33%(28/30),and that of the control group was 80%(24/30),the efficacy of the observation group was superior to that of the control group,and the difference was statistically significant(P<0.05).(2)After treatment,the VAS scores,ODI scores and SAS scores of patients in the two groups were significantly improved(P<0.05),and the observation group was significantly superior to that of the control group in improving VAS scores,ODI scores and SAS scores,and the difference was statistically significant(P<0.05).(3)There was no statistically significant difference between the incidence of adverse reactions in the two groups(P>0.05).Conclusion Acupuncture combined with TMS is effective in improving cognitive performance and daily living ability in patients with PSCI,however,due to the small number of included literature and the low quality of some of the literature,more large sample,multicenter randomized controlled trials are expected to validate this in the future.

关 键 词：针刺疗法 经颅磁刺激 脑卒中并发症 认知障碍 随机对照试验 META分析 

分 类 号：R246.9[医药卫生—针灸推拿学]