对侧控制型功能性电刺激对脑卒中上肢功能影响的meta分析  

A meta-analysis on the effects of CCFES on upper extremity function in stroke patients

作　　者：宋金萍 吉媛红 张茹 SONG Jinping;JI Yuanhong;ZHANG Ru(Department of Rehabilitation Medicine,Tangshan Gongren Hospital,Hebei,Tangshan 063000,China)

机构地区：[1]河北省唐山市工人医院康复医学科,河北唐山063000

出　　处：《中国医药科学》2023年第14期137-140,161,共5页China Medicine And Pharmacy

摘　　要：目的系统评价对侧控制型功能性电刺激(CCFES)对脑卒中上肢功能的影响。方法检索PubMed、The Cochrane Library、Web of Science、Science Direct、Embase、中国知网、维普、万方医学等数据库,搜集脑卒中患者运用CCFES训练的RCT研究,检索时限截至2022年9月。按照Cochrane系统评价手册对纳入文献进行质量评价并提取数据,采用Revman 5.3软件进行分析。结果共纳入9篇RCT,378例患者。meta分析显示,干预后CCFES组上肢Fugl-Meyer运动功能评定(FMA-UE)(病程<3周[MD=6.24,95%CI(2.94,9.55),P=0.0002]、病程3周至3个月[MD=3.19,95%CI(0.59,5.78),P=0.02])、Barthel指数(BI)[MD=5.99,95%CI(2.19,9.79),P=0.002]评分高于神经肌肉电刺激(NMES)组,差异有统计学意义;但在脑卒中3个月后,两组的FMA-UE评分差异无统计学意义[MD=0.34,95%CI(-0.64,1.32),P=0.50]。结论与传统的NMES相比,在脑卒中后3个月内开始使用CCFES干预可以有效改善患者的上肢运动功能及日常生活能力,且3周内开始干预的效果最佳。但在脑卒中3个月后两种干预方法疗效相似,推测与不同恢复时期的神经可塑性潜力有关。Objective To systematically assess the effects of contralaterally controlled functional electrical stimulation(CCFES)on upper extremity function in stroke patients.Methods Randomized controlled trials(RCTs)on stroke patients trained with CCFES included in PubMed,The Cochrane Library,Web of Science,Science Direct,Embase,China National Knowledge Internet,VIP,and Wanfang databases until September 2022 were retrieved.The included literature was subjected to quality assessment and data extraction according to the Cochrane Handbook for Systematic Reviews,and was analyzed using Revman 5.3 software.Results A total of 9 RCTs with 378 patients were included in this study.Meta-analysis showed that the post-intervention scores of Fugl-Meyer motor function assessment for the upper extremity(FMA-UE)(course of disease<3 weeks[MD=6.24,95%CI(2.94,9.55),P=0.0002],course of disease=3 weeks-3 months[MD=3.19,95%CI(0.59,5.78),P=0.02])and Barthel index(BI)[MD=5.99,95%CI(2.19,9.79),P=0.002]were higher in the CCFES group than in the neuromuscular electrical stimulation(NMES)group,with the differences were statistically significant.However,no statistically significant difference was found between the two groups in FMA-UE scores 3 months after stroke[MD=0.34,95%CI(-0.64,1.32),P=0.50].Conclusion Intervention with CCFES started within 3 months after stroke can improve patients’upper extremity motor function and activities of daily living more effectively than conventional NMES,with the best efficacy achieved upon intervention within 3 weeks after stroke.However,the efficacy of both interventions was similar 3 months after stroke,presumably related to the neurop lasticity potential of different recovery periods.

关 键 词：脑卒中 上肢 对侧控制型功能性电刺激 META分析 

分 类 号：R743.3[医药卫生—神经病学与精神病学]