经颅直流电刺激对脑卒中后偏侧忽略患者疗效的Meta分析  

Effects of Transcranial Direct Current Stimulation on Unilateral Spatial Neglect in Patients after Stroke:A Meta-analysis

作　　者：翁燕 张晓鸽 辛玉甫[2] 富奇志[3] WENG Yan;ZHANG Xiaoge;XIN Yufu;FU Qizhi(Clinical Medical College of Henan University of Science and Technology,Luoyang 471003,China;Department of Rehabilitation Medicine,the First Affiliated Hospital of Henan University of Science and Technology,Luoyang 471000,China;Department of Critical Care Medicine,the First Affiliated Hospital of Henan University of Science and Technology,Luoyang 471000,China)

机构地区：[1]河南科技大学临床医学院,河南洛阳471003 [2]河南科技大学第一附属医院康复医学科,河南洛阳471000 [3]河南科技大学第一附属医院重症医学内科,河南洛阳471000

出　　处：《医学综述》2023年第21期4754-4760,4767,共8页Medical Recapitulate

基　　金：河南省医学科技攻关计划项目(LHGJ20220676)。

摘　　要：目的系统评价经颅直流电刺激(tDCS)对脑卒中后偏侧忽略的治疗效果。方法检索PubMed、Ebase、The Cochrane Library、Web of Science、维普、万方、知网、中国生物医学文献数据库等,查找应用tDCS治疗脑卒中后偏侧忽略的相关文献,检索时限为建库至2023年2月。两名研究员按照纳入排除标准筛选文献、提取资料并评价纳入研究质量,采用RevMan 5.4软件进行Meta分析。结果最终纳入17篇文献,共563例患者,其中男139例、女424例。Meta分析结果显示,tDCS可明显改善直线二等分试验(LBT)评分(SMD=-1.00,95%CI-1.35~-0.64,P<0.00001)。亚组分析结果显示,阴极tDCS对LBT评分无明显改善(SMD=-0.28,95%CI-0.98~0.43,P=0.44),阳极tDCS可明显改善LBT评分(SMD=-1.09,95%CI-1.60~-0.58,P<0.0001),阳极tDCS+阴极tDCS可明显改善LBT评分(SMD=-1.56,95%CI-2.27~-0.85,P<0.0001)。与假刺激或其他治疗方式相比,tDCS可明显提高日常生活能力(ADL)评分(SMD=0.69,95%CI 0.42~0.96,P<0.00001)。结论tDCS可有效改善脑卒中后偏侧忽略及ADL,但仍需开展大样本、随机对照试验,以进一步验证tDCS对脑卒中后偏侧忽略患者的康复效果。Objective To systematically evaluate the therapeutic effect of transcranial direct current stimulation(tDCS)for post-stroke unilateral spatial neglect.Methods Published relevant literature of tDCS treatment of post-stroke unilateral spatial neglect from the earliest date available to Feb.,2023 were recalled from PubMed,Embase,The Cochrane Library,CNKI,VIP,CBM and Wanfang Database.Two reviewers independently screened the papers,extracted the data and evaluated the study quality;RevMan 5.3 was adopted for meta-analysis.Results Finally,17 articles were included,with a total of 563 patients,including 139 males and 424 females.The meta-analysis results showed that the tDCS could still significantly improve the line bisection test(LBT)score(SMD=-1.00,95%CI-1.35--0.64,P<0.00001).Subgroup analysis showed that cathodal tDCS did not significantly improve LBT score(SMD=-0.28,95%CI-0.98-0.43,P=0.44),anodal tDCS significantly improved LBT score(SMD=-1.09,95%CI-1.60--0.58,P<0.0001),and anodal tdCS+cathodal tDCS significantly improved LBT score(SMD=-1.56,95%CI-2.27--0.85,P<0.0001).Compared with sham stimulation or other treatment modalities,tDCS can significantly improve the activity of daily living(ADL)score(SMD=0.69,95%CI 0.42-0.96,P<0.00001).Conclusion tDCS is effective on unilateral spatial neglect and their ADL in post-stroke patients,but it is still necessary to conduct large-scale,randomized controlled trials to further validate the rehabilitation effect of tDCS on patients with unilateral spatial neglect after stroke.

关 键 词：脑卒中 偏侧忽略 经颅直流电刺激 META分析 

分 类 号：R743.3[医药卫生—神经病学与精神病学]