不同模式经颅磁刺激对脑卒中后吞咽障碍患者的干预效果:贝叶斯网状Meta分析  

Intervention Effect of Different Modes of Transcranial Magnetic Stimulation on Patients with Post-Stroke Dysphagia:a Bayesian Network Meta-analysis

作　　者：李春标 王婷[2] 袁娟 尤敏[2] LI Chunbiao;WANG Ting;YUAN Juan;YOU Min(School of Nursing,Anhui University of Chinese Medicine,Hefei 230012,China;Department of Nursing,the Second Affiliated Hospital of Anhui University of Chinese Medicine,Hefei 230001,China)

机构地区：[1]安徽中医药大学护理学院,安徽省合肥市230012 [2]安徽中医药大学第二附属医院护理部,安徽省合肥市230001

出　　处：《实用心脑肺血管病杂志》2024年第7期75-84,共10页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：安徽省高校科研项目(2023AH050784);安徽省科研编制计划项目(2022AH050463)。

摘　　要：目的通过贝叶斯网状Meta分析探讨不同模式经颅磁刺激(TMS)对脑卒中后吞咽障碍(PSD)患者的干预效果。方法计算机检索中国知网、维普网、万方数据知识服务平台、中国生物医学文献数据库、PubMed、Cochrane Library、Embase、Web of Science、CINAHL和Medline中关于不同模式TMS干预PSD患者的随机对照试验,检索时限为建库至2023-11-01。由两名研究人员独立筛选文献、提取资料并评价文献偏倚风险。试验组采用不同模式TMS治疗,对照组采用常规吞咽障碍治疗(CTD)或假刺激,结局指标包括吞咽功能指标〔标准吞咽功能评估量表(SSA)、纤维鼻咽内镜吞咽障碍严重程度量表(FEDSS)、功能性经口摄食量表(FOIS)评分〕、误吸风险指标〔渗透-误吸量表(PAS)评分〕及不良反应。采用R 4.3.0软件进行Meta分析、贝叶斯网状Meta分析。结果最终纳入26篇文献,样本量为1185例,其中对照组634例、试验组551例。Meta分析结果显示,接受3 Hz-重复经颅磁刺激(rTMS)治疗的PSD患者SSA评分低于接受CTD者,接受1 Hz-rTMS、3 Hz-rTMS、5 Hz-rTMS、10 Hz-rTMS、间歇性Theta爆发式磁刺激(iTBS)治疗的PSD患者SSA评分低于接受假刺激治疗者(P<0.05);接受5 Hz-rTMS、10 Hz-rTMS、iTBS治疗的PSD患者FEDSS评分低于接受假刺激治疗者(P<0.05);接受3 Hz-rTMS、5 Hz-rTMS治疗的PSD患者FOIS评分高于接受CTD者,接受1 Hz-rTMS、iTBS治疗的PSD患者FOIS评分高于接受假刺激治疗者(P<0.05);接受3 Hz-rTMS、5 Hz-rTMS、10 Hz-rTMS、iTBS治疗的PSD患者PAS评分低于接受CTD者,接受1 Hz-rTMS、5 Hz-rTMS、10 Hz-rTMS、iTBS治疗的PSD患者PAS评分低于接受假刺激治疗者(P<0.05)。贝叶斯网状Meta分析结果显示,接受3 Hz-rTMS治疗的PSD患者SSA评分低于接受CTD者,接受3 Hz-rTMS、5 Hz-rTMS、iTBS治疗的PSD患者SSA评分低于接受假刺激治疗者(P<0.05);接受10 Hz-rTMS、iTBS治疗的PSD患者FEDSS评分低于接受假刺激治疗者(P<0.05);接受3 Hz-rTMObjective To investigate the intervention effect of different modes of transcranial magnetic stimulation(TMS)on patients with post-stroke dysphagia(PSD)using Bayesian network meta-analysis.Methods CNKI,VIP,Wanfang Data,Chinese Biomedical Literature Database,PubMed,Cochrane Library,Embase,Web of Science,CINAHL and Medline were searched to collect randomised controlled trials on different modes of TMS of intervention for patients with PSD,with a timeframe of the search being from database construction to 2023-11-01.Two researchers independently screened the literature,extracted information and assessed the risk of literature bias.The experimental group was treated with different modes of TMS and the control group was treated with conventional treatment of dysphagia(CTD)or sham stimulation.Outcome indicators were swallowing function indicators[Standardized Swallowing Assessment(SSA),Fiberoptic Endoscopic Dysphagia Severity Scale(FEDSS)and Functional Oral Intake Scale(FOIS)scores],aspiration risk indicators[Penetration-Aspiration Scale(PAS)score]and adverse reactions.Meta-analysis and Bayesian network meta-analysis were performed using R 4.3.0 software.Results Twenty-six papers with a sample size of 1185 cases were finally included,including 634 cases in the control group and 551 cases in the experimental group.Meta-analysis results showed that SSA score of PSD patients treated with 3 Hz-repetitive transcranial magnetic stimulation(rTMS)was lower than that of patients treated with CTD,and the SSA score of PSD patients treated with 1 Hz-rTMS,3 Hz-rTMS,5 Hz-rTMS,10 Hz-rTMS and intermittent Theta burst stimulation(iTBS)was lower than that of patients treated with sham stimulation(P<0.05).The FEDSS scores of PSD patients treated with 5 Hz-rTMS,10 Hz-rTMS and iTBS were lower than those of patients treated with sham stimulation(P<0.05).The FOIS scores of PSD patients treated with 3 Hz-rTMS and 5 Hz-rTMS were higher than those of patients treated with CTD,and the FOIS scores of PSD patients treated with 1 Hz-rTMS and iTBS w

关 键 词：卒中 吞咽障碍 经颅磁刺激 吞咽功能 误吸 网状Meta分析 贝叶斯方法 

分 类 号：R743.3[医药卫生—神经病学与精神病学] G353.1[医药卫生—临床医学]