CAJ | 학술논문

目的：系统评价重复经颅磁刺激（rTMS）治疗卒中后吞咽功能障碍的有效性及安全性。方法采用计算机检索Pubmed、EMbase、MEDLINE、Cochrane图书馆、中文期刊全文数据库、中国生物医学文献数据库、万方数据库中关于rTMS治疗卒中后吞咽功能障碍的临床研究，截止日期为2013年12月。由2名研究者按纳入和排除标准选择文献、提取资料、交叉核对，而后进行分析。结果共纳入7篇研究（228例，其中rTMS 136例，对照92例），对4篇随机对照试验（RCT）进行Meta分析（rTMS组54例，对照组42例），另外3篇非RCT进行系统综述。（1）Meta分析表明，rTMS治疗后吞咽功能评分的改善优于对照组（SMD ＝1.73，95％CI：0.45～3.01，P ＝0.008）。（2）高频rTMS（＞1 Hz）治疗后吞咽功能评分的改善与对照组比较，差异有统计学意义（SMD＝1.60，95％CI：0.10～3.11，P＝0.04）；低频rTMS（1 Hz）与对照组相比，在一些吞咽功能评分的改善方面差异亦有统计学意义，提示低频治疗潜在的优势。（3）rTMS治疗后，卒中患者Barthel指数的改善与对照组相比差异有统计学意义（MD＝-21.60，95％CI：-36.21～-7.00，P＝0.004）。（4）在不良反应方面，7篇研究均未报道有头痛、耳鸣或癫痫等任何不良事件发作。结论对卒中后存在吞咽功能障碍的患者，采用rTMS治疗可显著促进患者吞咽功能的恢复，并且安全、有效。
목적：계통평개중복경로자자격（rTMS）치료졸중후탄인공능장애적유효성급안전성。방법채용계산궤검색Pubmed、EMbase、MEDLINE、Cochrane도서관、중문기간전문수거고、중국생물의학문헌수거고、만방수거고중관우rTMS치료졸중후탄인공능장애적림상연구，절지일기위2013년12월。유2명연구자안납입화배제표준선택문헌、제취자료、교차핵대，이후진행분석。결과공납입7편연구（228례，기중rTMS 136례，대조92례），대4편수궤대조시험（RCT）진행Meta분석（rTMS조54례，대조조42례），령외3편비RCT진행계통종술。（1）Meta분석표명，rTMS치료후탄인공능평분적개선우우대조조（SMD ＝1.73，95％CI：0.45～3.01，P ＝0.008）。（2）고빈rTMS（＞1 Hz）치료후탄인공능평분적개선여대조조비교，차이유통계학의의（SMD＝1.60，95％CI：0.10～3.11，P＝0.04）；저빈rTMS（1 Hz）여대조조상비，재일사탄인공능평분적개선방면차이역유통계학의의，제시저빈치료잠재적우세。（3）rTMS치료후，졸중환자Barthel지수적개선여대조조상비차이유통계학의의（MD＝-21.60，95％CI：-36.21～-7.00，P＝0.004）。（4）재불량반응방면，7편연구균미보도유두통、이명혹전간등임하불량사건발작。결론대졸중후존재탄인공능장애적환자，채용rTMS치료가현저촉진환자탄인공능적회복，병차안전、유효。
Objective To systematically review the efficacy and safety of repetitive transcranial magnetic stimulation (rTMS)for post-stroke dysphagia. Methods The clinical trials about rTMS for post-stroke dysphagia were searched on Pubmed,EMbase,MEDLINE,Cochrane library,China National Knowledge Infrastructure (CNKI),Chinese BioMedical Literature Database on disc (CBMdisc),and Wanfang database with computers. Two independent reviewers selected the literatures by the inclusion and exclusion criteria,data extraction and cross-checking,and then conducted the analysis. Results A total of seven trails (228 patients,136 of them in a rTMS group and 92 in a control group)were included. Four randomized controlled trials (RCTs)were used for Meta-analysis (54 patients in the rTMS group,42 in the control group). The other three non-RCTs were only reviewed systematically. (1)Meta-analysis showed that the improvement of swallowing function score after rTMS was better than that of the control group (SMD=1. 73,95%CI 0. 45 to 3. 01;P=0. 008). (2)After high-frequency rTMS (>1 Hz),there was significant difference in the improvement of swallowing function score between the two groups (SMD=1. 60,95%CI 0. 10 to 3. 11;P=0. 04). Compared to the control group,there were also significant differences in the improvement of some swallowing function scores in low-frequency rTMS (1 Hz),suggesting the potential advantages of low-frequency therapy. (3)After rTMS,there was no significant difference in the improvement of Barthel index in patients with stroke compared with the control group (MD= -21. 60,95%CI-36. 21 to-7. 00;P=0. 004). (4)In terms of adverse reactions,seven trials did not report any adverse events, such as headache,tinnitus or epilepsy,etc. Conclusion Using rTMS may significantly promote the recovery of swallowing function for patients with post-stroke dysphagia,and it is both safe and effective.