CAJ | 학술논문

背景：现有各项研究对重复经颅磁刺激应用于脑卒中患者运动功能康复效果的观点不一。 　　目的：系统评价重复经颅磁刺激对脑卒中患者运动功能障碍的治疗效果。 　　方法：计算机检索Cochrane Central Register of Control ed Trials、PubMed数据库、ISI Web of science、Medline、EMBASE、中国生物医学文献数据库、中国知识资源总库、维普中文科技期刊全文数据库、万方数据库中关于重复经颅磁刺激改善脑卒中患者运动功能障碍的随机对照试验，搜索时限从建库至2013年7月。按照 Cochrane 系统评价员手册推荐方法逐一评价纳入研究的质量，提取有效数据，对符合质量要求的文献数据进行Meta分析。采用RevMan 5.1软件和GRADEprofiler 3.6软件对最终纳入的文献数据进行统计学分析。 　　结果与结论：最终纳入23篇文献(干预组n=400，对照组n=301)。定量分析7项研究，其余作描述性研究。Meta分析2个结局指标Fugl-Meyer运动量表评分和Barthel指数，结果显示，干预组治疗后Fugl-Meyer运动评分[SMD=0.48，95%CI(0.10,0.86)]及 Barthel 指数[SMD=1.38，95%CI(0.68,2.09)]显著高于对照组。依据 GRADE 系统推荐分级方法评价结局指标级别，2个结局指标均为低质量。现有研究显示，重复经颅磁刺激能改善脑卒中患者的运动功能和日常生活活动能力。鉴于纳入文献质量不高，尚需进一步开展大样本﹑多中心﹑设计科学﹑操作规范的高质量临床随机对照试验，以验证重复经颅磁刺激对脑卒中后患者运动功能障碍的治疗效果。
배경：현유각항연구대중복경로자자격응용우뇌졸중환자운동공능강복효과적관점불일。 　　목적：계통평개중복경로자자격대뇌졸중환자운동공능장애적치료효과。 　　방법：계산궤검색Cochrane Central Register of Control ed Trials、PubMed수거고、ISI Web of science、Medline、EMBASE、중국생물의학문헌수거고、중국지식자원총고、유보중문과기기간전문수거고、만방수거고중관우중복경로자자격개선뇌졸중환자운동공능장애적수궤대조시험，수색시한종건고지2013년7월。안조 Cochrane 계통평개원수책추천방법축일평개납입연구적질량，제취유효수거，대부합질량요구적문헌수거진행Meta분석。채용RevMan 5.1연건화GRADEprofiler 3.6연건대최종납입적문헌수거진행통계학분석。 　　결과여결론：최종납입23편문헌(간예조n=400，대조조n=301)。정량분석7항연구，기여작묘술성연구。Meta분석2개결국지표Fugl-Meyer운동량표평분화Barthel지수，결과현시，간예조치료후Fugl-Meyer운동평분[SMD=0.48，95%CI(0.10,0.86)]급 Barthel 지수[SMD=1.38，95%CI(0.68,2.09)]현저고우대조조。의거 GRADE 계통추천분급방법평개결국지표급별，2개결국지표균위저질량。현유연구현시，중복경로자자격능개선뇌졸중환자적운동공능화일상생활활동능력。감우납입문헌질량불고，상수진일보개전대양본﹑다중심﹑설계과학﹑조작규범적고질량림상수궤대조시험，이험증중복경로자자격대뇌졸중후환자운동공능장애적치료효과。
BACKGROUND:Studies have different views on the effect of repetitive transcranial magnetic stimulation applied in stroke patients for improving motor function. OBJECTIVE:To evaluate the effect of repetitive transcranial magnetic stimulation on rehabilitation of motor function in patients with stroke. METHODS:We searched Cochrane Central Register of Control ed Trials, PubMed, ISI Web of science, Medline, EMBASE, China Biology Medicine disc, China National Knowledge Infrastructure, VIP Database for Chinese Technical Periodical, Wanfang Data (from database building to July 2013) for randomized control ed trials concerning repetitive transcranial magnetic stimulation on improving motor function in patients with stroke. The included studies were evaluated according to the method recommended by the Cochrane Col aboration. Meta analysis was performed in qualified literatures. The extracted data were analyzed by RevMan 5.1 software and GRADEprofiler 3.6 software. RESULTS AND CONCLUSION:A total of 23 trials were included (intervention group n=400, control group n=301). Quantitative analysis was conducted in seven studies, and descriptive study was performed in the remaining studies. Meta-analyses analyzed Fugl Meyer Motor Scale and Barthel index. Results showed that Fugl Meyer Motor Scale [SMD=0.48, 95%CI(0.10, 0.86)] and Barthel index [SMD=1.38, 95%CI (0.68, 2.09)] were significantly higher in the intervention group than that in the control group. In accordance with The Grading of Recommendations Assessment, Development and Evaluation, outcome indexes were evaluated, and the two indexes were graded low quality. The current evidence shows that repetitive transcranial magnetic stimulation appears to enhance motor function and activities of daily living of the patients with stroke. Considering the limitations of the included studies, more multi-central randomized control ed trials with large sample sizes and high qualities are required in future to verify the therapeutic efficacy of repetitive transcranial magnetic stimulation on motor function of stroke patients.