CAJ | 학술논문

目的：系统评价阴极经颅直流电刺激(c-tDCS)对脑卒中患者上肢功能障碍的康复效果。方法计算机检索Cochrane Central Register of Controlled Trials、PubMed、EMbase、Web of Science、Ovid、中国生物医学文献、中国知网、万方数据和维普数据库中关于c-tDCS改善脑卒中患者上肢功能障碍的随机对照试验，同时检索已纳入文献的参考文献。检索时间从建库至2013年7月。2名独立的研究人员依据Cochrane协作网推荐的偏倚风险评估方法，对纳入文献的质量进行严格评估及资料提取，对符合标准的随机对照试验进行Meta合并分析。统计分析采用RevMan 5.1软件。结果共纳入10篇。Meta分析显示，c-tDCS作用于病灶侧初级运动区后，患者的Fugl-Meyer运动功能量表上肢部分评分与假刺激组相比，差异无统计学意义[WMD=0.11,95%CI：-5.77~5.99, Z=0.04, P=0.97]， c-tDCS作用于病灶侧初级运动区对患者Jebsen手功能的作用效果与假刺激组相比，差异无统计学意义[WMD=-1.52,95%CI：-4.94~1.90, Z=0.87, P=0.38]。纳入文献质量的Jadad评分，低质量2篇，高质量8篇。结论目前，没有证据显示c-tDCS比假刺激更有效地改善脑卒中患者上肢运动功能障碍。
목적：계통평개음겁경로직류전자격(c-tDCS)대뇌졸중환자상지공능장애적강복효과。방법계산궤검색Cochrane Central Register of Controlled Trials、PubMed、EMbase、Web of Science、Ovid、중국생물의학문헌、중국지망、만방수거화유보수거고중관우c-tDCS개선뇌졸중환자상지공능장애적수궤대조시험，동시검색이납입문헌적삼고문헌。검색시간종건고지2013년7월。2명독립적연구인원의거Cochrane협작망추천적편의풍험평고방법，대납입문헌적질량진행엄격평고급자료제취，대부합표준적수궤대조시험진행Meta합병분석。통계분석채용RevMan 5.1연건。결과공납입10편。Meta분석현시，c-tDCS작용우병조측초급운동구후，환자적Fugl-Meyer운동공능량표상지부분평분여가자격조상비，차이무통계학의의[WMD=0.11,95%CI：-5.77~5.99, Z=0.04, P=0.97]， c-tDCS작용우병조측초급운동구대환자Jebsen수공능적작용효과여가자격조상비，차이무통계학의의[WMD=-1.52,95%CI：-4.94~1.90, Z=0.87, P=0.38]。납입문헌질량적Jadad평분，저질량2편，고질량8편。결론목전，몰유증거현시c-tDCS비가자격경유효지개선뇌졸중환자상지운동공능장애。
Objective To evaluate the effectiveness of cathodal transcranial direct current stimulation(c-tDCS) on the upper extremities of patients with stroke. Methods Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMbase, Web of Science, Ovid, China Biology Medicine disc (CBMdisc), China National Knowledge Infrastructure, Wanfang Data and VIP Database for Chinese Technical Periodicals were searched for the randomized controlled trials (RCTs) of c-tDCS in the treatment of the upper extremities of patients with stroke from the date of establishment of the databases to July 2013. The bibliographies of the retrieved studies were also searched. 2 indepen-dent researchers evaluated the included studies using the risk of bias provided by Cochrane Library. The extracted data were analyzed by RevMan 5.1 software. Results A total of 10 trials were discovered. Compared with the sham tDCS group, the c-tDCS group which stimulat-ed the area of primary motor cortex (M1) did not increase the score of Fugl-Meyer Assessment (upper extremity) [WMD=0.11, 95%CI:-5.77~5.99, Z=0.04, P=0.97] and Jebsen-Taylor Test [WMD=-1.52, 95%CI:-4.94~1.90, Z=0.87, P=0.38]. According to the Jadad Score of included studies, 2 of them were of low quality and 8 of them were of high quality. Conclusion Currently, no evidence shows that c-tDCS can improve the upper extremities function of stroke patients more than sham tDCS.