中国康复
中國康複
중국강복
CHINESE JOURNAL OF REHABILITATION
2015年
4期
257-261
,共5页
经颅直流电刺激%脑卒中%运动功能%Meta 分析%随机对照试验
經顱直流電刺激%腦卒中%運動功能%Meta 分析%隨機對照試驗
경로직류전자격%뇌졸중%운동공능%Meta 분석%수궤대조시험
transcranial direct current stimulation%stroke%motor function%Meta-analysis%randomized controlled trial
目的：：系统评价阳极经颅直流电刺激(a-tDCS)对脑卒中患者上肢运动功能恢复的影响。方法：采用计算机检索 Cochrane 图书馆、PubMed、EMbase、CBMdisc、中国知网和万方数据库中关于 a-tDCS 对脑卒中患者上肢运动功能恢复的随机对照试验(RCTs),并对纳入研究的偏倚风险和证据质量进行评价,对符合相同结局指标的RCTs 进行合并数据的 Meta 分析。结果：本研究共纳10篇 RCT。Meta 分析两个主要结局指标的结果显示：a-tDCS 作用于患侧大脑运动皮层后,患者的 Fugl-Meyer 运动评分量表的上肢评分部分与假刺激组相比,其差异无统计学意义[WMD=3.39,95%CI(-2.35,9.13)]；a-tDCS 作用于患侧大脑运动皮层后,患者的 Jebsen-Taylor 手功能测试评分与假刺激组比较,其差异有统计学意义[WMD=-3.01,95%CI(-5.18,-0.85)]。GRADE 系统推荐等级结果提示每个结局均为极低等级。结论：阳极经颅直流电刺激对脑卒中后患者上肢功能的改善有一定的作用,但仍有待开展大样本、多中心、方法科学规范的高质量 RCT,以进一步验证其康复效果。
目的：：繫統評價暘極經顱直流電刺激(a-tDCS)對腦卒中患者上肢運動功能恢複的影響。方法：採用計算機檢索 Cochrane 圖書館、PubMed、EMbase、CBMdisc、中國知網和萬方數據庫中關于 a-tDCS 對腦卒中患者上肢運動功能恢複的隨機對照試驗(RCTs),併對納入研究的偏倚風險和證據質量進行評價,對符閤相同結跼指標的RCTs 進行閤併數據的 Meta 分析。結果：本研究共納10篇 RCT。Meta 分析兩箇主要結跼指標的結果顯示：a-tDCS 作用于患側大腦運動皮層後,患者的 Fugl-Meyer 運動評分量錶的上肢評分部分與假刺激組相比,其差異無統計學意義[WMD=3.39,95%CI(-2.35,9.13)]；a-tDCS 作用于患側大腦運動皮層後,患者的 Jebsen-Taylor 手功能測試評分與假刺激組比較,其差異有統計學意義[WMD=-3.01,95%CI(-5.18,-0.85)]。GRADE 繫統推薦等級結果提示每箇結跼均為極低等級。結論：暘極經顱直流電刺激對腦卒中後患者上肢功能的改善有一定的作用,但仍有待開展大樣本、多中心、方法科學規範的高質量 RCT,以進一步驗證其康複效果。
목적：：계통평개양겁경로직류전자격(a-tDCS)대뇌졸중환자상지운동공능회복적영향。방법：채용계산궤검색 Cochrane 도서관、PubMed、EMbase、CBMdisc、중국지망화만방수거고중관우 a-tDCS 대뇌졸중환자상지운동공능회복적수궤대조시험(RCTs),병대납입연구적편의풍험화증거질량진행평개,대부합상동결국지표적RCTs 진행합병수거적 Meta 분석。결과：본연구공납10편 RCT。Meta 분석량개주요결국지표적결과현시：a-tDCS 작용우환측대뇌운동피층후,환자적 Fugl-Meyer 운동평분량표적상지평분부분여가자격조상비,기차이무통계학의의[WMD=3.39,95%CI(-2.35,9.13)]；a-tDCS 작용우환측대뇌운동피층후,환자적 Jebsen-Taylor 수공능측시평분여가자격조비교,기차이유통계학의의[WMD=-3.01,95%CI(-5.18,-0.85)]。GRADE 계통추천등급결과제시매개결국균위겁저등급。결론：양겁경로직류전자격대뇌졸중후환자상지공능적개선유일정적작용,단잉유대개전대양본、다중심、방법과학규범적고질량 RCT,이진일보험증기강복효과。
Objective:To evaluate the effectiveness of anodal transcranial direct current stimulation (tDCS)in trea-ting stroke patients with upper motor dysfunction.Methods:The Cochrane Library,MEDLINE,EMbase,CBMdi-sc,CNKI and Wanfang Data were searched from their inception to January 2014,and the references of the included studies were also retrieved to collect the randomized controlled trials (RCTs)on anodal tDCS in treating stroke pa-tients with upper motor dysfunction.Two reviewers independently screened articles according to the inclusion and exclusion criteria,extracted data and evaluated the quality of the included studies.The meta-analysis was performed using RevMan 5.0 software,and evidence quality and recommendation level were assessed using the GRADE sys-tem.Results:A total of 10 RCTs were included.The results of meta-analysis (including 7 RCTs,very low quality) showed that as compared with the sham tDCS group,the score of JTT in the a-tDCS group undergoing the stimula-tion of the area of primary motor cortex was increased (WMD=-3.01,95% CI -5.18 to -0.85),but the score of upper limb FMA in the a-tDCS group was not increased (WMD=3.39,95% CI -2.35 to 9.13).The two out-comes were all of low quality in the GRADE system.Conclusions:It is apparent from the available studies that a-tDCS may have a certain effect in treating stroke patients with upper motor dysfunction.But more large-sample, multicenter,and high-quality RCTs are required to further proof the effectiveness of a-tDCS in treating stroke pa-tients with limb dysfunction.
