电刺激治疗脑卒中后肩手综合征有效性的系统评价与Meta分析

doi:10.3969/j.issn.1006-9771.2023.09.008

摘要/Abstract

摘要：

目的系统评价电刺激治疗脑卒中后肩手综合征的效果，并比较不同电刺激治疗的效果。

方法检索PubMed、Web of Science、Embase、Cochrane Library、中国知网、中国生物医学文献数据库、维普和万方数据库，搜集从建库至2023年2月14日发表的关于电刺激治疗脑卒中后肩手综合征的随机对照试验。进行文献筛选和质量评价。采用RevMan 5.4软件和Stata 14.0软件分别进行Meta分析和网状Meta分析。

结果最终纳入18篇文献，共1 310例患者。与单纯常规康复疗法相比，电刺激联合常规康复疗法可提高脑卒中后肩手综合征患者的Fugl-Meyer评定量表上肢功能评分(MD = 8.17, 95%CI 6.90~9.45, P < 0.001)和改良Barthel指数评分(MD = 11.80, 95%CI 10.18~13.42, P < 0.001)，降低视觉模拟评分(MD = -1.68, 95%CI -2.03~-1.32, P < 0.001)和水肿评分(MD = -0.98, 95%CI -1.18~-0.79, P < 0.001)。改善上肢功能方面的最优排序为中频电疗>电针>低频电疗>常规康复疗法；改善疼痛方面的最优排序为电针>中频电疗>低频电疗>常规康复疗法。

结论电刺激疗法能够缓解脑卒中后肩手综合征患者的疼痛和水肿，并提高患者上肢运动能力和日常生活活动能力；其中在改善上肢功能方面中频电疗效果最好，在缓解疼痛方面电针疗效最佳。

关键词: 脑卒中, 肩手综合征, 电刺激疗法, 系统评价, 网状Meta分析

Abstract:

Objective To systematically evaluate the efficacy of electrical stimulation on shoulder-hand syndrome after stroke, and compare the curative effect of different electrical stimulation therapies.

Methods The randomized controlled trials (RCT) about the effect of electrical stimulation on shoulder-hand syndrome after stroke were retrieved from eight databases, including PubMed, Web of Science, Embase, Cochrane Library, CNKI, CBM, VIP and Wanfang data, from the establishment to February 14th, 2023. Two researchers selected and screened the literature, and evaluated the quality of methodology independently. RevMan 5.4 software and Stata 14.0 software were used for meta-analysis and network meta-analysis, respectively.

Results A total of 18 RCT were selected, including 1 310 cases. Compared to conventional rehabilitation therapy alone, electrical stimulation combined with conventional rehabilitation therapy could improve the scores of Fugl-Meyer Assessment-Upper Extremities (MD = 8.17, 95%CI 6.90 to 9.45, P< 0.001) and modified Barthel Index (MD = 11.80, 95%CI 10.18 to 13.42, P < 0.001), and reduce the Visual Analogue Score (MD = -1.68, 95%CI -2.03 to -1.32, P < 0.001) and edema score (MD = -0.98, 95%CI -1.18 to -0.79, P< 0.001). The best effect of improving upper limb function followed as intermediate frequency electrotherapy, electroacupuncture, low frequency electrotherapy and routine rehabilitation therapy. The best effect of improving pain followed as electroacupuncture, intermediate frequency electrotherapy, low frequency electrotherapy and routine rehabilitation therapy.

Conclusion Electrical stimulation therapy can relieve pain and edema of patients with shoulder-hand syndrome after stroke, and improve upper limb activity and activities of daily living. Intermediate frequency electrotherapy is the best in improving upper limb function, and electroacupuncture is the best in relieving pain.

Key words: stroke, shoulder-hand syndrome, electric stimulation therapy, systematic review, network meta-analysis

中图分类号:

R743.3

王贺, 韩靓, 阚梦凡, 于少泓. 电刺激治疗脑卒中后肩手综合征有效性的系统评价与Meta分析[J]. 《中国康复理论与实践》, 2023, 29(9): 1048-1056.

WANG He, HAN Liang, KAN Mengfan, YU Shaohong. Efficacy of electrical stimulation on shoulder-hand syndrome after stroke: a systematic review and meta-analysis[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(9): 1048-1056.

图/表 8

图1

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纳入文献基本特征"

纳入文献	n (C/T)	平均年龄(C/T)/岁	平均病程(C/T)	干预时间	干预周期	结局指标
单婷婷^[22](2021)	32/33	(59.03±10.21)/(59.25±10.24)	(33.09±6.56)/(33.11±6.72) d	每次30 min，每天1次	20 d	①②③
雷波等^[23](2017)	31/31	(49.2±7.5)/(48.3±8.1)	(33.4±5.5)/(32.3±6.1) d	每次30 min，每天1次	20 d	①②④
梁楠等^[24](2016)	42/42	(55.8±3.6)/(56.5±3.2)	(15 d~3个月)/(10 d~3个月)	每次30 min，每天1次	30 d	①②
石翠霞等^[25](2014)	40/40	(52.65±10.03)/(52.73±11.17)	(25.68±4.71)/(25.53±3.8) d	每次20 min，每天1次	4周	①②③④
章晓峰等^[26](2022)	32/33	(64.84±6.95)/(63.03±8.80)	(32.60±4.83)/(31.94±4.61) d	每次30 min，每天1次	8周	①②
张晓玲等^[27](2012)	33/35	(60.8±11.3)/(61.4±10.9)	(3.6±4.3)/(3.7±4.2) d	每次20 min，每天1次	3周	②④
崔高亮等^[28](2011)	24/23	(63.5±7.9)/(65.4±8.4)	50/47 d	每次10 min，每天1次	1个月	①②
费立凤等^[29](2009)	28/28	61/63	60/62 d	每次40 min，每天1次	1个月	①②
黄心熳等^[30](2022)	60/60	(61.24±11.15)/(60.08±10.97)	(20.42±6.47)/(18.92±5.17) d	每次30 min，每天1次，每周5 d	3周	①②④
李素丹等^[31](2022)	35/35	(55.3±13.2)/(55.5±13.0)	(47.2±11.9)/(47.5±11.6) d	每次30 min，每天1次	21 d	①②
刘学春等^[32](2021)	40/39	(64.21±9.35)/(63.38±9.22)	未提及	每次15~20 min，每天2次	2周	①②③
邵丽丽等^[33](2019)	39/39	(60.47±13.42)/(59.42±11.56)	(3.13±1.72)/(2.83±1.47)个月	每次20 min，每天1次	30 d	①③
吴延深等^[34](2022)	25/25	(55.39±2.54)/(55.23±2.52)	(3.22±0.43)/(3.53±0.51)个月	每次30 min，每天1次	1个月	①②
谢晶军等^[35](2016)	40/40	(51±10)/(55±11)	(15 d~2个月)/(14 d~2个月)	每次30 min，每周3次	4周	①②
徐力康^[36](2021)	60/60	(63.74±5.83)/(64.22±6.05)	(2.31±0.56)/(2.81±0.91)个月	每次30 min，每天1次	4周	①②
李水琴等^[37](2010)	50/48	(55.64±5.89)/(57.58±6.02)	(32.75±4.85)/(33.68±3.26) d	每次20 min，每天1次	1个月	①②
李新华^[38](2008)	24/24	(59±10)/(59±13)	未提及	每次40~60 min，每天1次	4周	①
周科望等^[39](2017)	20/20	(63.12±6.89)/(63.71±6.45)	(39.65±33.12)/(39.83±32.18) d	每次45 min，每天2次，每周6 d	6周	①

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结局指标		纳入研究数/n	异质性检验		效应模型	Meta分析结果
结局指标		纳入研究数/n	I²值(%)	P值	效应模型	MD (95%CI)	P值
FMA-UE		17^{[22,26,28⇓⇓⇓⇓⇓⇓⇓⇓⇓⇓-39]}	86	< 0.001	随机效应模型	8.17 (6.90, 9.45)	< 0.001
	病程< 1个月	5^{[22-23,25-26,30]}	91	< 0.001	随机效应模型	9.02 (5.39, 12.64)	< 0.001
	病程1~2个月	5^{[28-29,31,37,39]}	74	0.004	随机效应模型	9.62 (6.78, 12.46)	< 0.001
	病程> 2个月	3^[33,34,36]	51	0.130	随机效应模型	6.53 (5.64, 7.43)	< 0.001
VAS		15^{[22⇓⇓⇓⇓⇓⇓⇓⇓⇓⇓⇓⇓⇓⇓-37]}	94	< 0.001	随机效应模型	-1.68 (-2.03, -1.32)	< 0.001
	病程< 1个月	6^{[22-23,25⇓-27,30]}	94	< 0.001	随机效应模型	-1.39 (-1.95, -0.83)	< 0.001
	病程1~2个月	4^{[28-29,31,37]}	49	0.120	固定效应模型	-1.81 (-1.94, -1.68)	< 0.001
	病程> 2个月	2^[34,36]	99	< 0.001	随机效应模型	-2.39 (-4.72, -0.06)	< 0.001
水肿评分		4^{[22-23,25,27]}	44	0.150	固定效应模型	-0.98 (-1.18, -0.79)	< 0.001
MBI		4^{[22,25,32-33]}	46	0.130	固定效应模型	11.80 (10.18, 13.42)	< 0.001

结局指标	干预措施	MD (95%CI)
FMA-UE	常规康复疗法vs.电针	-8.34 (-11.36, -5.32)
	常规康复疗法vs.低频电疗	-7.62 (-11.06, -4.19)
	常规康复疗法vs.中频电疗	-11.43 (-16.36, -6.51)
	低频电疗vs.电针	-0.72 (-5.29, 3.86)
	中频电疗vs.电针	3.09 (-2.68, 8.87)
	中频电疗vs.低频电疗	3.81 (-2.19, 9.81)
VAS	常规康复疗法vs.电针	1.92 (1.48, 2.36)
	常规康复疗法vs.低频电疗	1.49 (0.93, 2.04)
	常规康复疗法vs.中频电疗	1.88 (1.01, 2.76)
	低频电疗vs.电针	0.44 (-0.27, 1.15)
	中频电疗vs.电针	0.04 (-0.94, 1.02)
	中频电疗vs.低频电疗	-0.40 (-1.43, 0.64)

结局指标	干预措施	累积排序概率/%
FMA-UE	电针	58.9
	低频电疗	49.4
	中频电疗	91.7
	常规康复疗法	0
VAS	电针	80.9
	低频电疗	45.1
	中频电疗	74.1
	常规康复疗法	0