目的系统评价重复经颅磁刺激(rTMS)对脑卒中患者单侧空间忽略的治疗效果。方法检索PubMed、OVID、Embase、Cochrane Library、中国知识资源总库(CNKI)、维普中文科技期刊全文数据库(VIP)、万方数据库中关于rTMS改善脑卒中患者单侧空间忽略的随机对照试验,搜索时限从建库至2016年7月。由两名研究者按纳入和排除标准筛选文献并提取有效数据,进行质量评价。采用RevMan 5.3软件和GRADE profiler 3.6软件对最终纳入的文献数据进行统计学分析。结果最终纳入12篇文献,共353例受试者。按照治疗组刺激频率分为低频rTMS组、高频rTMS组和持续短阵快速脉冲经颅磁刺激(cTBS)组分别进行分析。共考察3个结局指标：二等分线段试验(LBT)、星形删除试验(SCT)、Albert线段划消试验(AT)。结果显示,与对照组相比,接受rTMS治疗的患者,在3项结局指标上均有较好表现,不同刺激频率均显示较好疗效(低频rTMS：SMD=-1.21, 95%CI -2.17~-0.25。高频rTMS：SMD=-2.56, 95%CI -3.54~-1.58。cTBS：SMD=-2.51, 95%CI -3.66~-1.36)。结论rTMS能改善脑卒中患者单侧空间忽略。
ObjectiveTo evaluate the effect of repetitive transcranial magnetic stimulation (rTMS) on unilateral spatial neglect in stroke patients. MethodsPublished articles from the earliest date available to July, 2016 were recalled from PubMed, OVID, Embase, Cochrane Library, CNKI, VIP and Wanfang Database. Two reviewers selected independently the randomized controlled trials (RCTs) about rTMS for stroke patients with unilateral spatial neglect, and extracted data independently and analyzed with RevMan 5.3 and GRADE profiler 3.6. ResultsTwelve trials that represented 353 participants were evaluated. For improving Line Bisection Test, Star Cancellation Test, Albert Test, rTMS groups were significantly more effective than the controls. rTMS groups with different frequencies all showed significantly effective: for low frequency rTMS, SMD=-1.21, 95%CI=-2.17 to -0.25; for high frequency rTMS, SMD=-2.56, 95%CI=-3.54 to -1.58; for continuous theta burst stimulation (cTBS), SMD=-2.51, 95%CI=-3.66 to -1.36. ConclusionrTMS is effective on unilateral spatial neglectin in stroke patients.
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