目的 系统评价经颅直流电刺激(tDCS)治疗卒中后吞咽困难的疗效。方法 计算机检索Cochrane Library (CENTRAL)、Medline、EMBASE、中国生物医学文献数据库(CBMdisc)、中文科技期刊数据库(VIP)、中国知网(CNKI)和万方数字化期刊全文数据库中经颅直流电刺激治疗卒中后吞咽困难的随机对照试验(RCTs),检索时限为建库到2018年2月。由两位评价者独立筛选文献、提取资料并评价纳入研究的质量后,采用RevMan 5.3软件进行Meta分析。结果 共纳入8项RCTs,包括225例患者。与对照组比较,tDCS能够明显改善卒中后吞咽困难患者的吞咽功能(SMD=0.71, 95%CI: 0.32~1.10, P<0.001),并且具有较好的安全性。结论 tDCS能够改善卒中后吞咽困难患者的吞咽功能。受纳入研究的数量和质量限制,上述结论 尚需开展更多高质量研究予以验证。
Objective To evaluate the effect of transcranial direct current stimulation (tDCS) on post-stroke dysphagia. Methods Cochrane Library (CENTRAL), Medline, EMBASE, CBMdisc, VIP, CNKI and WANFANG Digital Journals were searched to collect randomized controlled trials (RCTs) about transcranial direct current stimulation for post-stroke dysphagia until February 2018. Two researchers independently screened literature, extracted data and evaluated the quality of the included studies. Then, meta-analysis was performed using RevMan 5.3 software.Results A total of eight RCTs were screened, including 225 patients. Compared to the control group, tDCS was effective on post-stroke dysphagia (SMD=0.71, 95%CI: 0.32~1.10, P<0.001) with safety.Conclusion tDCS could improve swallowing function of post-stroke dysphagia. Due to the limited quantity and quality of the included studies, more high quality studies are needed.
[1] Arnold M, Liesirova K, Broeg-Morvay A, et al.Dysphagia in acute stroke: incidence, burden and impact on clinical outcome[J]. PLoS One, 2016, 11(2): e0148424.
[2] 张婧. 卒中后吞咽困难的识别和管理指南[J]. 中国卒中杂志, 2007, 2(3): 242-255.
[3] Geeganage C, Beavan J, Ellender S, et al. Interventions for dysphagia and nutritional support in acute and subacute stroke [J]. Cochrane Database Syst Rev, 2012, 10(10): CD000323.
[4] Bikson M, Grossman P, Thomas C, et al.Safety of Transcranial Direct Current Stimulation: Evidence Based Update 2016[J]. Brain Stimulation, 2016, 9(5): 641-661.
[5] Jefferson S, Mistry S, Singh S, et al.Characterizing the application of transcranial direct current stimulation in human pharyngeal motor cortex[J]. Am J Physiol Gastrointest Liver Physiol, 2009, 297(6): G1035-G1040.
[6] Kumar S, Wagner CW, Frayne C, et al.Noninvasive brain stimulation may improve stroke-related dysphagia: a pilot study[J]. Stroke, 2011, 42(4): 1035-1040.
[7] Ghandehari KEM, Kiadarbandsari EPM.Transcranial direct current stimulation in post-stroke dysphagia: a systematic review of randomized controlled trials[J]. Rev Clin Med, 2016, 3(3): 117-121.
[8] Shigematsu T, Fujishima I, Ohno K.Transcranial direct current stimulation improves swallowing function in stroke patients[J]. Neurorehabil Neural Repair, 2013, 27(4): 363-369.
[9] Suntrup-Krueger S, Ringmaier C, Muhle P, et al.Randomized trial of transcranial direct current stimulation for poststroke dysphagia[J]. Ann Neurol, 2018, 83(2): 328-340.
[10] Yang EJ, Baek SR, Shin J, et al.Effects of transcranial direct current stimulation (tDCS) on post-stroke dysphagia[J]. Restor Neurol Neurosci, 2012, 30(4): 303-311.
[11] Ahn YH, Sohn H, Park J, et al.Effect of bihemispheric anodal transcranial direct current stimulation for dysphagia in chronic stroke patients: a randomized clinical trial[J]. J Rehabil Med, 2017, 49(1): 30-35.
[12] 何欢. 经颅直流电刺激治疗卒中后吞咽障碍的疗效研究[D]. 昆明:昆明医科大学, 2016.
[13] 袁英,汪洁,吴东宇,等. 经颅直流电刺激改善卒中后共济失调型吞咽障碍的疗效观察[J]. 中国康复医学杂志, 2015, 30(8): 765-770.
[14] 赖日英. 电针结合经颅直流电刺激对脑卒中后吞咽障碍的疗效观察[D]. 广州:广州中医药大学, 2017.
[15] Simons A, Hamdy S.The use of brain stimulation in dysphagia management[J]. Dysphagia, 2017,32(2):209-215.
[16] Fregni F, Pascual-Leone A.Technology insight: noninvasive brain stimulation in neurology-perspectives on the therapeutic potential of rTMS and tDCS[J]. Nat Clin Pract Neurol, 2007, 3(7): 383-393.
[17] Vasant DH, Mistry S, Michou E, et al.Transcranial direct current stimulation reverses neurophysiological and behavioural effects of focal inhibition of human pharyngeal motor cortex on swallowing[J]. J Physiol, 2014, 592(4): 695-709.
[18] Suntrup S, Teismann I, Wollbrink A, et al.Altered cortical swallowing processing in patients with functional dysphagia: a preliminary study[J]. PLoS One, 2014, 9(2): e89665.
[19] Pisegna JM, Kaneoka A, Pearson WG, et al.Effects of non-invasive brain stimulation on post-stroke dysphagia: A systematic review and meta-analysis of randomized controlled trials[J]. Clin Neurophysiol, 2016, 127(1): 956-968.
[20] Godinho MM, Junqueira DR, Castro ML, et al.Safety of transcranial direct current stimulation: evidence based update 2016[J]. Brain Stimul, 2017, 10(5): 983-985.
