重复经颅磁刺激治疗脑外伤患者认知障碍的Meta分析

doi:10.3969/j.issn.1006-9771.2021.11.007

Abstract

Abstract:

Objective To evaluate the effect of repetitive transcranial magnetic stimulation (rTMS) on cognitive dysfunction after traumatic brain injury (TBI).Methods Randomized controlled trials (RCTs) of rTMS for treating traumatic brain injury (TBI) patients with cognitive dysfunction were retrieved from the databases of PubMed, Embase, Web of Science, Cochrane Library, CNKI, Wanfang Database, VIP and SinoMed from the establishment of these databases to June, 2021. Two researchers independently screened the articles, extracted the data, and evaluated the quality. Meta-analysis was performed using RevMan 5.4.Results A total of ten RCTs with 368 patients were included. Subgroup analysis showed that rTMS could improve the single cognitive function (SMD = 1.00, 95%CI 0.04 to 1.96, P = 0.04) but for overall cognitive function (SMD = 0.47, 95%CI -0.05 to 0.98, P = 0.08). rTMS was well tolerated, that the adverse reactions such as dizziness and mild headache were not significantly different from the control group (RR = 1.67, 95%CI 0.98 to 2.86, P = 0.06).Conclusions It is still uncertain in the effectiveness of rTMS on cognitive dysfunction after TBI, but it is well tolerated.

Key words: repetitive transcranial magnetic stimulation, traumatic brain injury, cognitive dysfunction, meta-analysis

HAN Kai-yue,DANG Hui,ZHANG Hao. Efficacy of Repetitive Transcranial Magnetic Stimulation on Cognitive Dysfunction after Traumatic Brain Injury: A Meta-analysis[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2021, 27(11): 1282-1290.

Figures/Tables 9

纳入研究	国家	研究对象(T/C, n)	性别(男/女, n)	平均年龄 (岁)	平均病程 (年)	干预措施	刺激部位	rTMS治疗方案	结局指标	随访时间 (年)	脱落率 (T/C, n)
Stilling等(2020)^[27]	加拿大	10/10	2/18	36.00±11.40	2.71±1.16	T:rTMS C:假刺激	左侧DLFFC	“8”字形线圈,10 Hz,70% RMT,600个脉冲,1次/d,5 d/周,共2周	②	0.5	0/0
Neville等(2019)^[26]	巴西	13/17	27/3	T:32.6±12.81 C:29.0±10.35	> 1	T:rTMS C:假刺激	左侧DLFFC	“8”字形线圈,10 Hz,110% RMT,2000个脉冲,1次/d,5 d/周,共2周	③⑦⑧⑨	0.25	5/1
Hoy等(2019)^[23]	澳大利亚	11/10	10/11	T:41.3±10.04 C:51.8±13.38	T:14.73±10.83 C:22.11±13.59	T:rTMS C:假刺激	双侧DLFFC	“8”字形线圈,按先右后左的顺序治疗。右侧,1 Hz, 110% RMT,900个脉冲;左侧,1 Hz,110% RMT,1500个脉冲。1次/d,5 d/周,共4周	③⑦⑧	无	1/2
Lee等(2018)^[24]	韩国	7/6	9/4	T:42.4±11.32 C:41.3±11.02	T:3.85±1.67 C:3.88±1.94	T:rTMS+NDT C:假刺激+NDT	右侧DLFFC	“8”字形线圈,1 Hz,100% RMT,2000个脉冲,1次/d,5 d/周,共2周	①③⑦	无	0/0
Boggio等(2010)^[25]	巴西	9/8	5/12	T:40.7±13.65 C:45.9±11.45	T:4.12±4.61 C:3.42±4.48	T:rTMS C:假刺激	右侧DLFFC	“8”字形线圈,20 Hz,80% RMT,1600个脉冲,1次/d,5 d/周,共2周	③⑧	0.2	1/2
赵春梅等(2020)^[20]	中国	20/20	27/13	T:29.1±5.60 C:28.9±6.70	T:0.17±0.06 C:0.17±0.06	T:rTMS + 常规治疗 C:假刺激+常规治疗	双侧DLFFC	“8”字形线圈,1 Hz,80% RMT,750个脉冲,1次/d,5 d/周,共4周	②④	无	0/0
周俊香等(2019)^[21]	中国	32/32	31/33	T:41.1±3.70 C:39.5±2.60	T:0.15±0.01 C:0.15±0.02	T:rTMS + 常规治疗 C:常规治疗	额叶或双侧颞叶或枕叶	“8”字形线圈,2 Hz,80% RMT,20 min/次,1次/d,5次/周,共4周	①②	无	0/0
王单等(2016)^[22]	中国	30/30	40/20	T:32.8±8.63 C:31.7±9.32	T:0.10±0.05 C:0.09±0.04	T:rTMS +常规治疗 C:常规治疗	健侧前额叶	“8”字型线圈,1 Hz,80% RMT,1000个脉冲,1次/d,5次/周,共4周	⑥	无	0/0
关晨霞等(2016)^[18]	中国	20/20	30/10	T:47.5±10.10 C:45.3±9.50	T:0.12±0.02 C: 0.12±0.01	T:rTMS+ 常规治疗 C:假刺激+常规治疗	左侧DLFFC	“8”字形线圈,1 Hz,20 min/次,周一至周五2次/d,周六1次/d,共4周	②⑤⑨	无	0/0
黄居科等(2009)^[19]	中国	30/30	39/21	T:45.3±17.08 C:43.9±16.80	T:0.13±0.07 C:0.12±0.07	T:rTMS+ 常规治疗 C:常规治疗	双侧前额叶	“8”字形线圈,0.5 Hz,60% RMT,30次/序列,1个序列/d	①④⑤	无	0/0

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Efficacy of Repetitive Transcranial Magnetic Stimulation on Cognitive Dysfunction after Traumatic Brain Injury: A Meta-analysis

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