脑卒中偏瘫患者早期运动疗法康复效果的系统评价

Efficacy of Early Physical Rehabilitation for Stroke-induced Hemiplegia:A Systematic Review

目的系统评价早期运动疗法对脑卒中偏瘫患者的康复效果。方法计算机检索PubMed、Web of Science、The Cochrane Library（2014年7期）、EMbase、CNKI、VIP和WanFang Data数据库,检索时限均为从建库至2014年8月1日,搜集早期运动疗法治疗脑卒中偏瘫患者的相关随机对照试验（RCT）。由2位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.2软件进行Meta分析。结果共纳入6个RCT。Meta分析结果显示,卒中后1个月早期运动康复组的Furl-Meyer运动评分[MD=18.02,95%CI（6.24,29.80）,P=0.003]和BI评分[MD=32.32,95%CI（24.28,40.36）,P〈0.000 01]明显高于对照组,但两组在卒中后3个月m RS评分在0~2分的患者比例、病死率和并发症发生率方面,差异均无统计学意义。结论早期运动康复能够改善卒中患者的运动功能,促进日常生活活动能力的恢复。受纳入研究数量和质量的限制,上述结论尚需开展更多大样本、高质量的RCT予以验证。

Objective To systematically review the efficacy of early physical rehabilitation for patients with stroke-induced hemiplegia.Methods Databases including PubMed,Web of Knowledge,The Cochrane Library（Issue 7,2014）,EMbase,CNKI,VIP and WanFang Data were searched to collect randomized controlled trials（RCTs）about early physical rehabilitation for patients with stroke-induced hemiplegia from inception to 1st August 2014.Two reviewers independently screened literature,extracted data and assessed the risk of bias of included studies.Then,metaanalysis was performed using RevMan 5.2 software.Results A total of 6 RCTs were included.The results of metaanalysis showed that,after 1 month of treatment,the Fugl-Meyer scores（MD=18.02,95%CI 6.24 to 29.80,P=0.003）and BI scores（MD=32.32,95%CI 24.28 to 40.36,P0.000 01） in the early physical rehabilitation group were higher than that in the conventional rehabilitation group.But after 3 months of treatment,there were no statistical differences between two groups in the proportion of patients with 0-2 MRS scores,mortality and the incidence of complications.Conclusion Current evidence shows that early physical rehabilitation can effectively improve the limb motor function and daily living ability in patients with stroke-induced hemiplegia.However,due to the limited quantity and quality of the include studies,more large-scale,high quality RCTs are needed to verify the above conclusion.