中药冷热交替浸泡治疗脑卒中后肩手综合征效果的系统评价

Meta-analysis of effect of alternating hot-cold traditional Chinese medicine immersion for shoulder hand syndrome after stroke

[目的]系统评价在神经内科常规治疗护理基础上,进行中药冷热交替浸泡结合康复训练对脑卒中后肩手综合征的治疗效果。[方法]检索CNKI、VIP、CBM、Wanfang Date、The Cochrane Library、EMBASE、PubMed、Web of Science、OVID、EBSCO中关于中药冷热交替浸泡治疗脑卒中后肩手综合征的随机对照试验,检索时限均自建库至2018年1月。由2名评价员独立进行文献筛选、资料提取与质量评价后,采用RevMan 5.3行Meta分析。[结果]共纳入6项随机对照研究,508例病人。Meta分析结果显示:对脑卒中后肩手综合征病人实施中药冷热交替浸泡治疗后病人总有效率[OR=3.74,95%CI (2.18,6.41),P<0.000 01]、上肢简化Fugl-Meyer运动功能评分量表评分[MD=12.14,95%CI(10.75,13.52),P<0.000 01]、Bathel指数[SMD=2.68,95%CI(1.94,3.43),P<0.000 01]均高于在神经内科常规治疗护理基础上进行康复训练或康复训练结合冷热水交替浸泡。[结论]现有证据表明:在神经内科常规治疗护理基础上,进行康复训练联合中药冷热交替浸泡治疗,可提高脑卒中后肩手综合征病人治疗总有效率、病人上肢运动功能和日常生活能力,但受纳入研究数量与质量限制,上述结论尚需更多高质量研究予以验证。

Objective:To evaluate the effect of alternating hot-cold traditional Chinese medicine immersion combined with rehabilitation training on shoulder hand syndrome after stroke on the basis of routine nursing in neurology department.Methods:Databases including CNKI,VIP,CBM,Wanfang Date,The Cochrane Library,EMBASE,PubMed,Web of Science,OVID,EBSCO were searched electronically from inception to January 2018 to collect the randomized controlled trial on alternating hot-cold traditional Chinese medicine immersion for shoulder hand syndrome after stroke.Meta analysis was performed using RevMan 5.3 software.Results:6 RCTs 508 patients were included.Meta analysis showed that total effective rate[OR=3.74,95% CI(2.18,6.41),P<0.000 01],Fugl-Meyer Assessment Scale score[MD=12.14,95%CI(10.75,13.52),P<0.00001],Bathel index score[SMD=2.68,95%CI(1.94,3.43),P<0.00001]of patients with alternating hot-cold traditional Chinese medicine immersion for shoulder hand syndrome after stroke were higher than those received rehabilitation training or rehabilitation training combined with alternating hot-cold immersion on the basis of routine nursing in neurology department.Conclusion:Present evidences showed that alternating hot-cold traditional Chinese medicine immersion combined with rehabilitation training on shoulder hand syndrome after stroke on the basis of routine nursing in neurology department can improve the total effective rate of treatment,upper limb motor function and daily living ability of patients.But it is limited by the quantity and quality of included researches,so it needs to be verified by more high-quality studies.