呼吸训练对中风患者吞咽功能影响的Meta分析

Meta analysis of the effects of breathing training for swallowing function of patients with stroke

目的系统评价呼吸训练对中风患者吞咽功能的影响。方法计算机检索Cochrane Library、PubMed、Web of Science、AMED、CINAHL、EMbase、中国生物医学文献数据库、中国知网、万方数据库和维普中文期刊数据库中关于呼吸训练对中风患者吞咽障碍随机对照试验,检索时限为建库至2019年6月。根据纳入和排除标准筛选文献、提取数据并评价纳入研究的方法学质量,采用RevMan 5.3软件进行Meta分析。结果纳入13篇文献,906例患者。Meta分析结果显示,与对照组相比,干预组患者总有效率(MD=1.19,95%CI(1.11~1.27),P<0.01)、吞咽造影检查(VFSS)评分(MD=1.53,95%CI(1.00~2.05),P<0.01)、吞咽障碍特异性生活质量量表(SWAL-QOL)评分(MD=19.77,95%CI(13.18~26.36),P<0.01)高于对照组,洼田饮水试验评分(MD=-0.70,95%CI(-0.93^-0.46),P<0.01)、吸入性肺炎发生率(MD=0.35,95%CI(0.16~0.74),P=0.006)低于对照组。Rosenbek误吸程度评分低于对照组,但差异无统计学意义(MD=-0.77,95%CI(-1.63~0.09),P=0.08)。结论在常规治疗、护理和康复训练的基础上对中风吞咽障碍患者进行呼吸训练可以改善吞咽障碍程度、预防呼吸并发症的发生、提高生活质量。但鉴于该研究纳入文献较少、各研究间干预方案存在差异以及干预时间较短,所以以上结论需要更高质量的随机对照试验加以验证。未来的研究应优化呼吸训练方案,开展更加严谨的研究。

Objective To take a systematic review of the effects of breathing training on swallowing function in stroke patients.Methods The computer searched the Cochrane Library,PubMed,Web of Science,AMED,CINAHL,EMbase,Chinese Biomedical Literature Database,CNKI,Wanfang Database,and VTP Chinese Periodical Database for randomized controlled trials of breathing training on dysphagia in patients with stroke,and the retrieval limitation period was from the time of setting up the database to June 2019.The literature was screened according to the inclusion and exclusion criteria,the data were extracted,and the methodological quality of the included studies was evaluated.Meta-analysis was performed by using RevMan 5.3 software.Results We included thirteen literatures and 906 patients.Meta analysis results showed that the total effective rate(MD=1.19,95%CI(1.11~1.27),P<0.01),videofluoroscopic swallowing study(VFSS)score(MD=1.53,95%CI(1.00~2.05),P<0.01),and swallowing-related quality of life(SWAL-QOL)score(MD=19.77,95%CI(13.18~26.36),P<0.01)of the patients in the intervention group were higher than those in the control group,and the score of water swallow test(MD=-0.70,95%CI(-0.93^-0.46),P<0.01)and the incidence of aspiration pneumonia(MD=0.35,95%CI(0.16~0.74),P=0.006)were lower than those in the control group.Rosenbek's aspiration degree score was lower than the control group,but the difference was not statistically significant(MD=-0.77,95%CI(-1.63~0.09),P=0.08).Conclusion The application of respiratory training for swallowing function of patients with stroke based on routine treatment,nursing and rehabilitation training could improve the degree of swallowing dysphagia,prevent the occurrence of respiratory complications,and improve the quality of life.However,in view of the small literature included in the study,the differences in intervention programs between studies,and the short duration of intervention,the above conclusions need to be verified by higher quality randomized controlled trials.The future research should optimize breathing training programs and conduct more rigorous study.