咽部电刺激治疗脑卒中后吞咽障碍的Meta 分析

Pharyngeal Electrical Stimulation for Post-stroke Dysphagia: AMeta-analysis

目的综合评价咽部电刺激治疗脑卒中后吞咽障碍的疗效。方法计算机检索Cochrane Library、Embase、EBSCO、PubMed、Web of Science、中国生物医学文献数据库、维普信息资源系统、中国知网和万方医学数据库中咽部电刺激治疗脑卒中后吞咽障碍的随机对照试验(RCT),检索时限为建库到2020年6月,进行文献质量评价,采用RevMan 5.3软件进行Meta分析。结果共纳入5项RCT研究,包括325例患者。咽部电刺激在吞咽障碍严重程度评定量表评分(SMD=-0.27,95%CI-0.53^-0.01,P=0.04)和拔管率(RR=4.69,95%CI 2.02~10.87,P<0.001)方面有效,但在功能性经口摄食量表评分(SMD=0.24,95%CI-0.32~0.79,P=0.40)、渗漏-误吸量表评分(MD=-0.18,95%CI-0.74~0.39,P=0.54)和住院时间(SMD=-0.16,95%CI-0.42~0.11,P=0.25)方面与对照治疗无显著性差异。结论咽部电刺激能改善卒中后吞咽障碍患者的吞咽功能,提高鼻饲拔管率,但在经口摄食、减少误吸和住院时间方面尚需进一步研究。

Objective To evaluate the effect of pharyngeal electrical stimulation(PES)on post-stroke dysphagia.Methods Randomized controlled trial(RCT)about pharyngeal electrical stimulation for dysphagia after stroke were searched in Coehrane Library,Embase,EBSCO,PubMed,Web of Science,CBM,VIP,CNKI and Wanfang Data until June,2020.The literature quality was evaluated,and the data were analyzed with RevMan 5.3.Results Five RCTs were returned,including 325 patients.PES was more effective in improvement of Dysphagia Severity Rating Scale scores(SMD=-0.27,95%CI-0.53 to-0.01,P=0.04)and decannulation rate(RR=4.69,95%CI 2.02 to 10.87,P<0.001);however,there was no significant difference in Functional Oral Intake Scale scores(SMD=0.24,95%CI-0.32 to 0.79,P=0.40),Penetration-Aspiration Scale scores(MD=-0.18,95%CI-0.74 to 0.39,P=0.54)and length of stay(SMD=-0.16,95%CI-0.42 to 0.11,P=0.25)between PES and control.Conclusion Pharyngeal electrical stimulation can improve the swallowing function and enhance decannulation rate for post-stroke dysphagia,while it is uncertain for functional oral intake,risk of aspiration and length of stay.