经颅磁改善脑卒中患者下肢运动功能和日常生活能力的Meta分析

Transcranial Magnetic Field Improves Motor Function and Activities of Daily Living in Stroke Patients:A Meta Analysis

目的系统分析经颅磁刺激(TMS)治疗对脑卒中患者下肢运动功能和日常生活能力的改善作用。方法检索中国知网、生物医学、万方、维普、Pubmed、Embase、Cochrane共7个数据库,时间限定为建库开始至2020年8月;将检索到的文献导入Endnote软件管理并筛选出符合要求的文献,将提取的数据导入Rev Man 5.3软件进行系统分析,并统计分析意外事件的发生情况,分析TMS治疗的安全性。结果最终纳入14篇符合要求的文献。Meta分析运动功能量表(下肢部分)(FMA)和日常生活能力量表(MBI) 2个结局指标;治疗后脑卒中患者下肢FMA量表评分高于治疗前[MD=3.52,95%CI(1.71,5.34)],治疗后患者MBI评分高于治疗前[MD=9.29,95%CI(6.32,12.25)];可有效降低患者下肢肌张力,在纳入分析的14篇文献中有8篇文献涉及了安全性分析,2.3%患者发生了轻微的不适反应,而且都无需特殊处理,经过休息都可以缓解。结论 TMS可以有效改善脑卒中患者的下肢运动功能和日常生活能力,其疗效安全,不良事件发生极少而且轻微。TMS治疗可显著提高患者的日常生活能力。

Objective To systematically analyze the effect of transcranial magnetic stimulation(TMS)on motor function and activities of daily living(ADL)of stroke patients.Methods 7 databases including CNKI,biomedicine,Wanfang,VIP,PubMed,EMBASE and Cochrane were searched from the beginning of database establishment to August 2020.The retrieved literatures were imported into endnote software for management,and the eligible literatures were screened out,and the extracted data were imported into Revman 5.3 software system analysis.The occurrence of accidents and safety of TMS treatment were statistically analyzed.Result 14 eligible literatures were included.2 outcome indicators of the motor function scale(lower extremity part)(FMA)and the ability of daily living(MBI)were conducted by Meta-analysis.The rTMS before and after treatment can significantly improve the FMA score and MBI score of stroke patients[MD=3.52,95%CI(1.71,5.34)],[MD=9.29,95%CI(6.32,5.34),12.25].Among the 14 literatures included in the analysis,8 of them involved in the safety analysis,and only 2.3%patients had mild discomfort reaction,and did not need special treatment and could be relieved after rest.Conclusion The existing reports show that the TMS can effectively improve the motor function of lower limbs and activities of daily living of stroke patients,and its curative effect is safe,and the occurrence of adverse events is rare and mild.However,the number and quality of the literature included in this study is limited,which still needs to be further verified by multi center,large sample and more rigorous clinical research.