重复经颅磁刺激治疗脑卒中后吞咽障碍疗效的Meta分析

Efficacy of Repetitive Transcranial Magnetic Stimulation on Post-Stroke Dysphagia: A Me⁃ ta-analysis

目的:系统评价不同频率的重复经颅磁刺激(rTMS)刺激不同部位对不同分期卒中后吞咽障碍(PSD)的疗效,以及rTMS对改善患者吞咽相关生活质量的影响。方法:检索国内外数据库中采用rTMS治疗PSD的随机对照试验,根据Cochrane手册5.1.0版评价纳入文献的质量,采用RevMan5.3进行数据分析。结果:共纳入17篇,629例样本。Meta分析结果显示:在脑卒中恢复期,rTMS较常规吞咽治疗能够更明显改善PSD患者的吞咽功能(P<0.05);高频双侧、高频健侧和低频健侧rTMS治疗均能有效地改善脑PSD患者的吞咽功能(P<0.05);rTMS对改善PSD患者吞咽相关生活质量无明显作用(P>0.05)。结论:脑卒中恢复期的高频双侧、高频健侧和低频健侧的rTMS治疗PSD的疗效较好,但对吞咽相关功能障碍的生活质量改善不明显。

Objective:A Meta-analysis was conducted to investigate the effect of repetitive transcranial magnet-ic stimulation(rTMS)on post-stroke dysphagia(PSD),with different frequencies and stimulation locations,and on the improvement of swallowing-related quality of life.Methods:Multiple electronic databases were searched for randomized controlled trials which met the included standards.Cochrane handbook 5.1.0 and Rev-Man 5.3 software were separately used for the quality evaluation and Meta-analysis.Results:A total of 17 arti-cles with 629 patients were included.The results had shown that rTMS could more effectively improve PSD than that of the conventional swallowing therapy in convalescent stage(P<0.05),high-frequency rTMS on bilat-eral sides or unaffected side and low-frequency rTMS on unaffected side could effectively improve PSD(P<0.05).And rTMS had no significant effect on improving the swallowing-related quality of life in the patients with PSD(P>0.05).Conclusion:In convalescent stage,high-frequency rTMS on bilateral sides or unaffected side and low-frequency rTMS on unaffected side could effectively improve PSD,but there was no significant im-provement in the swallowing-related quality of life in PSD patients.