神经肌肉电刺激结合吞咽训练治疗脑卒中后吞咽障碍疗效性的Meta分析

Meta analysis of the efficacy of neuromuscular electrical stimulation combined with swallowing training in the treatment of dysphagia after stroke

目的采用Meta分析评估神经肌肉电刺激联合吞咽训练治疗脑卒中后吞咽障碍的疗效。方法分别在中国生物医学文献服务系统(CBM)、中国知网(CNKI)、万方知识数据服务平台(Wanfang Data)、维普网(VIP)、PubMed、Embase和Cochrane Library中检索近10年(2011年1月1日至2021年12月31日)文献。纳入文献后,采用RevMan5.3和Stata15.0提取文献数据并分析。结果纳入14篇文献,共1038位患者。Meta分析显示,临床疗效的二分类数据评分[相对危险度(relative risk,RR)=1.27,95%置信区间(confidence interval,CI):1.20~1.34,P<0.001]、洼田饮水试验的有序型数据评分[比值比(odds ratio,OR)=2.796,95%CI:–1.696~4.609,P<0.05]、洼田饮水试验的连续型数据评分[均数差(mean difference,MD)=–0.84,95%CI:–1.07~–0.60,P<0.05]、藤氏连续型数据评分(MD=1.45,95%CI:1.18~1.71,P<0.05)、吞咽造影检查连续型数据评分(MD=2.64,95%CI:2.38~2.89,P<0.05)。结论与单纯吞咽训练相比,神经肌肉电刺激联合吞咽训练治疗脑卒中后吞咽障碍的疗效更好。

Objective Meta–analysis is used to evaluate the efficacy of neuromuscular electrical stimulation combined with swallowing training for post–stroke swallowing disorders.Methods Documents were searched in CBM,CNKI,Wanfang,VIP,PubMed,Embase and Cochrane Library for last 10 years(2011.1.1 to 2021.12.31).After selecting the literature,the literature data was extracted and analyzed using RevMan 5.3 and Stata 15.0.Results A total of 14 references involving 1038 patients were included.Meta–analysis showed that neuromuscular electrical stimulation combined with swallowing training therapy was more effective than swallowing training alone.Specifically reflected in:the clinical efficacy of the two classification of data score(RR=1.27,95%CI:1.20–1.34,P<0.001),orderly type data score of Watian drinking water test(OR=2.796,95%CI:1.696–4.609,P<0.05),score of continuous type data of Watian drinking water test(MD=–0.84,95%CI:–1.07––0.60,P<0.05),score of continuous type data of Ichiro Fujishima(MD=1.45,95%CI:1.18–1.71,P<0.05),score of continuous type data of video fluoroscopic swallow study(VFSS)(MD=2.64,95%CI:2.38–2.89,P<0.05).Conclusion Compared with swallowing training alone,neuromuscular electrical stimulation combined with swallowing training has a better treatment for post–stroke swallowing disorders.