功能性电刺激改善脑卒中偏瘫患者上肢功能的Meta分析

doi:10.3969/j.issn.1006-9771.2020.03.006

摘要/Abstract

摘要：

目的评价功能性电刺激改善脑卒中偏瘫患者上肢功能的效果。方法计算机检索PubMed、EMBASE、Web of Science、Cochrane临床试验数据库、中国知网、万方数据库、CBM、维普数据库,收集功能性电刺激改善脑卒中偏瘫患者上肢功能的随机对照试验,对纳入的研究进行质量评价并提取相关数据,采用RevMan5.3软件进行Meta分析。结果共纳入13个随机对照试验,共744例患者。功能性电刺激组改善脑卒中偏瘫患者上肢的运动功能显著优于常规组(MD = 9.77, 95%CI 6.36~13.17, P < 0.001)。亚组分析显示,干预4周以上(MD = 13.42, 95%CI 8.43~18.41, P < 0.001)或以下(MD = 5.82, 95%CI 2.58~9.06, P < 0.001),干预30 min以下(MD = 9.78, 95%CI 6.26~13.29, P < 0.001)或45 min以上(MD = 14.20, 95%CI 0.99~27.40, P < 0.05),均可改善患者上肢运动功能。功能性电刺激组提高脑卒中偏瘫患者日常生活活动能力的效果显著优于常规组(MD = 13.72, 95%CI 11.60~15.84, P < 0.001)。结论对脑卒中偏瘫患者上肢进行功能性电刺激干预,有助于进一步提高患者上肢运动功能和日常生活活动能力,建议临床推广使用。

关键词: 脑卒中, 偏瘫, 功能性电刺激, 上肢, Meta分析

Abstract:

Objective To investigate the effect of functional electrical stimulation on upper-limb function in stroke patients with hemiplegia. Methods Randomized controlled trials about functional electrical stimulation on upper-limb function in stroke patients with hemiplegia were recalled from databases of PubMed, EMBASE, Web of Science, Cochrane, CNKI, Wanfang data, CBM and VIP. The quality of the trials was evaluated and the data were extracted. Data were analyzed with RevMan 5.3. Results A total of 13 trials involving 744 patients were included. Functional electrical stimulation group could improve upper-limb motor function more compared with routine rehabilitation group (MD = 9.77, 95%CI 6.36 to 13.17, P < 0.001), whatever less than 30 minutes a time (MD = 9.78, 95%CI 6.26 to 13.29, P < 0.001) or more than 45 minutes a time (MD = 14.20, 95%CI 0.99 to 27.40, P < 0.05), for less than four weeks (MD = 5.82, 95%CI 2.58 to 9.06, P < 0.001) or more (MD = 13.42, 95%CI 8.43 to 18.41, P < 0.001). Functional electrical stimulation group also improved the activities of daily living for stroke patients (MD = 13.72, 95%CI 11.60 to 15.84, P < 0.001). Conclusion Functional electrical stimulation is effective on upper-limb motor function and activities of daily living for stroke patients with hemiplegia, which could be widely applied in clinic.

Key words: stroke, hemiplegia, functional electrical stimulation, upper limb, meta analysis

中图分类号:

R743.3

张悦琪,赵梦娟,赵春善. 功能性电刺激改善脑卒中偏瘫患者上肢功能的Meta分析[J]. 《中国康复理论与实践》, 2020, 26(3): 295-300.

ZHANG Yue-qi,ZHAO Meng-juan,ZHAO Chun-shan. Effect of Functional Electrical Stimulation on Upper-limb Function in Stroke Patients with Hemiplegia: A Meta-analysis[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2020, 26(3): 295-300.

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文献	国家	样本量	干预措施		干预时间	干预疗程	结局指标
文献	国家	T/C	T	C	干预时间	干预疗程	结局指标
Khan等(2019)	印度	20/20	FES+理疗	理疗	每次30 min,3次/周	4周	FMA-UE、BI
Josdottir等(2017)	意大利	32/36	肌电FES+传统康复	传统康复	每次45 min,5次/周	5~6周	FMA-UE
Marquez-Chin等(2017)	加拿大	10/11	FES+常规康复	常规康复	每日45 min,5次/周	12~16周	FMA-UE
翟凤娟 (2015)	中国	54/54	控制型FES+常规康复	常规康复	每次30 min,1次/d	4周	FMA-UE
任海等(2014)	中国	20/20	FES+常规康复	常规康复	每次30 min,1次/d	3周	FMA-UE、BI
耿尚勇等(2014)	中国	28/25	FES+常规康复	常规康复	每次30 min,1次/d	6周	FMA-UE、BI
罗金维(2011)	中国	60/60	FES+常规康复	常规康复	每次30 min,1次/d	12周	FMA-UE
林子玲等(2010)	中国	19/18	FES+常规康复	常规康复	每次30 min,1次/d	3周	FMA-UE、BI
Chan等(2009)	中国	10/10	FES+常规康复	常规康复+假刺激	每次20 min	15 d	FMA-UE
Thrasher等 (2008)	美国	10/11	FES	常规康复	每次45 min,5次/周	12~16周	FMA-UE、BI
Alon等(2007)	美国	7/7	FES+常规康复	常规康复	每次30 min	12周	FMA-UE
刘忠良等(2005)	中国	58/58	FES+常规康复	常规康复	每次30 min,2次/d	7~15周	FMA-UE
方华等(2004)	中国	43/43	FES+常规康复	常规康复	每次20 min,1次/d	-	FMA-UE、BI