摘要
背景 肩手综合征是脑卒中患者致残的主要因素之一,严重影响患者身心健康及生活质量.目前,治疗脑卒中后肩手综合征的非药物干预方式众多,但临床上优选何种非药物治疗方式尚有一定困扰.目的 使用网状Meta分析评价 7 种非药物治疗方式改善脑卒中后肩手综合征疗效、疼痛视觉模拟评分(VAS)及简式肢体运动功能量表(FMA)评分的差异,为临床决策提供循证支持.方法 计算机检索中国知网、万方数据知识服务平台、维普网、中国生物医学文献服务系统、PubMed、Embase、Cochrane Library数据库中有关非药物治疗脑卒中后肩手综合征的随机对照试验,检索时间设定为建库至 2023 年 6 月.由 2 名研究员根据研究设计独立筛查文献与数据提取,使用RevMan 5.3、Stata 15.0 软件进行网状Meta分析.结果 共纳入 62 项研究,共 5 090 例患者,干预措施包含针灸疗法、中药熏蒸疗法、体外冲击波疗法、艾灸疗法、热敷疗法、电刺激疗法、中药泡洗疗法.网状Meta分析结果显示:7 种非药物治疗方式在改善肩手综合征患者总有效率、FMA评分方面均优于对照组(P<0.05);除艾灸疗法外,6 种非药物治疗方式在改善肩手综合征患者VAS评分方面均优于对照组(P<0.05).7 种非药物治疗方式改善总有效率的累积排序概率图下面积(SUCRA)依次为:针灸疗法(86.1%)>中药泡洗疗法(77.1%)>中药熏蒸疗法(54.7%)>体外冲击波疗法(53.1%)>热敷疗法(49.0%)>电刺激疗法(48.4%)>艾灸疗法(31.1%)>常规对照治疗(0.4%).7 种非药物治疗方式改善VAS评分的SUCRA依次为:热敷疗法(81.3%)>中药泡洗疗法(78.4%)>针灸疗法(76.7%)>电刺激疗法(58.4%)>中药熏蒸疗法(52.7%)>体外冲击波疗法(32.9%)>艾灸疗法(18.1%)>常规对照治疗(1.5%).7种非药物治疗改善FMA评分的SUCRA依次为:中药泡洗疗法(90.6%)>针灸疗法(83.5%)>中药熏蒸疗法(59.9%)>电刺激疗法(59.8%)>体外冲击波疗法(42.3%)>艾灸疗法(39.7%)>热敷疗法(24.1%)>常规对照治疗(0.2%).结论 与常规治疗相比,使用或联合非药物治疗方式在治疗脑卒中后肩手综合征的疗效更佳,由于受到原始研究限制,以上结论仍需开展更多临床试验以期论证.
Abstract
Background Shoulder-hand syndrome is one of the major disabling factors for stroke patients,which seriously affects their physical and psychological health as well as their quality of life.Currently,there are many non-pharmacologic treatments used to treat post-stroke shoulder-hand syndrome,but there is still some confusion about which non-pharmacologic treatment modality is more effective in clinical practice.Objective To provide evidence-based support for clinical decision-making,this network meta-analysis evaluates the efficacy of seven non-pharmacological treatments in improving outcomes for post-stroke shoulder-hand syndrome,pain as measured by the Visual Analogue Scale(VAS),and scores on the simplified Fugl-Meyer Assessment(FMA).Methods A computerized search of databases including CNKI,Wanfang Data,VIP,China Biomedical Literature Service System,PubMed,Embase,and Cochrane Library was conducted for randomized controlled trials on non-pharmacological treatments for post-stroke shoulder-hand syndrome up to June 2023.Two researchers independently screened the literature and extracted data,performing the network meta-analysis using RevMan 5.3 and Stata 15.0.Results The analysis included 62 studies involving 5 090 patients,assessing interventions such as acupuncture,herbal fumigation,extracorporeal shockwave therapy,moxibustion,herbal hot compress,electrical stimulation,and herbal soak.Results showed that all seven non-pharmacological treatments were superior to the control group in improving overall effectiveness,and FMA scores(P<0.05).Except for moxibustion,the six non-pharmacological treatments were superior to the control group in improving VAS scores in patients with shoulder hand syndrome(P<0.05).In terms of improving overall effectiveness,the cumulative ranking probability area(SUCRA)scores for the treatments were:acupuncture(86.1%),herbal soak(77.1%),herbal fumigation(54.7%),extracorporeal shockwave(53.1%),hot compress(49.0%),electrical stimulation(48.4%),and moxibustion(31.1%),with conventional control treatment at(0.4%).For VAS score improvement,the SUCRA scores were:hot compress(81.3%),herbal soak(78.4%),acupuncture(76.7%),electrical stimulation(58.4%),herbal fumigation(52.7%),extracorporeal shockwave(32.9%),moxibustion(18.1%),and conventional control(1.5%).For FMA score improvement,the SUCRA scores were:herbal soak(90.6%),acupuncture(83.5%),herbal fumigation(59.9%),electrical stimulation(59.8%),extracorporeal shockwave(42.3%),moxibustion(39.7%),hot compress(24.1%),and conventional control(0.2%).Conclusion Compared to conventional treatments,the use or combination of non-pharmacological treatments yields better therapeutic outcomes for treating post-stroke shoulder-hand syndrome.However,due to limitations in the original studies,these conclusions need to be substantiated by further clinical trials.
基金项目
国家自然科学基金(81904180)
湖南省自然科学基金(2023JJ50035)
湖南省自然科学基金(2024JJ8124)
湖南省卫生健康委科研项目(B202319018677)
湖南省中医药科研项目(A2024001)
湖南省社会科学成果评审委员会项目(XSP2023FXC066)
湖南省社会科学成果评审委员会项目(XSP24YBC413)
维普
万方数据