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13種干預方案治療腦卒中吞咽困難效果的網狀Meta分析
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| 添加時間：2020-6-29 19:23:05 來源：山西職稱論文 瀏覽次數：1563 |
13種干預方案治療腦卒中吞咽困難效果的網狀Meta分析
韓春彥，趙存，王興蕾，姚麗，田金徽，張麗紅，豆欣蔓
引用本文： 韓春彥，趙存，王興蕾，姚麗，田金徽，張麗紅，豆欣蔓.13種干預方案治療腦卒中吞咽困難效果的網狀Meta分析[J].護理研究,2020,34(11):1869-1877
摘要： [目的]評價13種干預方案在腦卒中吞咽困難病人中的應用效果。[方法]計算機檢索PubMed、Cochrane Library、Web of Science、EMbase、中國生物醫學文獻數據庫(CBM)、中國知網(CNKI)、萬方數據庫(WanFang Data)中有關腦卒中吞咽困難病人康復治療的隨機對照試驗，由2名研究員獨立篩選文獻、提取資料、質量評價，對符合質量標準的研究采用GeMTC統計軟件和Stata軟件進行數據分析。[結果]共納入46項研究，涉及13種干預方案，在有效率和電視透視吞咽功能檢查(videofluroscopic swallowing study,VFSS)評分方面均顯示吞咽訓練、神經肌肉電刺激聯合吞咽訓練、神經肌肉電刺激、電針聯合吞咽康復訓練、肌電生物反饋療法聯合吞咽訓練、針灸與常規護理比較差異有統計學意義(<0.05)。腦卒中吞咽困難康復的有效率指標中，電針聯合吞咽訓練效果最好；在VFSS評分方面，神經肌肉電刺激聯合吞咽訓練的效果最好。[結論]現有證據表明，根據有效率和VFSS評分兩個指標排序概率結果，電針聯合吞咽訓練或神經肌肉電刺激聯合吞咽訓練成為最好的干預方案的可能性最大，由于電針聯合吞咽訓練更為經濟，推薦使用，同時也要結合病人病情特點選擇適宜的干預方案。
關鍵詞： 腦卒中;吞咽困難;干預方案;網狀Meta分析;有效率;VFSS評分
課題： 2018年甘肅省隴原青年創新創業人才（團隊）項目() ;蘭州市城關區科技計劃項目(2019SHFZ0019)
A network Meta⁃analysis of the effect of 13 interventions on dysphagia in stroke patients
HAN Chunyan，ZHAO Cun，WANG Xinglei，YAO Li，TIAN Jinhui，ZHANG Lihong，DOU Xinman
Abstract [Objective]To evaluate the application effect of 13 interventions in stroke patients with dysphagia by using network Meta⁃analysis.[Methods]Randomized controlled trials on rehabilitation treatment of stroke⁃associated dysphagia were retrieved from the PubMed,Cochrane Library,Web of Science,EMbase,China Biomedical Medicine Database,CNKI and WanFang Data.The screening of literature,extraction of data,and evaluation of the quality of included studies were carried out by two researchers independently.Then network Meta⁃analysis was conducted for studies meeting quality standard using software GeMTC and Stata.[Results]A total of 46 studies were included,involving 13 interventions.In terms of total effective rate and videofluroscopic swallowing study score(VFSS),there were statistically significant differences between swallowing training,neuromuscular electrical stimulation combined swallowing training,neuromuscular electrical stimulation,electroacupuncture combined with swallowing rehabilitation training,electromyography biofeedback therapy combined swallowing training,acupuncture and conventional nursing(<0.05).Among the indicators of rehabilitation efficiency rate of stroke-associated dysphagia,the treatment effect of electroacupuncture combined with swallowing training was the best.As for VFSS score,the treatment effect of neuromuscular electrical stimulation combined with swallowing training was the best.[Conclusion]Current evidence showed that,from the aspects of the efficiency and VFSS scores,the comprehensive analysis,electro⁃acupuncture combined with swallowing training or neuromuscular electrical stimulation combined swallowing training is most likely to become the best intervention program.Because electroacupuncture combined with swallowing training is more economical,it is recommended to use during period of rehabilitation.At same time it should be suggested to choose the appropriate intervention program according to the characteristics of the patient's condition.
Keywords stroke;dysphagia;interventions;network Meta⁃analysis;efficiency;VFSS scores
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