经皮迷走神经刺激联合康复训练对脑卒中后上肢运动障碍的干预：一项系统综述
Transcutaneous Vagus Nerve Stimulation Combined with Rehabilitation Training in the Intervention of Upper Limb Movement Disorders After Stroke: A Systematic Review.
作者信息
Yan Long, Qian Yulin, Li Hong
机构信息
First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300380, People's Republic of China.
National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300380, People's Republic of China.
出版信息
Neuropsychiatr Dis Treat. 2022 Sep 16;18:2095-2106. doi: 10.2147/NDT.S376399. eCollection 2022.
INTRODUCTION
Stroke often leaves behind a wide range of functional impairments, of which limb movement disorders are more common. Approximately 85% of patients have varying degrees of upper limb motor impairment. In recent years, transcutaneous vagus nerve stimulation combined with rehabilitation training has been gradually used in the rehabilitation of upper limb motor dysfunction after stroke and appears to have some therapeutic benefits.
PURPOSE
We conducted the systematic review to evaluate the efficacy and safety of transcutaneous vagus nerve stimulation combined with rehabilitation training in the rehabilitation of upper limb motor dysfunction after stroke.
METHODS
Six databases, including PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure Database (CNKI), Wanfang Database, and China Science and Technology Journal Database (VIP), were searched for January 1, 2016 to January 30, 2022. Randomized controlled trials using TVNS combined with rehabilitation training to intervene in upper limb motor dysfunction after stroke were included, and meta-analysis was performed using Review Manager 5.4.1 software.
RESULTS
Total of 101 participants from 4 studies were included in this systematic review. These studies were evaluated using the Cochrane Review's Handbook 5.1 evaluation criteria and PEDro scores, and meta-analysis was performed on the collected data. The systematic review shows a significant effect of TVNS combined with rehabilitation training on the Upper Extremity Fugl-Meyer Score (MD=3.58, 95% CI [2.34, 4.82], P<0.00001, I2=0%), Function Independent Measure Score (MD=3.86, 95% CI [0.45, 7.27], P=0.03, I2=0%) and the Wolf Motor Function Test Score (MD=3.58, 95% CI [1.97, 5.18], P<0.0001, I2=0%).
CONCLUSION
Based on UE-FM, FIM, and WMFT scores, TVNS combined with rehabilitation training showed some improvement in upper limb motor dysfunction in post-stroke patients, but its long-term effects, stimulation sites, stimulation parameters, combined mode with rehabilitation training, and adverse effects still need further observation.
REGISTRATION
PROSPERO: CRD42022312453 (https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022312453).
引言
中风常常会遗留多种功能障碍，其中肢体运动障碍较为常见。约85%的患者存在不同程度的上肢运动功能障碍。近年来，经皮迷走神经刺激联合康复训练已逐渐应用于中风后上肢运动功能障碍的康复治疗，并显示出一定的治疗效果。
目的
我们进行了这项系统评价，以评估经皮迷走神经刺激联合康复训练对中风后上肢运动功能障碍康复的有效性和安全性。
方法
检索了6个数据库，包括PubMed、Embase、Cochrane图书馆、中国知网数据库（CNKI）、万方数据库和维普中文科技期刊数据库（VIP），检索时间为2016年1月1日至2022年1月30日。纳入使用经皮迷走神经刺激联合康复训练干预中风后上肢运动功能障碍的随机对照试验，并使用RevMan 5.4.1软件进行荟萃分析。
结果
本系统评价共纳入了4项研究中的101名参与者。这些研究采用Cochrane系统评价手册5.1的评估标准和PEDro评分进行评估，并对收集到的数据进行荟萃分析。系统评价显示，经皮迷走神经刺激联合康复训练对上肢Fugl-Meyer评分（MD = 3.58，95%CI [2.34, 4.82]，P < 0.00001，I² = 0%）、功能独立性测量评分（MD = 3.86，95%CI [0.45, 7.27]，P = 0.03，I² = 0%）和Wolf运动功能测试评分（MD = 3.58，95%CI [1.97, 5.18]，P < 0.0001，I² = 0%）有显著效果。
结论
基于上肢Fugl-Meyer评分、功能独立性测量评分和Wolf运动功能测试评分，经皮迷走神经刺激联合康复训练在中风后患者的上肢运动功能障碍方面显示出一定改善，但它的长期效果、刺激部位、刺激参数、与康复训练的联合方式以及不良反应仍需进一步观察。
注册信息
PROSPERO：CRD42022312453（https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022312453）
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