Wang Yuhan, Xu Lu, Wang Linjia, Jiang Minjiao, Zhao Ling
Acupuncture and Moxibustion College, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China.
Gastroenterology Department, Yongchuan Traditional Chinese Medicine Hospital Affiliated to Chongqing Medical University, Chongqing, China.
Front Neurol. 2023 May 9;14:1163045. doi: 10.3389/fneur.2023.1163045. eCollection 2023.
Dysphagia is one of the common complications after stroke. It is closely related to lung infection and malnutrition. Neuromuscular electrical stimulation (NMES) is widely used in the treatment of post-stroke dysphagia, but the evidence-based medical evidence of NMES is limited. Therefore, this study aimed to evaluate the clinical efficacy of NMES in patients with post-stroke dysphagia by systematic review and meta-analysis.
We searched the CNKI, Wanfang, VIP, SinoMed, PubMed, Embase, Cochrane Library, and Web of Science databases for all randomized controlled trials (RCTs) of NMES in the treatment of post-stroke dysphagia from the establishment of the database to 9 June 2022. The risk of bias assessment tool recommended by Cochrane and the GRADE method was used to assess the risk of bias and the quality of evidence. RevMan 5.3 was used for statistical analysis. Sensitivity and subgroup analyses were performed to evaluate the intervention effect more specifically.
A total of 46 RCTs and 3,346 patients with post-stroke dysphagia were included in this study. Our meta-analysis showed that NMES combined with routine swallowing therapy (ST) could effectively improve swallowing function in Penetration-Aspiration Scale (MD = -0.63, 95% CI [-1.15, -0.12], = 0.01), Functional Oral Intake Scale (MD = 1.32, 95% CI [0.81, 1.83], < 0.00001), Functional Dysphagia Scale (MD = - 8.81, 95% CI [-16.48, -1.15], = 0.02), the Standardized Swallowing Assessment (MD = -6.39, 95% CI [-6.56, -6.22], < 0.00001), the Videofluoroscopic Swallow Study (MD = 1.42, 95% CI [1.28, 1.57], < 0.00001) and the Water swallow test (MD = -0.78, 95% CI [-0.84, -0.73], < 0.00001). Furthermore, it could improve the quality of life (MD = 11.90, 95% CI [11.10, 12.70], < 0.00001), increase the upward movement distance of hyoid bone (MD = 2.84, 95% CI [2.28, 3.40], < 0.00001) and the forward movement distance of hyoid bone (MD = 4.28, 95% CI [3.93, 4.64], < 0.00001), reduce the rate of complications (OR = 0.37, 95%CI [0.24, 0.57], < 0.00001). Subgroup analyses showed that NMES+ST was more effective at 25 Hz, 7 mA or 0-15 mA, and at courses ( ≤ 4 weeks). Moreover, patients with an onset of fewer than 20 days and those older than 60 years appear to have more positive effects after treatment.
NMES combined with ST could effectively increase the forward and upward movement distance of the hyoid bone, improve the quality of life, reduce the rate of complications, and improve the swallowing function of patients with post-stroke dysphagia. However, its safety needs to be further confirmed.
https://www.crd.york.ac.uk/PROSPERO, identifier: CRD42022368416.
吞咽困难是中风后常见的并发症之一。它与肺部感染和营养不良密切相关。神经肌肉电刺激（NMES）广泛应用于中风后吞咽困难的治疗，但NMES的循证医学证据有限。因此，本研究旨在通过系统评价和荟萃分析评估NMES对中风后吞咽困难患者的临床疗效。
我们检索了中国知网、万方、维普、中国生物医学文献数据库、PubMed、Embase、Cochrane图书馆和Web of Science数据库，以获取从数据库建立至2022年6月9日所有关于NMES治疗中风后吞咽困难的随机对照试验（RCT）。采用Cochrane推荐的偏倚风险评估工具和GRADE方法评估偏倚风险和证据质量。使用RevMan 5.3进行统计分析。进行敏感性和亚组分析以更具体地评估干预效果。
本研究共纳入46项RCT和3346例中风后吞咽困难患者。我们的荟萃分析表明，NMES联合常规吞咽治疗（ST）可有效改善渗透-误吸量表（MD = -0.63，95%CI[-1.15，-0.12]，P = 0.01）、功能性经口摄食量表（MD = 1.32，95%CI[0.81，1.83]，P < 0.00001）、功能性吞咽困难量表（MD = -8.81，95%CI[-16.48，-1.15]，P = 0.02）、标准化吞咽评估（MD = -6.39，95%CI[-6.56，-6.22]，P < 0.00001）、电视荧光吞咽造影检查（MD = 1.42，95%CI[1.28，1.57]，P < 0.00001）和饮水试验（MD = -0.78，95%CI[-0.84，-0.73]，P < 0.00001）的吞咽功能。此外，它可改善生活质量（MD = 11.90，95%CI[11.10，12.70]，P < 0.00001），增加舌骨向上移动距离（MD = 2.84，95%CI[2.28，3.40]，P < 0.00001）和舌骨向前移动距离（MD = 4.28，95%CI[3.93，4.64]，P < 0.00001），降低并发症发生率（OR = 0.37，95%CI[0.24，0.57]，P < 0.00001）。亚组分析表明，NMES+ST在25Hz、7mA或0-15mA以及疗程（≤4周）时更有效。此外，发病少于20天的患者和60岁以上的患者治疗后似乎有更积极的效果。
NMES联合ST可有效增加舌骨向前和向上移动距离，改善生活质量，降低并发症发生率，改善中风后吞咽困难患者的吞咽功能。然而，其安全性需要进一步证实。
