Li Lili, Li Fei, Zhang Xinyin, Song Yuying, Li Shuyan, Yao Huiping
Emergency and Critical Care Center, Intensive Care Unit, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China.
Front Neurol. 2024 Jul 31;15:1403594. doi: 10.3389/fneur.2024.1403594. eCollection 2024.
While electrical stimulation has been demonstrated to improve medical research council (MRC) scores in critically ill patients, its effectiveness remains a subject of debate. This meta-analysis aimed to discuss recent insights into the effectiveness of electrical stimulation in improving muscle strength and its effects on different clinical outcomes in critically ill adults.
A comprehensive search of major electronic databases, including PubMed, Cochrane Library, and Embase, was conducted from inception to June 15, 2024, to identify randomized controlled trials (RCTs) that evaluated the effects of electrical stimulation in critically ill patients. The analysis focused on comparing electrical stimulation to standard care, sham interventions, or placebo. Outcomes of interest included MRC scores, duration of mechanical ventilation (MV), mortality rate, and intensive care unit (ICU) and hospital length of stay (LOS).
A total of 23 RCTs, including 1798 patients, met the inclusion criteria. The findings demonstrated a significant benefit of electrical stimulation over usual care in enhancing global muscle strength, as measured by MRC scores (MD =3.62, 95% CI 0.94 to 6.30, = 0.0008, I = 87%). While subgroup analysis of electrical muscle stimulation (EMS) demonstrated no significant effect on ICU LOS, sensitivity analysis indicated a potential reduction in ICU LOS for both EMS (MD = -11.0, 95% CI -21.12 to -0.88, = 0.03) and electrical stimulation overall (MD = -1.02, 95% CI -1.96 to -0.08, = 0.03) compared to the control group. In addition, sensitivity analysis suggested that both electrical stimulation (MD = -2.38, 95% CI -3.81 to -0.94, = 0.001) and neuromuscular electrical stimulation (NMES) specifically (MD = -2.36, 95% CI -3.85 to -0.88, = 0.002) may contribute to a decrease in hospital LOS. No statistically significant differences were observed in mortality or duration of MV.
Electrical stimulation appears to be an effective intervention for improving MRC scores in critically ill patients. However, further research is warranted to explain the potential effects of electrical stimulation on hospital LOS and ICU LOS.
虽然电刺激已被证明可提高重症患者的医学研究委员会（MRC）评分，但其有效性仍存在争议。本荟萃分析旨在探讨电刺激在改善重症成年患者肌肉力量方面的有效性及其对不同临床结局的影响的最新见解。
对主要电子数据库进行全面检索，包括PubMed、Cochrane图书馆和Embase，检索时间从建库至2024年6月15日，以识别评估电刺激对重症患者影响的随机对照试验（RCT）。分析重点是将电刺激与标准护理、假干预或安慰剂进行比较。感兴趣的结局包括MRC评分、机械通气（MV）持续时间、死亡率以及重症监护病房（ICU）和住院时间（LOS）。
共有23项RCT（包括1798例患者）符合纳入标准。研究结果表明，用电刺激改善整体肌肉力量方面，相较于常规护理有显著益处，以MRC评分衡量（MD = 3.62，95%CI 0.94至6.30，P = 0.0008，I² = 87%）。虽然肌肉电刺激（EMS）的亚组分析显示对ICU住院时间无显著影响，但敏感性分析表明，与对照组相比，EMS（MD = -11.0，95%CI -21.12至-0.88，P = 0.03）和总体电刺激（MD = -1.02，95%CI -1.96至-0.08，P = 0.03）均有可能缩短ICU住院时间。此外，敏感性分析表明，电刺激（MD = -2.38，95%CI -3.81至-0.94，P = 0.001）和神经肌肉电刺激（NMES）（MD = -2.36，95%CI -3.85至-0.88，P = 0.002）均可能有助于缩短住院时间。在死亡率或MV持续时间方面未观察到统计学显著差异。
电刺激似乎是改善重症患者MRC评分的有效干预措施。然而，有必要进行进一步研究以解释电刺激对住院时间和ICU住院时间的潜在影响。
