高压氧疗法对脑卒中后吞咽障碍疗效meta分析
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摘要
目的评价高压氧疗法对脑卒中后吞咽障碍的疗效,为有效防治脑卒中并发症提供循证医学依据。方法检索万方数据知识服务平台、中国生物医学文献数据库、PubMed数据库和Cochrane Library数据库,并辅以手工检索和文献追溯法收集2000年1月1日-2017年4月1日公开发表的关于高压氧疗法治疗脑卒中后吞咽障碍的相关文献,应用RevMan5.3软件对纳入的文献进行meta分析。结果最终纳入8篇中文文献,累计高压氧联合常规治疗组(试验组)患者324例,常规治疗组(对照组)患者316例;meta分析结果显示,试验组患者的疗效优于对照组患者(OR=5.35,95%CI=3.34～8.57);亚组分析结果显示,高压氧+常规治疗组(OR=4.18,95%CI=2.06～8.51)、高压氧+常规治疗+电刺激组(OR=6.41,95%CI=2.82～14.56)、高压氧+常规治疗+针刺组(OR=20.67,95%CI=2.42～176.42)、高压氧+常规治疗+电刺激+针刺组(OR=5.80,95%CI=2.15～15.70)患者的疗效均优于对照组患者(均P<0.001);敏感性分析和发表偏倚评估结果显示,纳入的文献不存在发表偏倚,结果较为可靠。结论高压氧疗法可提高脑卒中后吞咽障碍治愈率。
Objective To evaluate the effect of hyperbaric oxygen therapy(HOT) on post-stroke dysphagia and to provide evidence-based medical evidences for effective prevention and treatment of stroke complications. Methods We searched PubMed, Cochrane Library, Wanfang, and Chinese Biological Medical Literature for studies on hyperbaric oxygen therapy for dysphagia after stroke and published between January 1 st 2000 to April 1 st 2017 and conducted a manual retrieval for a supplementary. RevMan5.3 software was used to perform a meta-analysis. Results The meta-analysis included 8 studies published in Chinese and the studies involved 324 stroke patients with HOT and conventional therapy(test group) and 316 patients only with conventional therapy(control group). The results of the meta-analysis demonstrated that the therapeutic efficiency was better in the test group than in the control group(odds ratio [OR] = 5.35, 95% confidence interval [95% CI]: 3.34-8.57; P < 0.01). The subgroup analyses revealed that in comparison with that in the control patients,the therapeutic efficacy was significantly better in the patients with HOT plus conventional treatment(OR = 4.18, 95% CI:2.06-8.51), HOT plus conventional treatment and electrical stimulation(OR = 6.41, 95% CI: 2.82-14.56), HOT plus conventional treatment and acupuncture(OR = 20.67, 95% CI; 2.42-176.42), and HOT plus conventional treatment,electrical stimulation and acupuncture(OR = 5.80, 95% CI: 2.15-15.70)(P< 0.001 for all). No publication bias was observed for the literatures included in the study based on sensitivity analysis and publication bias assessment, indicating that the study results are reliable. Conclusion Hyperbaric oxygen therapy combined with conventional therapy can improve the cure rate of post-stroke dysphagia.
Objective To evaluate the effect of hyperbaric oxygen therapy(HOT) on post-stroke dysphagia and to provide evidence-based medical evidences for effective prevention and treatment of stroke complications. Methods We searched PubMed, Cochrane Library, Wanfang, and Chinese Biological Medical Literature for studies on hyperbaric oxygen therapy for dysphagia after stroke and published between January 1 st 2000 to April 1 st 2017 and conducted a manual retrieval for a supplementary. RevMan5.3 software was used to perform a meta-analysis. Results The meta-analysis included 8 studies published in Chinese and the studies involved 324 stroke patients with HOT and conventional therapy(test group) and 316 patients only with conventional therapy(control group). The results of the meta-analysis demonstrated that the therapeutic efficiency was better in the test group than in the control group(odds ratio [OR] = 5.35, 95% confidence interval [95% CI]: 3.34-8.57; P < 0.01). The subgroup analyses revealed that in comparison with that in the control patients,the therapeutic efficacy was significantly better in the patients with HOT plus conventional treatment(OR = 4.18, 95% CI:2.06-8.51), HOT plus conventional treatment and electrical stimulation(OR = 6.41, 95% CI: 2.82-14.56), HOT plus conventional treatment and acupuncture(OR = 20.67, 95% CI; 2.42-176.42), and HOT plus conventional treatment,electrical stimulation and acupuncture(OR = 5.80, 95% CI: 2.15-15.70)(P< 0.001 for all). No publication bias was observed for the literatures included in the study based on sensitivity analysis and publication bias assessment, indicating that the study results are reliable. Conclusion Hyperbaric oxygen therapy combined with conventional therapy can improve the cure rate of post-stroke dysphagia.
引文
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[18]黄银兰,梁繁荣,廖华强,等.563例缺血型脑卒中后吞咽障碍的相关危险因素分析[J].中华流行病学杂志,2007,28(6):601-604.
[19]Martino R,Foley N,Bhohsl S,et al.Dysphagia after stroke:incidence,diagnosis,and pulmonary complications[J].Stroke,2005,36(12):2756-2763.
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[21]张春红,王舒,郑灏泳.针刺对局灶性脑缺血大鼠脑细胞凋亡的影响[J].针灸研究,2001,26(2):102-105.
[22]李懿,屈云.高压氧治疗缺血性脑卒中的研究进展[J].中国康复,2013,28(4):302-305.
[23]周士枋.脑卒中后大脑可塑性研究及康复进展[J].中华物理医学与康复杂志,2002,24(7):437-439.
[24]殷俊,陈磊,朱少锋.高压氧联合神经电刺激疗法对颅脑外伤后神经功能的恢复作用[J].中华医学杂志,2015,95(26):2116-2118.
[25]周桂荣,刘爱萍,叶纯,等.北京门头沟中老年人群脑卒中患病现状及危险因素[J].中国公共卫生,2014,30(4):420-422.
[26]陈峰,姜宝法.青岛地区缺血性脑卒中危险因素分析[J].中国公共卫生,2010,26(11):1369-1371.
[2]王丽贤,刘金涛,齐林艳,等.唐山市40岁以上人群脑卒中危险因素现况调査[J].中国公共卫生,2008,24(3):261-263.
[3]朱卫红,黄久仪,管阳太.上海市≥50岁城镇社区居民脑卒中危险因素调查[J].中国公共卫生,2015,31(3):276-279.
[4]大西幸子,孙启良.脑卒中患者摄食-吞咽障碍的评价与训练[J].中国康复医学杂志,1997,12(3):141-143.
[5]Freed ML,Freed L,Chatbum RL,et al.Electrical stimulation for swallowing disorders caused by stroke[J].Respir Care,2001,46(5):466-474.
[6]邓景元,吴琼,彭宇,等.综合疗法治疗脑卒中后吞咽障碍的临床研究[J].西安交通大学学报:医学版,2013,34(6):835-837.
[7]Jadad AR,Moore KA,Carroll D,et al.Assessing the quality of reports of randomized clinical trails:is blinding necessary?[J].Control Clin Trials,1996,17(1):1-12.
[8]Higgins JP,Thompson SG,Deeks JJ,et al.Measuring inconsistency in meta-analyses[J].BMJ,2003,327:557-560.
[9]康德英,洪旗.如何评价Meta分析的统计分析结果[J].中国循证医学,2001(1):311-323.
[10]孔磊,谢金萍,宋献丽,等.高压氧结合吞咽功能康复训练治疗脑卒中后吞咽障碍效果观察[J].护理研究,2010,24(4):332-334.
[11]刘敏,林秋兰,黄兆民.高压氧综合治疗对脑卒中患者吞咽障碍的疗效观察[J].中国康复医学杂志,2006,21(3):243-244.
[12]刘敏,于元英,初悦美.高压氧联合吞咽功能训练治疗脑卒中后吞咽困难[J].中国康复,2012,27(3):169-170.
[13]吕铭新.低频电刺激联合高压氧对脑梗死后吞咽障碍的疗效观察[J].神经损伤与功能重建,2015,10(6):514-516.
[14]牛秀茹,王子臣,杜俊玲,等.综合康复疗法治疗脑卒中后吞咽障碍的疗效观察[J].河北医药,2009,31(6):701-702.
[15]邵金花,赵爱娟,郭丽曼.高压氧联合低频脉冲电刺激对脑梗死假性球麻痹吞咽困难的疗效观察[J].中国康复理论与实践,2010,16(6):591-592.
[16]于淑燕,王凤艳,徐建梅.早期综合康复训练联合高压氧治疗对改善脑卒中患者吞咽障碍的影响[J].国家护理学杂志,2010,29(5):649-651.
[17]张艳明.高压氧联合针灸治疗急性脑卒中后吞咽障碍效果观察[J].现代中西医结合杂志,2017,26(2):167-169.
[18]黄银兰,梁繁荣,廖华强,等.563例缺血型脑卒中后吞咽障碍的相关危险因素分析[J].中华流行病学杂志,2007,28(6):601-604.
[19]Martino R,Foley N,Bhohsl S,et al.Dysphagia after stroke:incidence,diagnosis,and pulmonary complications[J].Stroke,2005,36(12):2756-2763.
[20]孙伟平,阿依古丽·艾山,王欣华,等.115例急性脑卒中患者标准吞咽功能评估[J].中国康复理论与实践,2006,12(4):282-284.
[21]张春红,王舒,郑灏泳.针刺对局灶性脑缺血大鼠脑细胞凋亡的影响[J].针灸研究,2001,26(2):102-105.
[22]李懿,屈云.高压氧治疗缺血性脑卒中的研究进展[J].中国康复,2013,28(4):302-305.
[23]周士枋.脑卒中后大脑可塑性研究及康复进展[J].中华物理医学与康复杂志,2002,24(7):437-439.
[24]殷俊,陈磊,朱少锋.高压氧联合神经电刺激疗法对颅脑外伤后神经功能的恢复作用[J].中华医学杂志,2015,95(26):2116-2118.
[25]周桂荣,刘爱萍,叶纯,等.北京门头沟中老年人群脑卒中患病现状及危险因素[J].中国公共卫生,2014,30(4):420-422.
[26]陈峰,姜宝法.青岛地区缺血性脑卒中危险因素分析[J].中国公共卫生,2010,26(11):1369-1371.