综合吞咽训练对卒中相关性肺炎影响效果的Meta分析
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摘要
目的评价综合吞咽训练对卒中相关性肺炎的影响效果。方法计算机检索PubMed、中国生物医学文献服务系统(CBM)、维普数据库(VIP)和中国期刊全文数据库(CNKI) 4个数据库中关于综合吞咽训练对卒中相关性肺炎影响效果的随机对照试验(RCT)研究,检索期限为建库至2018年3月31日。由2名研究员依据纳入和排除标准分别进行文献筛选、资料提取、质量评价,然后运用Rev Man5.3软件对纳入数据进行整合并行Meta分析。结果纳入随机对照试验研究共9篇,共计994例患者。Meta分析结果提示,综合吞咽训练组与常规吞咽训练组相比可以减少卒中相关性肺炎(SAP)的发生率[RR=0.42,95%CI(0.31,0.56),P<0.001];能够改善患者吞咽困难评分[SMD=-1.22,95%CI(-1.44,-0.99),P<0.001];并可以提高吞咽困难患者疗效[RR=1.22,95%CI(1.13,1.32),P<0.001]。结论实施综合吞咽训练干预措施较常规吞咽训练更能降低患者SAP的发生率,改善患者的吞咽功能评分,提高吞咽困难患者的临床疗效。
Objective To evaluate the effect of comprehensive swallowing training on the strokeassociated pneumonia. Methods A computer-based search of PubMed,CBM,VIP and CNKI was conducted for randomized controlled trials (RCTs) for the effect of comprehensive swallowing trainings on the incidence of post-stroke-associated pneumonia. The search period was from the establishment of the database to March 31,2018. Two researchers screened the literatures according to the inclusion and exclusion criteria. They extracted the data,evaluated the quality,and then used Rev Man5.3 software to perform Meta analysis or only descriptive analysis. Results A total of 994 patients were included in 9 RCTs. The results of Meta analysis showed that the incidence of SAP in the comprehensive swallowing training group was significantly lower than that in the conventional swallowing training group [RR = 0.42,95% CI (0.31,0.56),P< 0.001]. The score of dysphagia was improved [SMD =-1.25,95%CI(-1.48,-1.01),P<0.001],and the curative effect of the patients with dysphagia was increased [RR = 1. 22,95% CI (1. 13,1. 32),P < 0. 001]. Conclusion The intervention of comprehensive swallowing training can reduce the incidence of SAP,improve the score of swallowing function and improve the clinical efficacy of dysphagia.
Objective To evaluate the effect of comprehensive swallowing training on the strokeassociated pneumonia. Methods A computer-based search of PubMed,CBM,VIP and CNKI was conducted for randomized controlled trials (RCTs) for the effect of comprehensive swallowing trainings on the incidence of post-stroke-associated pneumonia. The search period was from the establishment of the database to March 31,2018. Two researchers screened the literatures according to the inclusion and exclusion criteria. They extracted the data,evaluated the quality,and then used Rev Man5.3 software to perform Meta analysis or only descriptive analysis. Results A total of 994 patients were included in 9 RCTs. The results of Meta analysis showed that the incidence of SAP in the comprehensive swallowing training group was significantly lower than that in the conventional swallowing training group [RR = 0.42,95% CI (0.31,0.56),P< 0.001]. The score of dysphagia was improved [SMD =-1.25,95%CI(-1.48,-1.01),P<0.001],and the curative effect of the patients with dysphagia was increased [RR = 1. 22,95% CI (1. 13,1. 32),P < 0. 001]. Conclusion The intervention of comprehensive swallowing training can reduce the incidence of SAP,improve the score of swallowing function and improve the clinical efficacy of dysphagia.
引文
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2 Ji R,Shen H,Pan Y,et al.Novel risk score to predict pneumonia after acute ischemic stroke[J].Stroke,2013,44(5):1303-1309.
3 Sproson L,Pownall S,Enderb E,et al.Combined electrical stimulation and exercise for swallow rehabilitation post-stroke:a pilot randomized control trial[J].Int J Lang Commun Disord,2018,53(2):405-417.
4 Higgins J,Green S.Cochrane Handbook for Systemtic Reviews of Interventions Version 5.1.0[EB/OL].[2015-08-01].http://handbook.cochrane.org/1.
5曹清莲,王桂荣,吕义荣,等.运动想象疗法在脑卒中吞咽障碍患者康复护理中的应用[J].护理学杂志,2014,29(1):13-15.
6程富香,陈恬.针刺廉泉穴治疗卒中后吞咽困难疗效观察[J].中国针灸,2014,34(7):627-630.
7刘波,张芳,刘亚川,等.针刺结合雷火灸以及吞咽功能障碍治疗仪治疗脑卒中慢性期吞咽障碍的研究[J].现代中西医结合杂志,2016,25(16):1722-1725.
8李坤彬,姚先丽,李坤霞.冰刺激联合康复训练治疗卒中后吞咽困难的疗效观察[J].中华全科医学,2014,12(5):685-687.
9丁玲,汤显靖,杨小飞.吞咽治疗仪联合电针治疗卒中后吞咽障碍对卒中相关性肺炎发生率的影响[J].卒中与神经疾病,2013,20(1):39-41.
10金小红.吞咽治疗仪配合综合康复护理治疗脑卒中吞咽障碍患者的效果观察[J].护理实践与研究,2017,14(19):22-23.
11吴灵君,王亚静.运动想象联合电刺激在脑卒中后吞咽障碍患者康复中的应用[J].中国现代护理杂志,2015,21(34):4155-4157.
12 Carnaby G,Hankey GJ,Pizzi J.Behavioural inervention for dysphagia in acute stroke:a randomised controlled trail[J].Lancet Neurol,2006,5(1):31-37.
13 Kim HD,Choi JB,Yoo SJ,et al.Tongue-to-palate resistance training improves tongue strength and oropharyngeal swallowing function in subacute stroke survivors with dysphagia[J].J Oral Rehabil,2017,44(1):59-64.
14周志梅,罗秀忠.康复训练和吞咽治疗仪治疗卒中后吞咽障碍的疗效分析[J].中国实用神经疾病杂志,2011,22(24):54-55.
15 Warms T,Champion R,Mortensen L.The Paramatta hospital's assessment of dysphagia[J].Aust Commun Q,1990,11:25-26.
16 Devereux RB,Alonso DR,Lutas EM,et al.Echocardiographic assessment of left ventricular hyperthrophy:compaison to necropsy findings[J].Am J Cardiol,1986,57(5):450-458.
2 Ji R,Shen H,Pan Y,et al.Novel risk score to predict pneumonia after acute ischemic stroke[J].Stroke,2013,44(5):1303-1309.
3 Sproson L,Pownall S,Enderb E,et al.Combined electrical stimulation and exercise for swallow rehabilitation post-stroke:a pilot randomized control trial[J].Int J Lang Commun Disord,2018,53(2):405-417.
4 Higgins J,Green S.Cochrane Handbook for Systemtic Reviews of Interventions Version 5.1.0[EB/OL].[2015-08-01].http://handbook.cochrane.org/1.
5曹清莲,王桂荣,吕义荣,等.运动想象疗法在脑卒中吞咽障碍患者康复护理中的应用[J].护理学杂志,2014,29(1):13-15.
6程富香,陈恬.针刺廉泉穴治疗卒中后吞咽困难疗效观察[J].中国针灸,2014,34(7):627-630.
7刘波,张芳,刘亚川,等.针刺结合雷火灸以及吞咽功能障碍治疗仪治疗脑卒中慢性期吞咽障碍的研究[J].现代中西医结合杂志,2016,25(16):1722-1725.
8李坤彬,姚先丽,李坤霞.冰刺激联合康复训练治疗卒中后吞咽困难的疗效观察[J].中华全科医学,2014,12(5):685-687.
9丁玲,汤显靖,杨小飞.吞咽治疗仪联合电针治疗卒中后吞咽障碍对卒中相关性肺炎发生率的影响[J].卒中与神经疾病,2013,20(1):39-41.
10金小红.吞咽治疗仪配合综合康复护理治疗脑卒中吞咽障碍患者的效果观察[J].护理实践与研究,2017,14(19):22-23.
11吴灵君,王亚静.运动想象联合电刺激在脑卒中后吞咽障碍患者康复中的应用[J].中国现代护理杂志,2015,21(34):4155-4157.
12 Carnaby G,Hankey GJ,Pizzi J.Behavioural inervention for dysphagia in acute stroke:a randomised controlled trail[J].Lancet Neurol,2006,5(1):31-37.
13 Kim HD,Choi JB,Yoo SJ,et al.Tongue-to-palate resistance training improves tongue strength and oropharyngeal swallowing function in subacute stroke survivors with dysphagia[J].J Oral Rehabil,2017,44(1):59-64.
14周志梅,罗秀忠.康复训练和吞咽治疗仪治疗卒中后吞咽障碍的疗效分析[J].中国实用神经疾病杂志,2011,22(24):54-55.
15 Warms T,Champion R,Mortensen L.The Paramatta hospital's assessment of dysphagia[J].Aust Commun Q,1990,11:25-26.
16 Devereux RB,Alonso DR,Lutas EM,et al.Echocardiographic assessment of left ventricular hyperthrophy:compaison to necropsy findings[J].Am J Cardiol,1986,57(5):450-458.