文章摘要
田沛 ，范荣富 ，胡雪艳 ，赵国伟.盐酸替扎尼定联合康复训练治疗脑卒中后肌痉挛疗效的 Meta分析[J].神经损伤功能重建,2024,(11):648-654
盐酸替扎尼定联合康复训练治疗脑卒中后肌痉挛疗效的 Meta分析
Meta-analysis of the Efficacy of Tizanidine Hydrochloride Combined with RehabilitationTraining in the Treatment of Muscle Spasm after Sroke
  
DOI：
中文关键词: 脑卒中  肌痉挛  盐酸替扎尼定  康复训练  Meta分析
英文关键词: stroke  muscle spasm  Tizanidine hydrochloride  rehabilitation training  Meta-analysis
基金项目:
作者单位
田沛a ，范荣富b ，胡雪艳c ，赵国伟a 中国康复研究中心 北京博爱医院 a. 药 剂科，b. 普外科，c. 神经康复一科 
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中文摘要:
      目的：系统性评价盐酸替扎尼定联合康复训练治疗脑卒中后肌痉挛的临床疗效。方法：在中国知网 数据库、万方数据库、维普数据库、Pubmed、Web of Science、Embase 和 Cochrane Library数据库中检索盐酸 替扎尼定治疗卒中后肌痉挛的随机对照试验（RCTs），检索时间从建库至 2022 年 9 月。对符合纳入标准 的研究采用RevMan 5.4软件进行Meta分析。结果：共纳入9项随机对照试验（n=683）。Meta分析结果显示， 替扎尼定联合康复训练组 MAS 评分[WMD=－0.22，95%CI －0.29～－0.14，P＜0.00001]和 MBI 评分 [WMD=2.68，95%CI 0.10～5.27，P=0.04]明显优于对照组，但FMA评分[WMD=2.14，95%CI －0.33～4.61，P= 0.09]与对照组无差异。在不同对照干预措施的亚组分析中，相比于单纯康复训练，替扎尼定可有效缓解脑 卒中后患者肌痉挛[MAS 评分：WMD=－0.38，95%CI －0.48～－0.27，P＜0.00001；CSI 评分：WMD=－2.61， 95%CI －3.30～－1.92，P＜0.00001]，提高 ADL 能力[MBI 评分：WMD=10.48，95%CI 8.20～12.75，P＜ 0.00001]，但在运动障碍的改善上无明显优势[FMA评分：WMD=4.55，95%CI－1.03～10.13，P=0.11]。相比 对照药物巴氯芬、乙哌立松，替扎尼定组MAS评分[WMD=－0.06，95%CI －0.16～0.05，P=0.31]、FMA 评 分[WMD=0.82，95%CI －0.31～1.96，P=0.16]、MBI 评分[WMD=0.27，95%CI －0.77～1.32，P=0.61]和临床 有效率[WMD=2.07，95%CI 0.97～4.43，P=0.06]均与对照组无差异。替扎尼定的不良反应的发生率低于巴 氯芬[WMD=0.51，95%CI 0.30～0.88，P=0.02]，但与乙哌立松没有差异[WMD=1.37，95%CI 0.52～3.57，P= 0.53]。结论：盐酸替扎尼定联合康复训练较单纯康复训练能有效改善脑卒中后患者肌肉痉挛，提高患者日 常生活能力，与其他口服抗痉挛药物疗效相当，安全性较好。
英文摘要:
      To systematically evaluate the effect of tizanidine hydrochloride combined with rehabilitation training in the treatment of muscle spasm after stroke. Methods: Randomized controlled trials of tizanidine hydrochloride in the treatment of muscle spasm after stroke were searched from China National Knowledge Intemet(CNKI), Wanfang Data medicalinformation system(WF), VIP database, Pubmed, Web of Science, Embase and Cochrane Library databases from the establishment to September 2022. Meta-analysis of the studies that met the inclusion criteria was performed using RevMan 5.4. Results: Nine studies involving 683 patients were included. The results of Meta-analysis showed that the modified Ashworth Scale(MAS) score (WMD=－0.22, 95% CI －0.29～－0.14, P<0.00001) and modified Barthel Index(MBI) score (WMD=2.68, 95%CI 0.10～5.27, P=0.04) in the treatment group were better than those in the control group, but there was no difference in the Fugl-Meyer assessment(FMA) score [WMD=2.14, 95% CI － 0.33～4.61, P=0.09]. In subgroup analysis of different control interventions, compared with rehabilitation training alone, tizanidine can effectively relieve muscle spasm (MAS score: WMD=－0.38, 95%CI －0.48～－0.27, P<0.00001；CSI score: WMD=－2.61, 95%CI －3.30～－1.92, P<0.00001) after stroke and improve the activies of daily living(ADL) (MBI score：WMD=10.48, 95% CI 8.20～12.75, P<0.00001), but has no obvious advantage in improving movement disorders (FMA score：WMD=4.55，95% CI －1.03～10.13, P=0.11). There was no difference in MAS score[WMD=－0.06，95%CI －0.16～0.05, P=0.31), FMA score[WMD=0.82，95%CI (－0.31, 1.96), P= 0.16], MBI score[WMD=0.27，95%CI －0.77～1.32, P=0.61) and clinical effective rate[WMD=2.07, 95%CI 0.97～4.43, P=0.06) between the treatment group(Tizanidine) and the control drug group(Baclofen and Eperisone).The incidence of adverse reactions of tizanidine was lower than that of Baclofen(WMD=0.51，95% CI 0.30～0.88, P=0.02), but not different from eperisone (WMD=1.37, 95% CI 0.52～3.57, P=0.53). Conclusion: Compared with rehabilitation training alone, tizanidine combined with rehabilitation training can effectively reduce muscle tone and improve daily living ability of patients after stroke, while the efficacy is comparable to other oral antispasticity drugs, and the safety is better.
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