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| 呼吸肌训练对脑卒中后吞咽功能障碍疗效的Meta分析 |
| Efficacy of respiratory muscle training on swallowing dysfunction after stroke: a meta-analysis |
| 投稿时间：2024-12-20 修订日期：2024-12-20 |
| DOI： |
| 中文关键词: 脑卒中 呼吸肌训练 吞咽困难 吞咽功能 Meta分析 |
| 英文关键词: stroke respiratory muscle training dysphagia swallowing function meta-analysis |
| 基金项目:1.山东省中医药科技项目：循经点穴对脑卒中后痉挛状态的临床疗效及机制研究(No. M-2023142)；2.山东省医务职工科技创新计划项目：针刺同步康复对脑卒中后肢体功能障碍的临床疗效研究(No. SDYWZGKCJH2022024)作者单位：1. 山东中医药大学康复医学院,山东省济南市,250355；2. 山东省疾病预防控制中心,山东省济南市,250013；3. 山东中医药大学附属医院康复科,山东省济南市,250014 |
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| 中文摘要: |
| 目的 系统评价呼吸肌训练对脑卒中后吞咽功能障碍的疗效。方法 计算机检索维普、万方、中国知网、中国生物医学文献数据库以及PubMed、Embase、Web of science、Cochrane Library数据库中相关的随机对照试验,检索时限为自建库至2024年8月公开发表的中英文文献。通过Revman5.4软件进行Meta分析,采用Stata 18.0软件判断发表偏倚,并采用GRADE系统进行证据质量评价。结果 纳入23个随机对照研究,包括1233例患者。Meta分析结果表明：与常规吞咽治疗相比,试验组在临床总有效率[OR=5.24,95%CI(3.41,8.04),P＜0.001]、吞咽造影评分[MD=1.51,95%CI(1.25,1.77),P＜0.001]、标准吞咽功能评估量表[MD=-4.91,95%CI(-6.37,-3.46),P＜0.001]、渗透-误吸评估[MD=-0.87,95%CI(-1.35,-0.39),P＜0.001]、功能性经口摄食评分[MD=0.42,95%CI(0.26,0.57),P＜0.001]方面均有显著改善与提升。GRADE证据等级评价显示,临床总有效率、VFSS和FOIS证据级别为中等质量,SSA、PAS证据级别为低质量。结论 当前证据显示,呼吸肌训练能够改善脑卒中患者吞咽功能,增强吞咽肌群力量,减少误吸与呛咳的发生。 |
| 英文摘要: |
| Objective To systematically evaluate the effect of respiratory muscle training on swallowing dysfunction in stroke patients. Methods VIP, Wanfang, CNKI, China Biomedical Literature Database, PubMed, Web of Science, Embase, and Cochrane Library for relevant randomized controlled trials were searched, and the search time limit is from the establishment of the database to the publication of Chinese and English documents in August 2024. Meta-analysis was performed by Revman 5.4 software, publication bias was judged by Stata 18.0 software, and the quality of evidence was assessed by GRADE system. Results A total of 23 randomized controlled studies involving 1233 patients were included. The results of meta-analysis showed that compared with conventional swallowing treatment, the total clinical response rate [OR=5.24,95%CI(3.41,8.04),P＜0.001], swallowing contrast score [MD=1.51, 95%CI (1.25, 1.77), P<0.001], standard swallowing function evaluation scale [MD=-4.91, 95%CI (-6.37, -3.46), P<0.001], and osmo-aspiration assessment [MD=-0.87, 95%CI (-1.35, -0.39), P<0.001], and functional oral intake scale [MD=0.42, 95%CI (0.26, 0.57), P<0.001] were significantly improved. The GRADE evaluation of evidence level showed that the quality of the evidence for total clinical response rate, VFSS and FOIS was moderate, and the quality of evidence for SSA and PAS was low. Conclusion Current evidence suggests that respiratory muscle training can improve swallowing function, strengthen swallowing muscles, and reduce aspiration and choking in stroke patients. |
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