文章摘要
高世爱 ，于子夫 ，陈金慧 ，曹新燕 ，冷晓轩 ，刘西花.呼吸肌训练对脑卒中后吞咽功能障碍疗效的Meta分析[J].神经损伤功能重建,2025,(7):402-407
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: aMeta-analysis
  
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: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）；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. SDY WZGKCJH20220 24）
作者单位
高世爱1 ，于子夫2 ，陈金慧1 ，曹新燕1 ，冷晓轩1 ，刘西花3 1. 山东中医药大 学康复医学院 2. 山东省疾病预 防控制中心 3. 山东中医药大 学附属医院康复 科 
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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1 233 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%C（I 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%C（I 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:
      To systematically evaluate the efficacy of respiratory muscle training (RMT) on swallowing dysfunction after stroke. Methods: Relevant randomized controlled trials (RCTs) were searched in electronic databases including VIP, Wanfang Data, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), as well as PubMed, Embase, Web of Science, and the Cochrane Library. The search covered Chinese and English literature published from the inception of each database to August 2024. Meta-analysis was conducted using RevMan 5.4 software. Stata 18.0 software was employed to assess publication bias, and the GRADE system was used to evaluate the quality of evidence. Results: A total of 23 RCTs involving 1 233 patients were included. The Meta-analysis results demonstrated that, compared with conventional swallowing therapy, the experimental group showed significant improvements in clinical total effective rate [OR=5.24, 95% CI (3.41, 8.04), P< 0.001], videofluoroscopic swallowing study (VFSS) score [MD=1.51, 95% CI(1.25, 1.77), P< 0.001], Standardized Swallowing Assessment (SSA) score [MD=－ 4.91, 95% CI (－ 6.37, － 3.46), P<0.001], Penetration-Aspiration Scale (PAS) score [MD=－0.87, 95% CI (－1.35, －0.39), P<0.001], and Functional Oral Intake Scale (FOIS) score [MD=0.42, 95% CI (0.26, 0.57), P<0.001]. According to the GRADE evidence quality evaluation, the evidence levels for clinical total effective rate, VFSS, and FOIS were of moderate quality, while those for SSA and PAS were of low quality. Conclusion: Current evidence suggests that RMT can improve swallowing function in stroke patients, enhance the strength of swallowing muscles, and reduce the occurrence of aspiration and choking.
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