A型肉毒素治疗卒中后上肢痉挛疗效的Meta分析

发布时间：2018-04-22 07:22

本文选题：卒中 + 上肢痉挛　；参考：《中国脑血管病杂志》2017年02期

【摘要】：目的系统评价A型肉毒素治疗卒中后上肢痉挛的临床疗效。方法计算机检索Pub Med、EMbase、Cochrane Library、CBM、中国知网(CNKI)和万方数据库。搜集A型肉毒素结合康复训练与常规康复治疗卒中后上肢痉挛疗效比较的随机对照试验或两组病例对照研究,检索时限均从建库至2016年9月1日。由至少2名评价员按纳入与排除标准进行文献筛查、资料提取和质量评价。利用Cochrane协作网提供的Rev-Man 5.3软件进行Meta分析。结果共检出相关文献356篇,最终11篇文献符合纳入标准,改良Jadad评分显示9篇文献在4分以上,属高质量文献。11篇文献共含614例患者,其中肉毒素治疗组316例,对照组298例。Meta分析结果显示,肉毒素治疗组在Fugl-Meyer评分[标准化均数差(SMD)=0.94,95%CI:0.75~1.12]、改良Ashworth评分(SMD=-1.59,95%CI:-1.78~-1.40)及改良Barthel指数(SMD=0.86,95%CI:0.65~1.08)方面均优于对照组,差异均有统计学意义(均P0.05),两组不良事件发生率(RR=1.06,95%CI:0.78~1.45)相似,差异无统计学意义(P0.05)。结论 A型肉毒素治疗卒中后上肢痉挛疗效确切,安全性高,配合适当的康复训练,能够有效地改善患者肢体运动功能、肌肉紧张状态及生活质量。
[Abstract]:Objective to evaluate the clinical efficacy of botulinum toxin A (Botulinum toxin A) in the treatment of upper limb spasm after stroke. Methods Pub Medsite EMbase Cochrane Library CBM (CNKI) and Wanfang database were searched. A randomized controlled trial or two case-control studies were conducted to compare the efficacy of Botulinum toxin A combined with rehabilitation training and conventional rehabilitation in the treatment of post-stroke upper limb spasm. The retrieval time was from the establishment of the bank to September 1, 2016. Literature screening, data extraction and quality evaluation were performed by at least 2 evaluators according to inclusion and exclusion criteria. The Meta analysis is carried out by using the Rev-Man 5.3 software provided by the Cochrane Cooperative Network. Results A total of 356 articles were identified, 11 of which met the inclusion criteria. The improved Jadad score showed that 9 articles were above 4 points, which belonged to the high quality literature. 11 articles included 614 patients, including 316 cases in the botulinum toxin treatment group, and 316cases in the botulinum toxin treatment group, and 316cases in the botulinum toxin treatment group. The results of meta analysis of 298 cases in the control group showed that the botulinum toxin treatment group was superior to the control group in terms of Fugl-Meyer score (standardized mean difference: 0.94% CI: 0.75 / 1.12), modified Ashworth score (SMD-1.59% 95 CIW -1.40) and modified Barthel index (0.8695 CIW 0.65C 1.08). The difference was statistically significant (all P 0.05, the incidence of adverse events in the two groups was 1.06%), and there was no significant difference between the two groups in the incidence of adverse events (CI: 0.78 / 1.45). There was no significant difference in the incidence of adverse events between the two groups (P < 0.05). Conclusion Botulinum toxin A is effective and safe in the treatment of post-stroke upper limb spasm. Combined with proper rehabilitation training, Botox A can effectively improve the limb motor function, muscle tension and quality of life of the patients.
【作者单位】：武汉大学中南医院康复医学科;
【分类号】：R743.3

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