综合康复疗法治疗脑卒中后肩手综合症的Meta分析

发布时间：2018-05-27 22:01

本文选题：综合康复疗法 + 肩手综合征　；参考：《北京体育大学》2014年硕士论文

【摘要】：目的：肩手综合征是脑卒中后常见的并发症之一。本病常用的治疗手段为药物。综合康复疗法具有缓解手浮肿、皮肤温度升高的作用,可以从局部和整体治疗。此方法无副作用且疗效显著,因此被称为绿色疗法。对大量的文献进行检索发现,现代循证医学在研究问题上使用的较少,为了对综合康复疗法治疗肩手综合征的疗效进行分析及评价,本研究采用Meta分析法对综合康复疗法治疗本病临床文献做回顾性分析,以达到较为客观的评价综合康复疗法治疗本病的临床疗效且为今后使用综合康复疗法治疗本病提供可靠的依据。结果：本文通过对1990年-2012年在国内各类期刊杂志中发表的综合康复疗法治疗肩手综合征临床RCT(随机对照试验)进行研究,在对大量的文献筛选过程中使用了Jadad评分,分析使用的是Review Manager4.2处理软件。对符合本研究文献要求的17篇文献进行Meta分析,在经过JADAD评分后发现,国内研究者没有严格的按照Cochrane协作组织给出的文献纳入的标准来对文献进行筛选,因此,今后在对纳入文献的方面要严格的按照Cochrane协作组织给出的标准纳入文献。根据干预措施不同,可以分为三组来进行分析,所用文献15篇,分析结果显示：1、综合康复疗法结合常规的药物治疗疗效优势比(OR)值为8.60,95%的置信区间为[4.77,15.51],P0.05,差异有统计学意义。2、针灸结合常规康复训练疗效优势比值(OR)为8.83,95%的置信区间为[5.93,13.14],P0.05差异有统计学意义3、综合康复疗法结合常规康复训练疗效优势比值(OR)4.65,95%的置信区间为[2.58,8.40],P0.05差异有统计学意义。由于另外两篇的干预措施不同,故不作Meta分析。结论：综合康复疗法治疗肩手综合征是有效的；综合康复疗法与常规药物治疗结合的疗效优于单纯使用常规药物治疗、综合康复疗法与常规康复训练结合优于单纯使用康复训练、针灸疗法与常规康复训练的结合优于单纯使用常规康复训练。综合康复训练仍然是需要大样本、多中心、高标准的临床随机对照试验以补充说明。
[Abstract]:Objective: shoulder-hand syndrome is one of the common complications after stroke. The commonly used treatment for this disease is medicine. Comprehensive rehabilitation therapy has the effect of relieving hand swelling and increasing skin temperature, and can be treated locally and as a whole. This method has no side effects and is effective, so it is called green therapy. In order to analyze and evaluate the curative effect of comprehensive rehabilitation therapy on shoulder-hand syndrome, a large number of literatures have been searched and found that modern evidence-based medicine is less used in research. In this study, Meta analysis was used to review the clinical literature of comprehensive rehabilitation therapy for this disease. Objective to evaluate the clinical efficacy of comprehensive rehabilitation therapy and to provide reliable basis for the future use of comprehensive rehabilitation therapy for the treatment of this disease. Results: the clinical RCT (randomized controlled trial) of comprehensive rehabilitation therapy for shoulder and hand syndrome, published in various domestic journals from 1990 to 2012, was studied, and Jadad scores were used in the screening of a large number of literatures. The analysis uses Review Manager4.2 processing software. Through Meta analysis of 17 articles that meet the requirements of this study, it is found that the domestic researchers did not screen the literature strictly according to the criteria of literature inclusion given by the Cochrane collaboration organization after the JADAD score. In the future, we should strictly follow the standards given by the Cochrane collaboration organization to include the literature. According to the intervention measures, we can divide them into three groups to analyze them. The results showed that the odds ratio of comprehensive rehabilitation therapy combined with routine drug therapy was 8.6095% (P 0.05), the difference was statistically significant (P < 0.01), and the odds ratio of acupuncture and routine rehabilitation training was 8.83% (P < 0.05). There was significant difference (P < 0.05) between two groups (P < 0.05). There was significant difference between two groups (P < 0.05). The confidence interval of comprehensive rehabilitation therapy combined with conventional rehabilitation training was 4.6595% (P < 0.05). Meta analysis was not performed because of the different interventions in the other two articles. Conclusion: comprehensive rehabilitation therapy is effective in the treatment of shoulder-hand syndrome, and the combination of comprehensive rehabilitation therapy and routine drug therapy is better than that of simple conventional drug therapy. The combination of comprehensive rehabilitation therapy and routine rehabilitation training is better than that of simple use of rehabilitation training, and the combination of acupuncture therapy and routine rehabilitation training is better than that of simple routine rehabilitation training. Comprehensive rehabilitation training continues to require large, multicenter, high-standard randomized controlled trials to supplement the description.
【学位授予单位】：北京体育大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.3

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