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目的系统评价重复经颅磁刺激对脑卒中患者肢体运动功能障碍的疗效。方法计算机检索Cochrane图书馆、MEDLINE、EMbase、CBM、CNKI和WanFang Data中关于重复经颅磁刺激改善脑卒中后患者肢体运动功能障碍的随机对照试验(RCT),同时追溯纳入文献的参考文献。检索时限均为从建库至2012年1月。由两名研究者按照纳入与排除标准独立进行文献筛选、资料提取和质量评价后,采用RevMan 5.0.2软件进行Meta分析,并使用GRADE系统评价证据质量。结果共纳入11个RCT,376例患者。3个低质量RCT的Meta分析结果显示,与常规康复治疗相比,2～4周重复经颅磁刺激对脑卒中患者肢体运动功能障碍的疗效更好,其差异有统计学意义[WMD=11.02,95%CI(2.56,19.47)],其余8个研究仅作相应的描述性分析。结论重复经颅磁刺激对脑卒中患者的肢体运动功能障碍的治疗效果尚不能确定。因此,在临床上应用重复经颅磁刺激治疗脑卒中患者运动功能障碍时仍需谨慎。
Objective To systematically evaluate the effect of repetitive transcranial magnetic stimulation on motor dysfunction in stroke patients. METHODS: Randomized controlled trials (RCTs) were conducted in the Cochrane Library, MEDLINE, EMbase, CBM, CNKI, and WanFang Data for improving transcranial magnetic stimulation in patients with limb motor dysfunction following stroke and were retrospectively incorporated into the literature. The search period is from the database to January 2012. Two researchers independently screened, extracted and evaluated the literature according to inclusion and exclusion criteria. Meta-analysis was performed using RevMan 5.0.2 software and the quality of evidence was evaluated using the GRADE system. Results A total of 11 RCTs and 376 patients were included. Meta-analysis of 3 low-quality RCTs showed that 2 to 4 weeks of repeated transcranial magnetic stimulation had a better effect on limb motor dysfunction in stroke patients than in conventional rehabilitation, with a statistically significant difference [WMD = 11.02 , 95% CI (2.56, 19.47)], and the remaining 8 studies only corresponded descriptively. Conclusion The effect of repeated transcranial magnetic stimulation on limb motor dysfunction in patients with stroke is yet to be determined. Therefore, the clinical application of repeated transcranial magnetic stimulation in patients with stroke dysfunction still need to be cautious.