神经肌肉电刺激治疗脑卒中后吞咽障碍临床疗效的Meta分析
The effectiveness of surface neuromuscular electrical stimulation for relieving post-stroke dysphagia: A meta-analysis of randomized and controlled trials

目的 评价神经肌肉电刺激治疗脑卒中后吞咽障碍的疗效,为临床治疗和进一步研究提供参考依据。 方法 计算机检索Cochrane library、Pubmed、Embase、CINAHL、Pro Quest、Psyc ARTICLES、中国知网数据库、中国生物医学文献数据库、维普中文科技期刊全文数据库、万方数据库中有关神经肌肉电刺激治疗脑卒中后吞咽障碍临床疗效的随机对照试验文献，同时筛检纳入文献的参考文献，检索时限为建库至2017年7月30日。由2名研究员按照纳入和排除标准筛选文献、评价质量、提取资料和合并数据，采用RevMan 5.3版软件对文献进行Meta分析。 结果 共纳入11篇随机对照试验文献，共计576例患者。Meta分析结果表明，在有效性上，神经肌肉电刺激联合吞咽训练的疗效优于单纯的吞咽训练，差异具有统计学意义(P<0.01)，但并不能缩短咽传递时间(P>0.05)；在安全性上，神经肌肉电刺激联合吞咽训练可降低发生误吸的风险，差异具有统计学意义(P<0.01)；且神经肌肉电刺激联合吞咽训练可改善生活质量（P<0.01）。 结论 神经肌肉电刺激联合吞咽训练可改善脑卒中后吞咽障碍患者的吞咽功能和生活质量，并降低发生误吸的风险，且目前尚证据表明神经肌肉电刺激联合吞咽训练可缩短咽传递时间。
Objective To evaluate the effectiveness of swallowing training supplemented with neuromuscular electrical stimulation to provide a reference for clinical treatment and further study. Methods Reports of randomized and controlled trials of surface neuromuscular electrical stimulation in treating post-stroke dysphagia were sought in the Cochrane library, the PubMed and Embase databases, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and also in the ProQuest, PsycARTICLES, CBMdisc, China National Knowledge Infrastructure (CNKI), CQVIP database and Wanfang databases. All of the literature found was evaluated by 2 researchers according to predefined inclusion and exclusion criteria and the data were extracted and combined. Then meta-analysis was performed using version 5.3 of the RevMan software package. Results Eleven randomized and controlled trials involving 576 patients were included in the meta-analysis. Together, the data showed that swallowing training supplemented by neuromuscular electrical stimulation is significantly more effective than swallowing training alone in improving swallowing function. It reduces the risk of aspiration and improves quality of life. It does not, however, generally shorten the pharyngeal transmit time. Conclusions Swallowing training supplemented with neuromuscular electrical stimulation is a promising approach for treatment of post-stroke dysphagia and warrants further study