经颅直流电刺激对脑卒中患者单侧忽略康复效果的影响: 网状meta分析

doi:10.3969/j.issn.1004-583X.2024.12.001

临床荟萃 ›› 2024, Vol. 39 ›› Issue (12): 1061-1072.doi: 10.3969/j.issn.1004-583X.2024.12.001

• 循证研究 • 下一篇

经颅直流电刺激对脑卒中患者单侧忽略康复效果的影响: 网状meta分析

张琦¹^,², 孙增鑫²^,³, 赵越¹, 袁野²^,³, 秦小露²^,³, 吕红香⁴, 尹昱¹^,²^,³(), 张雅文⁵

1.华北理工大学护理与康复学院,河北唐山 063210
2.河北省人民医院康复医学科,河北石家庄 050000
3.河北省脑网络与认知障碍疾病重点实验室,河北石家庄 050000
4.临沂市中心医院康复科,山东临沂 276400
5.河北医科大学研究生院,河北石家庄 050000

收稿日期:2024-08-21 出版日期:2024-12-20 发布日期:2025-01-10
通讯作者: 尹昱,Email:yinyu-99@163.com
基金资助:
河北省中医药类科研计划课题——针刺联合经颅直流电刺激对脑卒中后偏侧忽略的康复疗效以及神经网络机制的临床研究(2021168)

Rehabilitation effect of transcranial direct current stimulation on unilateral spatial neglect in stroke patients: a network meta-analysis

Zhang Qi¹^,², Sun Zengxin²^,³, Zhao Yue¹, Yuan Ye²^,³, Qin Xiaolu²^,³, Lyu Hongxiang⁴, Yin Yu¹^,²^,³(), Zhang Yawen⁵

1. College of Nursing and Rehabilitation,North China University of Science and Technology,Tangshan 063210,China
2. Department of Rehabilitation Medicine,Hebei General Hospital,Shijiazhuang 050000,China
3. Hebei Provincial Key Laboratory of Brain Network and Cognitive Disorders,Shijiazhuang 050000,China
4. Department of Rehabilitation,Linyi Central Hospital,Linyi 4276400,China
5. Graduate School,Hebei Medical University,Shijiazhuang 050000,China

Received:2024-08-21 Online:2024-12-20 Published:2025-01-10
Contact: Yin Yu; Email: yinyu-99@163.com

摘要/Abstract

摘要：

目的采用网状meta分析比较不同刺激方式的经颅直流电刺激(transcranial direct current stimulation, tDCS)对脑卒中后单侧忽略(unilateral spatial neglect, USN)患者的康复疗效。方法计算机检索中国知网(CNKI)、万方数据知识服务平台(Wanfang Data)、维普网(VIP)、PubMed、Embase、Cochrane Library、Web of Science、ProQuest数据库中有关tDCS治疗USN的随机对照试验(RCT)和随机交叉实验(RCE),对照组采用假刺激或常规物理治疗,试验组为不同刺激方式的tDCS治疗,检索时间为建库至2024年5月。由两名研究员对文献进行筛选及数据的提取,采用RevMen5.3以及Stata14.0软件进行数据分析。结果最终纳入11篇文献,共462例患者。结果显示:多靶点刺激、阳极刺激以及阴极刺激对于提高USN患者的二等分线段测试(LBT)、星形消去测试(SCT)评分均高于对照组,阳极刺激和多靶点刺激对USN患者行为忽略测试(BIT)评分较假刺激改善明显。不同措施改善USN患者LBT评分的累积排序概率曲线下面积(SUCRA)排序结果显示:多靶点刺激(84.4%)>阳极刺激(82.4%)>阴极刺激(77.8%)>双通道刺激(76.3%)>假刺激(52.5%)>双通道刺激联合物理治疗(30.3%)>阳极联合物理治疗(22.7%)>多靶点刺激联合物理治疗(17.9%)>物理治疗(5.8%),提高SCT评分的SUCRA排序结果显示:多靶点刺激(67.1%)>阳极刺激(66.7%)>双通道刺激(56.0%)>阳极刺激联合物理治疗(47.7%)>阴极刺激(43.2%)>假刺激(41.6%)>多靶点刺激联合物理治疗(27.7%),降低BIT评分的SUCRA排序结果显示:多靶点刺激(99.7%)>阳极刺激联合物理治疗(61.1%)>多靶点刺激联合物理治疗(59.8%)>阳极刺激(59.4%)>假刺激(20.0%)>阴极刺激联合物理治疗(0.0%)。结论现有证据表明,在假刺激及常规对照的基础上,多靶点刺激和阳极刺激改善脑卒中患者USN的效果优于阴极刺激以及各种刺激联合物理治疗。受所纳入的试验的数量和质量限制,上述结果仍需谨慎采用,未来还需要引用更多更高质量的研究进一步验证。

关键词: 卒中, 单侧忽略, 经颅直流电刺激, 康复, Meta分析

Abstract:

Objective To compare the rehabilitation efficacy of transcranial direct current stimulation (tDCS) with different stimulation modes on unilateral spatial neglect (USN) in post-stroke patients with unilateral spatial neglect (USN) by a network meta-analysis. Methods Randomized controlled trials (RCTs) and randomized cross-over experiments (RCEs) reporting post-stroke patients with USN were searched in CNKI, Wanfang Data, VIP, PubMed, Embase, Cochrane Library, Web of Science, and ProQuest databases. The search time was from the establishment of the database to May 2024. Patients in the control group were given sham stimulation or conventional physical therapy, and those in the experimental group were treated with tDCS via different stimulation methods. Two researchers screened the literature and extracted the data. RevMen5.3 and Stata 14.0 software were used for data analysis. Results Eleven studies representing 462 patients were included. The results showed that the Line Bisection Test (LBT) and the Star Cancellation Test (SCT) scores after multi-target stimulation, anodic stimulation and cathodic stimulation were significantly higher in the experimental group than those of the control group. The Behavioral Inattention Test (BIT) score in post-stroke patients with USN was significantly improved by the anodic and multi-target stimulation in comparison to the cathodic stimulation. The largest surface under the cumulative ranking curve (SUCRA) of stimulation modes in improving the LBT score in post-stroke patients with USN was observed in multi-target stimulation (84.4%), followed by anodic stimulation (82.4%), cathodic stimulation (77.8%), dual-channel stimulation (76.3%), sham stimulation (52.5%), dual-channel stimulation combined with physical therapy (30.3%), anode combined with physical therapy (22.7%), multi-target stimulation combined with physical therapy (17.9%) and physical therapy (5.8%). The largest SUCRA of stimulation modes in improving the SCT score in post-stroke patients with USN was observed in the multi-target stimulation (67.1%), followed by anodic stimulation (66.7%), dual-channel stimulation (56.0%), anodic stimulation combined with physical therapy (47.7%), cathodic stimulation (43.2%), sham stimulation (41.6%), and multi-target stimulation combined with physical therapy (27.7%). The largest SUCRA of stimulation modes in lowering the BIT score in post-stroke patients with USN was observed in the multi-target stimulation (99.7%), followed by anodic stimulation combined with physical therapy (61.1%), multi-target stimulation combined with physical therapy (59.8%), anodic stimulation (59.4%), sham stimulation (20.0%) and cathodic stimulation combined with physical therapy (0.0%). Conclusion The available evidence shows that on the basis of sham stimulation and conventional control, multi-target stimulation and anodic stimulation are better than cathodic stimulation and various stimulation combined with physical therapy in improving USN in post-stroke patients. Due to the quantitative and qualitative limitations of the included trials, these results still need to be used with caution, and more and higher-quality studies need to be cited for further validation in the future.

Key words: stroke, unilateral spatial neglect, transcranial direct current stimulation, rehabilitation, meta-analysis

中图分类号:

R743

张琦, 孙增鑫, 赵越, 袁野, 秦小露, 吕红香, 尹昱, 张雅文. 经颅直流电刺激对脑卒中患者单侧忽略康复效果的影响: 网状meta分析[J]. 临床荟萃, 2024, 39(12): 1061-1072.

Zhang Qi, Sun Zengxin, Zhao Yue, Yuan Ye, Qin Xiaolu, Lyu Hongxiang, Yin Yu, Zhang Yawen. Rehabilitation effect of transcranial direct current stimulation on unilateral spatial neglect in stroke patients: a network meta-analysis[J]. Clinical Focus, 2024, 39(12): 1061-1072.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2024.12.001

https://huicui.hebmu.edu.cn/CN/Y2024/V39/I12/1061

图/表 11

参考文献 47

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纳入研究	国家	样本量 (EG/CG)	年龄 (岁)	干预措施(CG/EG)	刺激强度	干预时长	结局指标
Zhao等^[18] 2023	中国	10(10/10)	42~63	假刺激(阳极置于右侧顶叶皮层,阴极置于左侧肩膀)/单靶点刺激(阳极置于右侧顶叶皮层,阴极置于对侧肩膀)/多靶点刺激(阳极依次置于右侧顶下小叶、右侧颞中回和右侧前额叶,阴极置于对侧肩膀)	2mA	5次/周,共3周	①②③
Sunwoo等^[19] 2013	韩国	10(10/10)	37~81	假刺激(阳极置于右侧后顶叶皮层,阴极置于左侧眶上缘)/单通道刺激(阳极置于右侧后顶叶皮层,阴极置于左侧眶上缘)/双通道刺激(阳极置于右侧后顶叶皮层,阴极置于左侧后顶叶皮层)	1mA	共4次	①
Bang等^[20]2015	韩国	6/6	60~72	阳极tDCS联合物理治疗(阳极置于右侧后顶叶皮层,阴极置于左侧眶上缘联合反馈训练)/物理治疗(反馈训练)	1mA	5次/周,共3周	①
Ladavas等^[21] 2015	意大利	11(11/8)	59~80	假刺激联合物理治疗(5例阴极置于左侧后顶叶皮层,阳极置于右侧眶上缘,6例阳极置于右侧后顶叶皮层,阴极置于左眶上缘联合棱镜训练)/阳极联合物理治疗(阳极置于右侧后顶叶皮层,阴极置于左侧眶上联合棱镜训练)/阴极联合物理治疗(阴极置于左侧后顶叶皮层,阳极置于右侧眶上缘联合棱镜训练)	2mA	5次/周,共2周	③
毛阗睿^[22] 2019	中国	12/12	26~75	假刺激(阳极置于右侧后顶叶皮层,阴极置于左侧眶上缘)/阳极tDCS(阳极置于右侧后顶叶皮层,阴极置于左侧眶上缘)	1.6mA	5次/周,共2周	①②
姜春静等^[23] 2021	中国	10/10	37~78	假刺激(阳极置于右侧后顶叶皮层,阴极置于左侧眶上缘)/阳极tDCS(阳极置于右侧后顶叶皮层,阴极置于左侧眶上缘)	1mA	5次/周,共2周	①
易琼等^[24] 2022	中国	41/41	42~86	假刺激联合物理治疗(阳极置于右侧后顶叶后部,阴极置于左侧肩部联合高压氧)/阳极tDCS联合物理治疗(阳极置于右侧后顶叶后部,阴极置于左侧肩部联合高压氧)	1.4mA	5次/周,共4周	①
成帅等^[25] 2022	中国	30(30/30)	20~80	假刺激联合物理治疗(阳极置于右侧顶下小叶,阴极置于左侧肩部联合针刺)/单部位刺激联合物理治疗(阳极置于右侧顶下小叶,阴极置于左侧肩部联合针刺)/多部位刺激联合物理治疗(阳极依次置于右侧顶下小叶、颞上回、前额叶,阴极置于左侧肩部联合针刺)	未交代	5次/周,共3周	①②
Yi等^[26] 2016	韩国	10(10/10)	39~82	假刺激[阳极置于右侧后顶叶皮层,阴极置于中央点(Cz区)]/阳极tDCS[阳极置于右侧后顶叶皮层,阴极置于中央点(Cz区)]/阴极tDCS[阴极置于左侧后顶叶皮层,阳极置于中央点(Cz区)]	2mA	5次/周,共3周	①②
王雅楠等^[27] 2019	中国	15/15		假刺激(阳极置于右侧后顶叶皮层,阴极置于左侧肩部)/阳极tDCS刺激(阳极置于右侧后顶叶皮层,阴极置于左侧肩部)	1.4mA	5次/周,共4周	①
甄巧霞等^[28] 2018	中国	15/15	34~72	假刺激联合物理治疗(阳极置于右侧顶叶皮质,阴极置于左侧顶叶皮质联合认知训练)/双极刺激联合物理治疗(阳极置于右侧顶叶皮质,阴极置于左侧顶叶皮质联合认知训练)	1mA	5次/轴,共4周	①

纳入研究	国家	样本量 (EG/CG)	年龄 (岁)	干预措施(CG/EG)	刺激强度	干预时长	结局指标
Zhao等^[18] 2023	中国	10(10/10)	42~63	假刺激(阳极置于右侧顶叶皮层,阴极置于左侧肩膀)/单靶点刺激(阳极置于右侧顶叶皮层,阴极置于对侧肩膀)/多靶点刺激(阳极依次置于右侧顶下小叶、右侧颞中回和右侧前额叶,阴极置于对侧肩膀)	2mA	5次/周,共3周	①②③
Sunwoo等^[19] 2013	韩国	10(10/10)	37~81	假刺激(阳极置于右侧后顶叶皮层,阴极置于左侧眶上缘)/单通道刺激(阳极置于右侧后顶叶皮层,阴极置于左侧眶上缘)/双通道刺激(阳极置于右侧后顶叶皮层,阴极置于左侧后顶叶皮层)	1mA	共4次	①
Bang等^[20]2015	韩国	6/6	60~72	阳极tDCS联合物理治疗(阳极置于右侧后顶叶皮层,阴极置于左侧眶上缘联合反馈训练)/物理治疗(反馈训练)	1mA	5次/周,共3周	①
Ladavas等^[21] 2015	意大利	11(11/8)	59~80	假刺激联合物理治疗(5例阴极置于左侧后顶叶皮层,阳极置于右侧眶上缘,6例阳极置于右侧后顶叶皮层,阴极置于左眶上缘联合棱镜训练)/阳极联合物理治疗(阳极置于右侧后顶叶皮层,阴极置于左侧眶上联合棱镜训练)/阴极联合物理治疗(阴极置于左侧后顶叶皮层,阳极置于右侧眶上缘联合棱镜训练)	2mA	5次/周,共2周	③
毛阗睿^[22] 2019	中国	12/12	26~75	假刺激(阳极置于右侧后顶叶皮层,阴极置于左侧眶上缘)/阳极tDCS(阳极置于右侧后顶叶皮层,阴极置于左侧眶上缘)	1.6mA	5次/周,共2周	①②
姜春静等^[23] 2021	中国	10/10	37~78	假刺激(阳极置于右侧后顶叶皮层,阴极置于左侧眶上缘)/阳极tDCS(阳极置于右侧后顶叶皮层,阴极置于左侧眶上缘)	1mA	5次/周,共2周	①
易琼等^[24] 2022	中国	41/41	42~86	假刺激联合物理治疗(阳极置于右侧后顶叶后部,阴极置于左侧肩部联合高压氧)/阳极tDCS联合物理治疗(阳极置于右侧后顶叶后部,阴极置于左侧肩部联合高压氧)	1.4mA	5次/周,共4周	①
成帅等^[25] 2022	中国	30(30/30)	20~80	假刺激联合物理治疗(阳极置于右侧顶下小叶,阴极置于左侧肩部联合针刺)/单部位刺激联合物理治疗(阳极置于右侧顶下小叶,阴极置于左侧肩部联合针刺)/多部位刺激联合物理治疗(阳极依次置于右侧顶下小叶、颞上回、前额叶,阴极置于左侧肩部联合针刺)	未交代	5次/周,共3周	①②
Yi等^[26] 2016	韩国	10(10/10)	39~82	假刺激[阳极置于右侧后顶叶皮层,阴极置于中央点(Cz区)]/阳极tDCS[阳极置于右侧后顶叶皮层,阴极置于中央点(Cz区)]/阴极tDCS[阴极置于左侧后顶叶皮层,阳极置于中央点(Cz区)]	2mA	5次/周,共3周	①②
王雅楠等^[27] 2019	中国	15/15		假刺激(阳极置于右侧后顶叶皮层,阴极置于左侧肩部)/阳极tDCS刺激(阳极置于右侧后顶叶皮层,阴极置于左侧肩部)	1.4mA	5次/周,共4周	①
甄巧霞等^[28] 2018	中国	15/15	34~72	假刺激联合物理治疗(阳极置于右侧顶叶皮质,阴极置于左侧顶叶皮质联合认知训练)/双极刺激联合物理治疗(阳极置于右侧顶叶皮质,阴极置于左侧顶叶皮质联合认知训练)	1mA	5次/轴,共4周	①

经颅直流电刺激对脑卒中患者单侧忽略康复效果的影响: 网状meta分析

Rehabilitation effect of transcranial direct current stimulation on unilateral spatial neglect in stroke patients: a network meta-analysis

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