中国组织工程研究

中国组织工程研究 ›› 2025, Vol. 29 ›› Issue (24): 5224-5236.doi: 10.12307/2025.683

• 组织构建循证医学 evidence-based medicine in tissue construction • 上一篇    下一篇

不同电磁刺激方案改善脑卒中后吞咽障碍的网状Meta分析

胡  通1，李  萱1，袁  静2，王  伟3   

  1. 1山东中医药大学康复医学院，山东省济南市  250300；2齐鲁医药学院康复医学院，山东省淄博市  255300；3海军青岛特勤疗养中心，山东省青岛市  266071


  • 收稿日期:2024-07-02 接受日期:2024-08-13 出版日期:2025-08-28 发布日期:2025-02-05
  • 通讯作者: 王伟，医学博士，副主任医师，硕士生导师，海军青岛特勤疗养中心，山东省青岛市 266071
  • 作者简介:胡通，男，2002年生，江苏省宿迁市人，汉族，山东中医药大学在读硕士，主要从事运动和神经康复研究。
  • 基金资助:
    军队保健专项课题(20BJZ08)，项目负责人：王伟；海军特勤人员伤病康复功能实验室建设项目

Different electromagnetic stimulation programs improve post-stroke dysphagia: a network Meta-analysis

Hu Tong1, Li Xuan1, Yuan Jing2, Wang Wei3   

  1. 1Rehabilitation Medical College of Shandong University of Traditional Chinese Medicine, Jinan 250300, Shandong Province, China; 2School of Rehabilitation Medicine, Qilu Medical University, Zibo 255300, Shandong Province, China; 3Navy Qingdao Special Service Rehabilitation Center, Qingdao 266071, Shandong Province, China 
  • Received:2024-07-02 Accepted:2024-08-13 Online:2025-08-28 Published:2025-02-05
  • Contact: Wang Wei, MD, Associate chief physician, Master’s supervisor, Navy Qingdao Special Service Rehabilitation Center, Qingdao 266071, Shandong Province, China
  • About author:Hu Tong, Master’s candidate, Rehabilitation Medical College of Shandong University of Traditional Chinese Medicine, Jinan 250300, Shandong Province, China
  • Supported by:
    Army Healthcare Special Project, No. 20BJZ08 (to WW); Naval Special Service Personnel Injury and Disease Rehabilitation Functional Laboratory Construction Project

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摘要：


文题释义：
电磁刺激：利用电刺激或磁刺激作用于人体的中枢或外周组织产生刺激效应，促进中枢神经系统或外周组织功能的恢复。 
脑卒中后吞咽障碍：在发生脑卒中后出现的进食或饮水时的咽下困难。

摘要
目的：采用网状Meta分析评价不同电磁刺激方案治疗脑卒中后吞咽障碍的疗效，探讨最佳电磁刺激方案。
方法：全面检索中国知网、维普、万方、中国生物医学文献数据库、PubMed、Web of Science、Embase和The Cochrane Library文献数据库。英文检索词为“Electric Stimulation”“ Magnetic Stimulation”“ stroke”“ Deglutition Disorders”等，中文检索词为“磁刺激”“电刺激”“脑卒中”和“吞咽障碍”等。收集有关不同电磁刺激方案治疗脑卒中后吞咽障碍的临床随机对照试验，对照组采用常规吞咽训练，实验组在对照组的基础上进行电磁刺激。检索时限为各数据库建库至2024-05-11。运用EndNote X9软件进行文献管理，采用Cochrane风险偏倚评估工具和修订版Jadad量表对纳入文献进行风险偏倚和文献质量评价。使用RevMan 5.4软件Stata 17.0软件的network命令对功能性经口摄食量表评分、渗漏-误吸分级评分和吞咽肌群肌电活动评分指标进行直接Meta分析及网状Meta分析。根据GRADE证据等级及推荐强度分级标准对结局指标进行证据强度等级评价。
结果：共纳入59篇文献，其中高质量文献50篇，低质量文献9篇，包括3 801例患者，涉及15种电磁刺激方案。①在经口摄食能力评定上，累积排序概率图下面积(SUCRA)排序结果前5位电磁刺激方案为重复经颅磁刺激+重复外周磁刺激+神经肌肉电刺激(99.4%) > 重复外周磁刺激+神经肌肉电刺激(80.8%) > 重复经颅磁刺激+神经肌肉电刺激(74.2%) > 重复经颅磁刺激+肌电生物反馈电刺激(68.4%) > 经颅直流电刺激+神经肌肉电刺激(63.2%)；②在防误吸能力评定上，累积排序概率图下面积 (SUCRA)排序结果前5位电磁刺激方案为重复经颅磁刺激+重复外周磁刺激+神经肌肉电刺激(99.25%) > 重复经颅磁刺激+肌电生物反馈电刺激(87.5%) > 重复经颅磁刺激+神经肌肉电刺激(80.6%) > 重复外周磁刺激+神经肌肉电刺激(66.7%) > 经颅直流电刺激+神经肌肉电刺激(57.8%)；③在吞咽肌群表面肌电活动水平评定上，累积排序概率图下面积 (SUCRA)排序结果前5位电磁刺激方案为重复经颅磁刺激+神经肌肉电刺激(87.1%) > 重复经颅磁刺激+经颅直流电刺激(86.3%) > 经颅直流电刺激+神经肌肉电刺激(83.9%) > 肌电生物反馈电刺激+神经肌肉电刺激(77.8%) > 经颅直流电刺激+肌电生物反馈电刺激(74.4%)。
结论：电磁刺激对脑卒中后吞咽障碍患者吞咽功能的改善具有显著疗效，中枢与外周的联合磁刺激在改善脑卒中患者经口摄食能力和防误吸能力效果最佳 (中级别证据)，其次为中枢磁刺激联合外周电刺激(中级别证据)。
https://orcid.org/0009-0005-8145-4542(胡通)

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

关键词: 吞咽障碍, 神经肌肉电刺激, 经颅磁刺激, 经颅直流电刺激, 肌电生物反馈, 外周磁刺激, 物理治疗, 脑卒中, 功能恢复, 网状Meta分析

Abstract: OBJECTIVE: To conduct a network Meta-analysis to assess the efficacy of various electromagnetic stimulation programs in managing post-stroke dysphagia and identify the optimal stimulation program. 
METHODS: A comprehensive search was conducted across multiple databases, including CNKI, VIP, WanFang, the Chinese Biomedical Literature Database, PubMed, Web of Science, Embase, and The Cochrane Library. The search terms included “electric stimulation,” “magnetic stimulation,” “stroke,” and “deglutition disorders” in Chinese and English. The aim was to collect clinical randomized controlled trials evaluating various electromagnetic stimulation programs for the treatment of post-stroke dysphagia. The control group underwent conventional swallowing training, whereas the experimental group received electromagnetic stimulation in addition to the control treatment. The search was limited to publications from the inception of the databases until May 11, 2024. EndNote X9 software was utilized for literature management, and the Cochrane risk of bias assessment tool along with the revised Jadad scale was used to assess the risk of bias and the quality of the included studies. Direct Meta-analysis and network Meta-analysis were performed on the functional oral intake scale score, leakage-aspiration grade score, and swallowing muscle group electromyographic activity score index using RevMan 5.4 software and Stata 17 software. The strength of evidence for the outcome indicators was evaluated in accordance with the GRADE evidence level and recommendation strength grading standards.
RESULTS: A total of 59 studies were included in this analysis, comprising 50 high-quality documents and 9 low-quality documents, with a collective sample size of 3 801 patients and encompassing 15 different electromagnetic stimulation programs. (1) In the evaluation of feeding ability, the top five electromagnetic stimulation programs, ranked by the area under the cumulative ranking probability chart (SUCRA), were repetitive transcranial magnetic stimulation combined with repetitive peripheral magnetic stimulation and neuromuscular electrical stimulation (99.4%) > repetitive peripheral magnetic stimulation and neuromuscular electrical stimulation (80.8%) > repetitive transcranial magnetic stimulation and neuromuscular electrical stimulation (74.2%) > repetitive transcranial magnetic stimulation and myoelectric biofeedback electrical stimulation (68.4%) > transcranial direct current stimulation combined with neuromuscular electrical stimulation (63.2%). (2) In the assessment of anti-aspiration ability, the top five electromagnetic stimulation programs, ranked by the area under the cumulative ranking probability chart (SUCRA), were repetitive transcranial magnetic stimulation combined with repetitive peripheral magnetic stimulation and neuromuscular electrical stimulation (99.25%) > repetitive transcranial magnetic stimulation combined with myoelectric biofeedback electrical stimulation (87.5%) > repetitive transcranial magnetic stimulation combined with neuromuscular electrical stimulation (80.6%) > repetitive pheriphal magnetic stimulation combined with neuromuscular electrical stimulation (66.7%) > transcranial direct current stimulation combined with neuromuscular electrical stimulation (57.8%). (3) In the assessment of surface electromyographic activity levels in the swallowing muscles, the top five electromagnetic stimulation programs ranked by the area under the cumulative ranking probability chart (SUCRA) were repetitive transcranial magnetic stimulation combined with neuromuscular electrical stimulation (87.1%) > repetitive transcranial magnetic stimulation combined with transcranial direct current stimulation (86.3%) > transcranial direct current stimulation combined with neuromuscular electrical stimulation (83.9%) > myoelectric biofeedback electrical stimulation combined with neuromuscular electrical stimulation (77.8%) > transcranial direct current stimulation combined with myoelectric biofeedback electrical stimulation (74.4%).
CONCLUSION: Electromagnetic stimulation significantly improves swallowing function in patients with post-stroke dysphagia. Combined central and peripheral magnetic stimulation has the best effect on improving oral intale ability and anti-aspiration ability in stroke patients (medium-level evidence), followed by central magnetic stimulation combined with peripheral electrical stimulation (medium-level evidence).

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

Key words: dysphagia, neuromuscular electrical stimulation, transcranial magnetic stimulation, transcranial direct current stimulation, electromyographic biofeedback therapy, peripheral magnetic stimulation, physical therapy, stroke, functional restoration, network meta-analysis

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