阴极经颅直流电刺激改善脑卒中患者上肢功能障碍的系统评价

目的系统评价阴极经颅直流电刺激(c-tDCS)对脑卒中患者上肢功能障碍的康复效果。方法计算机检索Cochrane Central Register of Controlled Trials、PubMed、EMbase、Web of Science、Ovid、中国生物医学文献、中国知网、万方数据和维普数据库中关于c-tDCS改善脑卒中患者上肢功能障碍的随机对照试验，同时检索已纳入文献的参考文献。检索时间从建库至2013 年7 月。2 名独立的研究人员依据Cochrane 协作网推荐的偏倚风险评估方法，对纳入文献的质量进行严格评估及资料提取，对符合标准的随机对照试验进行Meta 合并分析。统计分析采用RevMan 5.1 软件。结果共纳入10 篇。Meta 分析显示，c-tDCS作用于病灶侧初级运动区后，患者的Fugl-Meyer 运动功能量表上肢部分评分与假刺激组相比，差异无统计学意义WMD=0.11, 95%CI: -5.77~5.99, Z=0.04, P=0.97]，c-tDCS 作用于病灶侧初级运动区对患者Jebsen 手功能的作用效果与假刺激组相比，差异无统计学意义WMD=-1.52, 95%CI: -4.94~1.90, Z=0.87, P=0.38 ]。纳入文献质量的Jadad 评分，低质量2 篇，高质量8 篇。结论目前，没有证据显示c-tDCS比假刺激更有效地改善脑卒中患者上肢运动功能障碍。

Effect of Cathodal Transcranial Direct Current Stimulation on Upper Extremities of Patients with Stroke: A Systematic Review of Randomized Controlled Trials

Objective To evaluate the effectiveness of cathodal transcranial direct current stimulation(c-tDCS) on the upper extremities of patients with stroke. Methods Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMbase, Web of Science, Ovid,China Biology Medicine disc (CBMdisc), China National Knowledge Infrastructure, Wanfang Data and VIP Database for Chinese Technical Periodicals were searched for the randomized controlled trials (RCTs) of c-tDCS in the treatment of the upper extremities of patients withstroke from the date of establishment of the databases to July 2013. The bibliographies of the retrieved studies were also searched. 2 independent researchers evaluated the included studies using the risk of bias provided by Cochrane Library. The extracted data were analyzed by RevMan 5.1 software. Results A total of 10 trials were discovered. Compared with the sham tDCS group, the c-tDCS group which stimulated the area of primary motor cortex (M1) did not increase the score of Fugl- Meyer Assessment (upper extremity) WMD=0.11, 95%CI: -5.77~5.99, Z=0.04, P=0.97] and Jebsen-Taylor Test WMD=-1.52, 95%CI: -4.94~1.90, Z=0.87, P=0.38]. According to the Jadad Score of included studies, 2 of them were of low quality and 8 of them were of high quality. Conclusion Currently, no evidence shows that c-tDCS can improve the upper extremities function of stroke patients more than sham tDCS.