强化呼吸训练对脑卒中后吞咽障碍患者康复应用效果的系统分析

吴立燕; 崔严尹; 张玉杰; 雷善言; 杨芳

doi:10.16766/j.cnki.issn.1674-4152.003776

强化呼吸训练对脑卒中后吞咽障碍患者康复应用效果的系统分析

doi: 10.16766/j.cnki.issn.1674-4152.003776

1.
杭州师范大学附属医院呼吸与危重症医学科，浙江杭州 310015
2.
浙江中医药大学人文与管理学院，浙江杭州 311403

基金项目:

浙江省中医药科技计划局省共建中医药现代化研究计划重点项目 GZY-ZJ-KJ-23062

浙江省基础公益研究计划项目 LTGY23H270005

国家自然科学基金面上项目 71874157

浙江中医药大学2024年度省哲学社会科学重点培育研究基地自设课题 2024JDYB09

详细信息

通讯作者:
杨芳，E-mail：20191087@zcmu.edu.cn

中图分类号: R743.3 R493
计量
- 文章访问数: 15
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- 被引次数: 0
出版历程
- 收稿日期: 2024-01-09
- 网络出版日期: 2024-12-31

Systematic analysis of the effect of intensive breathing training on the application of rehabilitation for patients with post-stroke dysphagia

1.
Department of Respiratory Critical Medicine, Hangzhou Normal University Hospital, Hangzhou, Zhejiang 310015, China

摘要

摘要: 目的系统评价强化呼吸训练在脑卒中后吞咽障碍康复中的应用效果。方法计算机检索PubMed、Embase、Cochrane Library、Web of Science、中国生物医学文献服务系统、中国知网、维普和万方数据库中关于强化呼吸训练对脑卒中后吞咽障碍康复的对照研究，检索时限从建库至2023年6月。根据Cochrane系统、渥太华评分量表评价纳入研究质量，使用RevMan5.4软件对结局指标进行meta分析。结果纳入文献13篇，包括12项随机对照研究、1项回顾性对照研究，共计患者708例。Meta分析结果显示，训练组与对照组呼气峰值流量(PEF)差异无统计学意义(P>0.05)，洼田饮水试验疗效(KDWT)、功能性口服摄入量表(FOIS)、用力肺活量(FVC)、渗透-抽吸量表(PAS)、吸入性肺炎发生率比较差异均有统计学意义(P < 0.05)。亚组分析结果显示，吞咽康复效果在干预方式(P=0.030)、治疗时长(P=0.060)存在异质性，肺功能康复效果存在干预方式(P=0.090)的异质性。结论现有证据表明，强化呼吸训练能够促进脑卒中后吞咽障碍患者吞咽功能的恢复，有效降低吸入性肺炎的发生率。
- 卒中后吞咽障碍 /
- 强化呼吸训练 /
- 康复效果 /
- 系统评价
Abstract: Objective To systematically evaluate the effect of intensive respiratory training on the rehabilitation application of dysphagia after stroke. Methods The controlled studies of intensive breathing training on rehabilitation of swallowing disorder after stroke from PubMed, Embase, Cochrane Library, Web of Science, China Biomedical Literature Service System, CNKI, Vip, and Wanfang were searched by computer from the establishment of the database to June 2023. The quality of the included studies was evaluated according to the Cochrane system and Ottawa Scale, and the meta-analysis of outcome indicators was performed using RevMan5.4. Results Thirteen papers were included in the literature, including 12 randomized controlled studies and one retrospective controlled study with a total of 708 patients. Meta-analysis showed that the difference in PEF between the training group and the control group was not statistically significant (P>0.05). In terms of kubota drinking water test (KDWT), functional oral intake scale (FOIS), forced vital capacity (FVC), and penetration-aspiration scale (PAS), The incidence of aspiration pneumonia was statistically significant (P < 0.05). Subgroup analyses showed heterogeneity in swallowing rehabilitation outcomes in terms of intervention modality (P=0.030) and treatment duration (P=0.060), and heterogeneity in pulmonary function rehabilitation outcomes in terms of intervention modality (P=0.090). Conclusion Available evidence suggests that intensive respiratory training can promote the recovery of swallowing function and effectively reduce the incidence of aspiration pneumonia in patients with post-stroke dysphagia.
- Poststroke dysphagia /
- Intensive breathing training /
- Rehabilitation effect /
- Systematic evaluation

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图 1 纳入随机对照研究的偏倚风险评估

Figure 1. Risk of bias assessment for inclusion in randomised controlled studies

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图 2 KDWT的发表偏倚漏斗图

Figure 2. Funnel plot assessing publication bias for the efficacy of KDWT

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表 1 纳入研究的基本特征

Table 1. Basic characteristics of the included studies

作者	地区	样本量T/C	年龄(岁)		干预措施		疗程(周)	结局指标
作者	地区	样本量T/C	T	C	T	C	疗程(周)	结局指标
陈惜珠2018^[10]	中国	45/45	46.2±1.3	45.98±1.1	吞咽康复训练	强化呼吸训练	4	①
章志超2017^[11]	中国	21/21	58.7±5.9	58.7±7.1	吞咽康复训练	强化呼吸训练	4	①④
武广艳2019^[12]	中国	42/42	68.56±4.37	69.04±4.11	常规康复治疗	强化呼吸训练	6	①⑤
李婷2019^[13]	中国	43/43	70.8±4.7	71.0±4.9	吞咽康复训练	强化呼吸训练	4	①⑤
李名生2021^[14]	中国	35/35	46.67±1.27	45.56±1.34	吞咽康复训练	强化呼吸训练	4	①④⑤
权程2017^[15]	中国	30/30	56.90±16.92	53.97±19.51	吞咽康复训练	Power Breath-k5训练器	8	①
景荣华2023^[16]	中国	49/49	58.53±6.97	58.87±6.05	常规康复治疗	强化呼吸训练	6	①②④
周芳2018^[17]	中国	24/24	52.12±9.28	51.29±8.64	吞咽康复训练	Power Breath-k5训练器	4	④
ARNOLD R J 2020^[18]	美国	10/10	70.50	66.10	常规康复治疗	呼吸肌训练装置	4	②③
EOM M J 2017^[19]	韩国	13/13	69.2±4.1	70.2±3.6	安慰剂治疗	门静脉呼气肌训练器	4	③
LIAW M Y 2020^[20]	中国	11/10	66.80±11.47	61.18±10.69	常规康复治疗	Dofin训练器	6	②④
JANG K W 2019^[21]	韩国	18/18	67.28±9.48	71.15±8.61	吞咽康复训练	呼吸肌训练装置	2	②③
PARK J S 2016^[22]	韩国	14/13	64.3±10.7	65.8±11.3	安慰剂治疗	EMST训练装置	4	②③
注：T为实验组，C为对照组。结局指标为①KDWT；②FOIS；③PAS；④肺功能相关指标FVC、PEF；⑤吸入性肺炎发生率。

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表 2 强化呼吸训练治疗脑卒中后吞咽障碍的meta分析结果

Table 2. Meta-analysis of intensive respiratory training for the treatment of PSD

结局指标	纳入研究	异质性		效应模型	meta结果
结局指标	纳入研究	P值	I²(%)	效应模型	SMD/WMD/OR(95% CI)	P值
KDWT	7项^[10-16]	0.999	0	固定	4.94(2.76~8.85)	< 0.001
FOIS	5项^{[16, 18, 20-22]}	< 0.001	76	随机	0.73(0.08~1.38)	0.030
PAS	4项^{[18-19, 21-22]}	0.250	28	固定	-0.48(-0.80~-0.17)	0.002
FVC	5项^{[11, 14, 16-17, 20]}	< 0.001	95	随机	2.22(0.80~3.63)	0.002
PEF	2项^{[11, 18]}	< 0.001	90	随机	1.92(-0.56~4.40)	0.130
吸入性肺炎发生率	3项^{[10, 12, 14]}	0.800	0	固定	0.26(0.12~0.58)	0.001

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表 3 FOIS、FVC的亚组分析结果

Table 3. Results of subgroup analysis of FOIS and FVC

结局指标	亚组分组	纳入研究	meta结果		异质性
结局指标	亚组分组	纳入研究	WMD/SMD(95% CI)	P值	I²(%)	P值
FOIS	干预方式
	不使用呼吸训练装置	2项^{[16, 21]}	1.40(1.00~1.81)	< 0.001	80.0	0.030
	使用呼吸训练装置	3项^{[18, 20, 22]}	0.67(0.17~1.17)	< 0.001
	治疗时间
	2周	1项^[21]	0.03(-0.62~0.68)	0.920	64.4	0.060
	4周	2项^{[18, 20]}	0.71(-0.63~2.04)	0.300
	6周	2项^{[16, 22]}	1.14(0.49~1.79)	< 0.001
FVC	干预方式
	不使用呼吸训练装置	2项^{[17, 20]}	0.76(-1.34~2.87)	0.480	65.1	0.090
	使用呼吸训练装置	3项^{[11, 14, 16]}	3.19(1.33~5.05)	< 0.001
	治疗时间
	4周	3项^{[11, 16-17]}	3.03(0.91~5.15)	< 0.001	27.3	0.240
	6周	2项^{[16, 20]}	1.02(-1.58~3.63)	0.440

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