中医外治法治疗脑卒中后肩手综合征临床疗效的Meta分析

Clinical Efficacy of Traditional Chinese Medicine External Treatment for Post-Stroke Shoulder-Hand Syndrome: A Meta-Analysis

摘要: 目的：系统评价中医外治法对脑卒中后肩手综合征(Shoulder-Hands Syndrome, SHS)患者的临床疗效。方法：检索中国知网(CNKI)、维普中文科技期刊数据库(VIP)、中国生物医学文献数据库(CBM)、万方数据库(WanFang database)、PubMed、the Cochrane Library、Web of Science、Embase数据库，筛选中医外治法治疗脑卒中后SHS的临床随机对照试验研究文献，检索时间为建库至2022年5月6日，经文献筛选、数据提取和质量评价后，采用Review Manager 5.4统计软件对符合纳入标准的文献进行Meta分析。结果：本研究共纳入24篇文献，合计1750例患者；Meta分析结果显示：试验组的总有效率(RR = 1.24, 95%CI = [1.15, 1.34], P < 0.001)、治愈率(RR = 1.92, 95%CI = [1.15, 3.20], P < 0.001)均高于对照组。此外，与对照组相比，试验组能更有效改善脑卒中后SHS患者的患肢运动功能(SMD = 2.21, 95%CI = [1.40, 3.01], P < 0.001)、减轻患肢疼痛程度(SMD = −1.93, 95%CI = [−2.48, −1.37], P < 0.001)和肿胀程度(SMD = −1.19, 95%CI = [−1.70, −0.68], P < 0.001)，提高病人的日常生活活动能力(SMD = 1.24, 95%CI = [0.59, 1.88], P < 0.001)。结论：中医外治法在治疗脑卒中后SHS患者康复过程中发挥着较好的作用，具有操作简单、疗效明确、经济安全的优点。但因纳入文献中方法学质量偏低，且存在发表偏倚的可能，未来需要更多高质量、多中心大样本、设计严谨的随机对照研究来进一步验证结果。

Abstract: Objective: To systematically evaluate the clinical effect of external treatment of traditional Chinese medicine on post-stroke patients with Shoulder-Hands Syndrome (SHS). Methods: Search China National Knowledge Infrastructure (CNKI), VIP Chinese Science and Technology Periodical Database (VIP), China Biomedical Literature Database (CBM), WanFang da-tabase, PubMed, the Cochrane Library, Web of Science, Embase database, and screen The research literatures of clinical randomized controlled trials in the treatment of SHS after cerebral apoplexy by external therapy of traditional Chinese medicine. The retrieval time was from the establishment of the database to May 6, 2022. After literature screening, data extraction and quality evaluation, the Review Manager 5.4 statistical software was used to identify eligible patients for inclusion. Standard literature meta-analysis was performed. Results: A total of 24 literatures were included in this study, with a total of 1750 patients; meta-analysis results showed that: the total effective rate (RR = 1.24, 95%CI = [1.15, 1.34], P < 0.001) of the experimental group, the cure rate (RR = 1.92, 95%CI = [1.15, 3.20], P < 0.001) were higher than those in the control group. In addition, compared with the control group, the experimental group could more effectively improve the motor function of the affected limb in SHS patients after stroke (SMD = 2.21, 95%CI = [1.40, 3.01], P < 0.001), re-duce the pain degree of the affected limb (SMD = −1.93, 95%CI = [−2.48, −1.37], P < 0.001) and swelling degree (SMD = −1.19, 95%CI = [−1.70, −0.68], P < 0.001), improve the patient’s Activities of daily living (SMD = 1.24, 95%CI = [0.59, 1.88], P < 0.001). Conclusion: External therapy of tradi-tional Chinese medicine plays a good role in the rehabilitation process of post-stroke SHS patients, and has the advantages of simple operation, clear curative effect, economical safety. However, due to the low methodological quality of the included literature and the possibility of publication bias, more high-quality, multi-center, large-sample, and well-designed randomized controlled studies are needed to further verify the results in the future.