卒中后疲劳体力活动干预研究meta分析

摘要/Abstract

摘要： 目的系统评价脑卒中患者体力活动管理对卒中后疲劳水平的影响,为卒中后疲劳患者相关干预方案的制订提供参考。方法按照PIS检索原则,在中国知网、PubMed、Web of Science、Embase、Cochrane、万方数据、维普中文期刊8个数据库检索有关卒中后疲劳体力活动干预的随机对照试验,检索时间为建库至2022年4月。检索后对文献进行筛选、评估,通过RevMan 5.3对纳入文献进行异质性检验及效应量统计;使用软件Stata 17.0进行敏感性分析及发表偏倚的检验。结果最终对12篇共包含832名受试者的符合纳入标准的文献进行分析,异质性检验I²=84.6%,故采用随机效应模型进行效应合并,meta分析结果：合并效应量[d =-1.08,95%CI：-1.05（-1.20, -0.90）,P <0.00001],说明体力活动对改善卒中后疲劳有显著效果;敏感性分析结果示：剔除周萍（2019）、马艳（2016）、王小丽（2021）、王梦佳（2021）的研究后,异质性有所降低,I²=61%,95%CI：-0.69 （-0.87, -0.51）,P<0.00001;使用Egger's test检测发表性偏倚,得出P=0.366,说明无明显发表偏倚。结论有计划且缓慢、轻松的运动及力量训练和抗阻力训练能有效缓解卒中后疲劳症状。建议在为卒中后疲劳患者制订体力活动方案时,为活动前心肺功能的评估及活动中心肺功能的监测制订详细的方案。

关键词: 卒中后疲劳, 体力活动, meta分析

Abstract: Objective To systematically evaluate the impact of physical activity management of stroke patients on the level of post-stroke fatigue, and provide reference for the formulation of relevant intervention plans for patients with post-stroke fatigue. Methods According to the principle of PIS retrieval, 8 databases retrieve randomized controlled trials on post-stroke fatigue physical activity intervention in China CNKI, PubMed, Web of Science, Embase, Cochrane, Wanfang Data and Weipu Chinese journals. The warehouse will be built until April 2022. After retrieval, the literature is screened and evaluated, and the heterogeneity test and effect statistics of the included literature are carried out through RevMan 5.3. Use the software Stata 17.0 for sensitivity analysis and publish bias tests. Results Finally, 12 literature containing a total of 832 documents that met the exclusion criteria were analyzed. The heterogeneity test I²=84.6%, so the stochastic effect model was used for effect merging. The meta analysis results: the combined effect amount [d=-1.08, 95%CI: -1.05 (-1.20, -0.90), P<0.00001], indicating that physical activity has a significant effect on improving post-stroke fatigue. The sensitivity analysis results show that after excluding Zhou Ping (2019), Ma Yan (2016), Wang Xiao-li (2021) and Wang Meng-jia (2021), the heterogeneity has decreased. I²=61%, 95%CI: -0.69 (-0.87, -0.51), P<0.00001; using Egger's test to detect publication bias, and it is no obvious publication bias. Conclusion Planned, slow and relaxed exercise, strength training and resistance training can effectively relieve post-stroke fatigue symptoms. It is recommended to formulate a detailed plan for the evaluation of cardiopulmonary function before activity and the monitoring of pulmonary function in the activity center when formulating a physical activity plan for patients with post-stroke fatigue.

Key words: post-stroke fatigue, physical activity, meta analysis

中图分类号:

R473.2

王诗洋, 贾雪媛. 卒中后疲劳体力活动干预研究meta分析[J]. 中华养生保健, 2023, 41(8): 8-12.

参考文献

[1] GROOT M H D, PHILLIPS S J, ESKES G A. Fatigue Associated with Stroke and Other Neurologic Conditions: Implications for Stroke Rehabilitation[J]. Archives of Physical Medicine and Rehabilitation, 2003,84(11):1714-1720.
[2] SARIKAYA H, FERRO J, ARNOLD M.Stroke prevention-medical and lifestyle measures[J]. Eur Neurol,2015,73(3-4):150-157.
[3] 杜彤帅. 缺血性脑卒中患者卒中后疲劳与自我效能的相关性研究[D].长春:吉林大学,2018.
[4] 王小丽. 基于症状管理理论构建急性期脑卒中后疲劳干预方案及临床实证研究[D].遵义:遵义医科大学,2021.
[5] 王利,卞光荣,马先军,等.多量表分析脑卒中后疲劳相关因素及对老年人预后的影响[J].中国老年学杂志,2015,35(2):329-330.
[6] PONCHEL A, BOMBOIS S, BORDET R, et al.Factors Associated with Poststroke Fatigue: A Systematic Review[J]. Stroke Res Treat,2015,2015:347920.
[7] KENNEDY C, KIDD L.Interventions for post-stroke fatigue: A Cochrane review summary[J]. Int J Nurs Stud,2018,85:136-137.
[8] MUTAI H, FURUKAWA T, HOURI A, et al.Factors associated with multidimensional aspect of post-stroke fatigue in acute stroke period[J]. Asian J Psychiatr,2017,26:1-5.
[9] 肖洪江,闫华平,孔晓娜.基于保护动机理论健康管理模式对脑卒中患者神经功能及生活自理能力的影响[J].中华养生保健,2022,40(14):129-132.
[10] OGDEN J A, MEE E W, UTLEY T.Too little, too late: does tirilazad mesylate reduce fatigue after subarachnoid hemorrhage?[J]. Neurosurgery,1998,43(4):782-787.
[11] BRIOSCHI A, GRAMIGNA S, WERTH E, et al.Effect of modafinil on subjective fatigue in multiple sclerosis and stroke patients[J]. Eur Neurol,2009,62(4):243-249.
[12] JOHANSSON B, CARLSSON A, CARLSSON M L, et al.Placebo-controlled cross-over study of the monoaminergic stabiliser (-)-OSU6162 in mental fatigue following stroke or traumatic brain injury[J]. Acta Neuropsychiatr,2012,24(5):266-274.
[13] 于文琦. 艾灸足三里穴缓解卒中后疲劳的临床研究[D].广州:广州中医药大学,2017.
[14] 郭玉怀. 扬刺百会穴结合康复训练治疗卒中后疲劳的临床疗效观察[D].哈尔滨:黑龙江中医药大学,2016.
[15] 杨子晴. 卒中后疲劳护理干预现状及非药物护理方案构建[D].广州:广东药科大学,2021.
[16] 国家卫生健康委脑卒中防治工程委员会.中国脑卒中防治指导规范[M].北京:人民卫生出版社,2018:478.
[17] WINSTEIN C J, STEIN J, ARENA R, et al.Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association[J]. Stroke,2016,47(6):e98-e169.
[18] LANCTOT K L, LINDSAY M P, SMITH E E, et al.Canadian Stroke Best Practice Recommendations: Mood, Cognition and Fatigue following Stroke, 6th edition update 2019[J]. Int J Stroke,2020,15(6):668-688.
[19] ZEDLITZ A M, RIETVELD T C, GEURTS A C, et al.Cognitive and graded activity training can alleviate persistent fatigue after stroke: a randomized, controlled trial[J]. Stroke,2012,43(4):1046-1051.
[20] YOON H S, CHA Y J, YOU J.The effects of dynamic core-postural chain stabilization on respiratory function, fatigue and activities of daily living in subacute stroke patients: A randomized control trial[J]. NeuroRehabilitation,2020,47(4):471-477.
[21] 王建平, 桂沛君, 谢瑛.八段锦小组治疗对脑卒中后疲劳的康复效果研究[J].临床和实验医学杂志,2020,19(4):399-403.
[22] 郑刚,徐前纬,杨开仁.膈肌锻炼联合运动训练对脑卒中后疲劳的康复效果研究[J].浙江医学,2019,41(4):355-358.
[23] 周萍,魏群.佳木斯快乐舞步健身操联合护理干预在脑卒中后疲劳患者中的应用[J].实用临床医学,2019,20(7):79-81.
[24] 赵茂晶. 脑卒中急性期患者卒中后疲劳的调查及下肢运动训练对其疗效的影响[D].遵义:遵义医学院,2018.
[25] 杨浩东. 太极拳治疗脑卒中后疲劳的临床观察[D].广州:广州中医药大学,2021.
[26] 杜晴,陈苏倩.心肺康复训练在缺血性卒中后疲劳患者中的疗效观察[J].反射疗法与康复医学,2020,29(10):104-105.
[27] 王梦佳. 瑜伽休息术在脑卒中后疲劳患者中的应用研究[D].湖州:湖州师范学院,2021.
[28] KIM I.Effects of an enjoyable nurse-led intervention to promote movement in poststroke inpatients[J]. Clin Nurs Res,2012,21(4): 390-405.
[29] 马艳,王小云,岳翔,等.膈肌训练对脑卒中后疲劳患者日常生活活动的影响[J].中华物理医学与康复杂志,2016,38(8):587-590.