不同干預措施對頭頸癌病人術后頸肩功能障礙影響的網狀Meta分析

Interventions on neck and shoulder function dysfunction of postoperative patients with head and neck cancer：a network Meta-analysis

SUN Shiyan，YU Xiurong，SHAO Fangfei，LI Cheng，WANG Shanshan，ZHOU Minmin，TANG XiuruBinzhou Medical University Hospital，Shandong 256600 ChinaCorresponding Author YU Xiurong，E-mail：yxr0204@163.com

Abstract Objective：To evaluate the effects of seven different interventions on neck and shoulder function dysfunction of postoperative patients with head and neck cancer using network Meta-analysis.Methods：A computerized search of randomized controlled trials on the effects of different interventions on neck and shoulder function and daily living ability of postoperative patients with head and neck cancer was performed in PubMed，the Cochrane Library，Web of Science，EMbase，CBM，VIP，CNKI and WanFang Database.The retrieval time was from the inception to May 23，2024.Literature screening and data extraction were performed independently by two researchers.RevMan 5.4 was used to evaluate the quality of the included literature for risk of bias，and ADDIS 1.16.8 and Stata 15.0 were used for network Meta-analysis and graphing.Results：A total of 19 studies with 1 386 patients involving 7 interventions were included.The results of the network Meta-analysis showed that acupuncture had the better efficacy in improving functional evaluation indexes of the shoulder joint（SMD=49.97，95%CI 42.77-57.28，P＜0.05） and NDII（SMD=19.16，95%CI 1.84-36.35，P＜0.05）;and neck and shoulder aerobics had the best efficacy in improving lateral neck flexion（SMD=9.61，95%CI 5.73-12.88，P＜0.05），and neck rotation（SMD=12.82，95%CI 5.54-34.31，P＜0.05）.Conclusion：Current evidence suggests that acupuncture is the most preferred recommended intervention to reduce postoperative shoulder pain and improve the ability of daily living in patients with head and neck cancer;and neck and shoulder aerobics are advantageous in improving neck mobility （neck lateral flexion，and neck rotation），but more high-quality studies are needed to further validate this conclusion.

Keywords head and neck cancer;intervention;neck and shoulder function;network Meta-analysis；evidence-based nursing

摘要 目的：采用網狀Meta分析方法評價7種不同干預措施對頭頸癌病人術后頸肩功能障礙的影響。方法：計算機檢索PubMed、the Cochrane Library、Web of Science、EMbase、中國生物醫學文獻數據庫、維普數據庫、中國知網、萬方數據庫中關于不同干預措施對頭頸癌病人術后頸肩功能影響的隨機對照試驗，檢索時限為建庫至2024年5月23日。由2名研究者獨立進行文獻篩選、資料提取。采用RevMan 5.4對納入的文獻進行偏倚風險質量評價，采用ADDIS 1.16.8及Stata 15.0進行網狀Meta分析及圖形繪制。結果：共納入19項研究，涉及1 386例病人、7種干預措施。網狀Meta分析結果顯示，針灸在改善肩關節功能評價指標［SMD=49.97，95%CI（42.77，57.28），P＜0.05］和頸淋巴結損傷指數［SMD=19.16，95%CI（1.84，36.35），P＜0.05］方面療效較好；頸肩有氧操在改善頸部側屈［SMD=9.61，95%CI（5.73，12.88），P＜0.05］及頸部旋轉［SMD=12.82，95%CI（5.54，34.31），P＜0.05］方面療效較好。結論：當前證據顯示，針灸是降低頭頸癌病人術后肩部疼痛、提高其日常生活能力最優先推薦的干預措施；頸肩有氧操在提高病人頸部運動度（頸部側屈、頸部旋轉）方面具有優勢，但還需更多高質量的研究進一步驗證此結論。

關鍵詞 頭頸癌；干預措施；頸肩功能；網狀Meta分析；循證護理

doi：10.12102/j.issn.2095-8668.2024.19.006

頭頸癌是指發生于口腔、咽部、喉部、唾液腺、甲狀腺及鼻道等部位的惡性腫瘤［1］，是最常見的惡性腫瘤之一。研究顯示，全球每年新增約55萬例頭頸癌病人［2］，我國頭頸癌發病率居惡性腫瘤的第6位［3］。頸淋巴結清掃術是頭頸癌病人綜合治療的關鍵步驟，但該手術方式易不同程度地牽拉或損傷脊髓副神經，導致病人術后出現頸肩部疼痛、僵硬及活動受限等并發癥，從而影響病人的日常生活能力和生活質量［4］。……