重复经颅磁刺激辅助治疗创伤性颅脑损伤患者有效性及安全性的Meta分析OA

Objective To systematically evaluate the efficacy and safety of repetitive transcranial magnetic stimulation(rTMS)in the adjuvant treatment of patients with traumatic brain injury(TBI).Methods The Chinese and English literature about rTMS adjuvant therapy for TBI in CNKI,Wanfang Data,Chinese Biomedical Literature Database,VIP,PubMed,Web of Science,Cochrane Library and Embase were searched by computer from the establishment of the databases to November 2025.The Cochrane bias risk assessment tool was used to evaluate the quality of the included literature,and RevMan 5.3 and Stata 18.0 softwares were used for meta-analysis.Results Finally,29 literature were included,including 26 Chinese literature and 3 English literature.The total sample size was 2 224 cases,including 1 032 cases in the control group and 1 192 cases in the combined group.The meta-analysis results showed that,after treatment,Mini-Mental State Examination(MMSE)score[mean difference(MD)=3.27,95%CI(2.52-4.02)],Montreal Cognitive Assessment(MoCA)score[MD=3.43,95%CI(2.63-4.23)],Fugl-Meyer Assessment(FMA)score[MD=11.17,95%CI(7.54-14.81)],Glasgow Coma Scale(GCS)score[MD=1.99,95%CI(0.85-3.12)],modified Barthel Index(mBI)[MD=10.05,95%CI(7.76-12.35)],Activities of Daily Living(ADL)Scale score[MD=10.83,95%CI(6.48-15.18)],and the total effective rate of treatment[relative risk(RR)=1.28,95%CI(1.16-1.42)]in the combined group were higher than those in the control group,the amplitude of event-related potential P300[MD=2.00,95%CI(1.29-2.71)]was greater than that in the control group,the latency of event-related potential P300[MD=-22.92,95%CI(-30.77--15.07)]and the completion time of Trail Making Test(TMT)[standard mean difference(SMD)=-1.09,95%CI(-1.44--0.74)]were shorter than those in the control group(P<0.05).There were no statistically significant difference of Stroop Color Word Test(SCWT)results after treatment[SMD=-2.10,95%CI(-4.62-0.42)]and incidence of adverse reactions[RR=1.86,95%CI(0.92-3.74)]between the control group and the combined group(P>0.05).The results of sensitivity analysis showed that there was no significant change in the results of meta-analysis after changing the effect model.Conclusion rTMS adjuvant therapy can effectively improve the cognitive function and motor function of TBI patients,reduce the severity of the disease,improve ADL and total effective rate of treatment,and has high safety.