重复经颅磁刺激联合神经肌肉电刺激治疗卒中后吞咽障碍的疗效分析  

Repetitive Transcranial Magnetic Stimulation Combined with Neuromuscular Electrical Stimulation for Treatment of Poststroke Dysphagia

作　　者：饶金柱[1] 李华娇[2] 王晶 李芳 鲍晓[1] 刘惠宇[1] RAO Jin-zhu;LI Hua-jiao;WANG Jing;LI Fang;BAO Xiao;LIU Hui-yu(Department of Rehabilitation Medicine,Yue Bei People’s Hospital,Guangdong 512026,China;Medical College of Shaoguan University,Guangdong 512026,China)

机构地区：[1]粤北人民医院康复医学科,广东韶关512026 [2]韶关学院医学院,广东韶关512026

出　　处：《神经损伤与功能重建》2021年第7期373-377,共5页Neural Injury and Functional Reconstruction

基　　金：韶关市2019年卫生计生科研计划项目(No.Y19004)。

摘　　要：目的:探讨重复经颅磁刺激(rTMS)联合神经肌肉电刺激(NMES)对单侧脑卒中吞咽障碍的治疗作用。方法:单侧卒中后吞咽障碍患者96例,随机分为(rTMS+NMS)组、rTMS组、NMES组,每组32例,分别给予(真rTMS+真NMES)、(真rTMS+假NMES)和(假rTMS+真NMES)治疗。在基线、治疗2周后、治疗结束1月后采用标准吞咽功能评估量表(SSA)、吞咽X线荧光透视检查(VFSS)下Rosenbek渗透-误吸量表评估(PAS)评估吞咽功能。结果:90例进入结果分析,3组在基线、治疗2周后及治疗1月后,SSA评分(F(2,86)=322.85;P<0.001)、PAS评分(F_((2,86))=482.44;P<0.001)均显著下降;治疗2周后(rTMS+NMES)联合组PAS评分及SSA评分均低于rTMS组(P_(SSA)=0.031,P_(PAS)=0.000),且低于NMES组(P_(SSA)=0.007,P_(PAS)=0.001)。结论:患侧高频rTMS刺激后立即进行NMES治疗可以显著改善吞咽功能,其疗效优于单独rTMS治疗及NMES治疗。Objective:To assess therapeutic effect of repetitive transcranial magnetic stimulation(rTMS)combined with neuromuscular electrical stimulation(NMES)on dysphagia after unilateral stroke.Methods:A total of 96 patients with poststroke dysphagia were enrolled.They were randomly divided into the(rTMS+NMES)group,rTMS group,or NMES group(each n=32)and treated respectively with rTMS and NMES,rTMS and sham NMES,or sham rTMS and NMES.At baseline,2 weeks after treatment,and 1 month after treatment,the standardized swallowing assessment(SSA),videofluoroscopic swallow study(VFSS),and Rosenbek’s penetration aspiration scale(PAS)were used to assess swallowing function.Results:Ninety cases were enrolled in the analysis.At baseline,2 weeks after treatment,and 1 month after treatment,SSA score(F_((2,86))=322.85,P<0.001)and PAS score(F_((2,86))=482.44,P<0.001)were significantly decreased in all 3 groups.After 2 weeks of treatment,PAS and SSA scores in the(rTMS+NMES)group were lower than that of both the rTMS group(P_(SSA)=0.031,P_(PAS)=0.000)and NMES group(P_(SSA)=0.007,P_(PAS)=0.001).Conclusion:High frequency rTMS stimulation followed immediately by NMES therapy in the affected side can significantly improve swallowing function,and its efficacy is superior to that of rTMS or NMES alone.

关 键 词：重复经颅磁刺激 神经肌肉电刺激 卒中 吞咽障碍 

分 类 号：R741[医药卫生—神经病学与精神病学] R743.3[医药卫生—临床医学]