rTMS与iTBS模式经颅磁刺激治疗脑卒中后吞咽障碍的疗效对比研究  

rTMS and iTBS modes of transcranial magnetic stimulation for the treatment of dysphagia after stroke

作　　者：刘子财 温馨 彭阳 钟立达 李芳 刘惠宇[2] Liu Zi-cai;Wen Xin;Peng Yang;Zhong Li-da;Li Fang;Liu Hui-yu(School of Rehabilitation Medicine,Gannan Medical University,Ganzhou 341000,Jiangxi,China;Department of Rehabilitation Medicine,Yuebei People’s Hospital,Shaoguan 512026,Guangdong,China)

机构地区：[1]赣南医学院康复学院,江西赣州341000 [2]粤北人民医院康复医学科,广东韶关512026

出　　处：《兰州大学学报（医学版）》2021年第5期76-80,共5页Journal of Lanzhou University（Medical Sciences）

基　　金：广东省科技计划资助项目(201803010)。

摘　　要：目的探讨重复经颅磁刺激(rTMS)和间歇性Theta节律刺激(iTBS)两种模式的经颅磁刺激作用小脑部位治疗脑卒中后吞咽障碍的疗效对比。方法选取2020年1月—2021年6月收治的脑卒中后吞咽障碍患者89例,根据干预方式不同分为rTMS组(30例)、iTBS组(24例)、对照组(35例);rTMS组给予重复经颅磁刺激小脑部位,iTBS组给予经颅磁的iTBS模式刺激小脑,对照组给予rTMS假刺激,3组患者均在标准吞咽治疗基础上进行治疗。以纤维内镜下吞咽困难严重程度评估量表(FEDSS)和标准吞咽功能评分(SSA)评价3组患者干预前后吞咽功能的情况。结果干预2周后,rTMS组、iTBS组、对照组的FEDSS评分和SSA评分均低于治疗前,rTMS组、iTBS组的FEDSS评分和SSA评分均低于对照组,对比有显著性差异(P<0.05);rTMS组的FEDSS评分高于iTBS组评分,差异有统计学意义(P<0.05),rTMS组、iTBS组在SSA评分比较中差异无统计学意义(P=0.907)。结论rTMS模式、iTBS模式均可有效治疗脑卒中后吞咽障碍,iTBS不劣于rTMS,在吞咽疗效方面可能更具有优势,值得临床推广。Objective To evaluate the efficacy of the intercranial magnetic stimulant of rTMS and iTBS in the treatment of postoperative swallowing disorder.Methods During January 2020 to June 2021,the patients with dysphagia after stroke was divided into the rTMS(n=30),the iTBS(n=24)and the sham(n=35)groups.In the rTMS group,the cerebellum was stimulated with repeated transcranial magnetic routine mode.In the iTBS group,the cerebellum was stimulated in iTBS mode,and in the sham group,repeated transcranial magnetic sham stimulation was given.All participants were treated on standard swallowing therapy.Fiber Endoscopic Dysphagia Severity Scale(FEDSS)and Standard Swallowing Assessment(SSA)were used to evaluate the recovery of swallowing function.Results After two weeks intervention,the FEDSS score and SSA score of the rTMS group,the iTBS group and the sham group were lower than the baseline values.The mean changes in FEDSS score and SSA score of the rTMS group and the iTBS group were lower than the sham group(P<0.05).The mean changes in FEDSS score were higher in the rTMS group than in the iTBS group(P<0.05),while the SSA score had no between group-differences(P=0.907).Conclusion Both rTMS and iTBS were effective for the treatment of swallowing dysfunction after stroke,iTBS was not inferior to rTMS and may have an advantage in swallowing efficacy,and worthy of clinical promotion.

关 键 词：重复经颅磁刺激 脑卒中 吞咽障碍 间歇性Theta节律刺激 小脑刺激 

分 类 号：R743[医药卫生—神经病学与精神病学]