高频重复经颅磁刺激对脑卒中后吞咽障碍患者摄食功能的影响  

The effect of high-frequency repetitive transcranial magnetic stimulation on the feeding function of patients with dysphagia after stroke

作　　者：章一锋 范虹[3] 陈争一[1,2] 司马振奋 顾杭丽[1,2] 滕树利 ZHANG Yifeng;FAN Hong;CHEN Zhengyi;SIMA Zhenfen;GU Hangli;TENG Shuli(Department of Rehabilitation Medicine,Shaoxing People's Hospital in Zhejiang Province,Shaoxing 312000,China;Shaoxing Cardiovascular and Cerebrovascular Disease Rehabilitation Technology Innovation and Application Key Laboratory in Zhejiang Province,Shaoxing 312000,China;Department of Geriatrics,Shaoxing People's Hospital in Zhejiang Province,Shaoxing 312000,China)

机构地区：[1]浙江省绍兴市人民医院康复医学科,浙江绍兴312000 [2]浙江省绍兴市心脑血管疾病康复技术创新与应用重点实验室,浙江绍兴312000 [3]浙江省绍兴市人民医院老年科,浙江绍兴312000

出　　处：《中国现代医生》2021年第29期36-39,43,共5页China Modern Doctor

基　　金：浙江省中医药科技计划项目(2020ZB270);浙江省绍兴市科技计划项目(2018C30102)。

摘　　要：目的探讨高频重复经颅磁刺激(rTMS)对脑卒中后吞咽障碍患者摄食功能和进食途径的影响。方法选取2019年5月至2020年5月绍兴市人民医院康复医学科收治的脑卒中后留置鼻饲管的吞咽障碍患者60例,按随机数字表法分为对照组30例和观察组30例。对照组给予常规摄食训练,观察组rTMS后行摄食训练。治疗前后,两组行改良曼恩吞咽能力评估(MMASA)和功能性经口摄食评估(FOIS),并比较治疗后拔管人数。结果治疗前,两组患者MMASA评分、FOIS评分比较,差异无统计学意义(P>0.05)。治疗后,观察组MMASA评分、FOIS评分分别为(85.03±9.01)分、(5.64±1.42)分,均高于对照组的(77.27±18.66)分、(4.62±1.80)分,差异有统计学意义(P<0.05);观察组拔管例数(27例)多于对照组(19例),差异有统计学意义(P<0.05)。结论高频重复经颅磁刺激能改善患者吞咽摄食功能水平,帮助患者尽快拔除鼻饲管,恢复正常经口进食。Objective To explore the effect of high-frequency repetitive transcranial magnetic stimulation(rTMS)on the feeding function and feeding route of patients with dysphagia after stroke.Methods A total of 60 patients with dysphagia who had indwelling a nasal feeding tube after stroke admitted to the Department of Rehabilitation Medicine of Shaoxing People's Hospital from May 2019 to May 2020 were selected.They were divided into the control group(30 cases)and the observation group(30 cases)according to the random number table method.The control group was given regular feeding training,and the observation group was given feeding training after rTMS.Before and after treatment,the two groups underwent Modified Mann Swallowing Assessment(MMASA)and Functional Oral Ingestion Assessment(FOIS).And the number of extubations after treatment was compared between the two groups.Results Before treatment,there was no statistically significant difference in MMASA score and FOIS scores between the two groups(P>0.05).After treatment,the observation group's MMASA score and FOIS score[(85.03±9.01)points,(5.64±1.42)points]were higher than those of the control group[(77.27±18.66)points,(4.62±1.80)points],and the difference was statistically significant(P<0.05).The number of extubations in the observation group(27 cases)was more than the control group(19 cases),and the difference was statistically significant(P<0.05).Conclusion High-frequency repetitive transcranial magnetic stimulation can improve the level of swallowing and feeding function of patients,and help patients to remove the nasogastric tube as soon as possible and return to normal oral feeding.

关 键 词：脑卒中 吞咽障碍 高频重复经颅磁刺激 摄食训练 拔管 

分 类 号：R743.3[医药卫生—神经病学与精神病学]