小脑间歇性θ短阵脉冲刺激对小脑卒中吞咽障碍的影响及机制  

The efficacy and mechanism of theta burst stimulation for the relief of dysphasia after a stroke

作　　者：李坤彬 吴志远 温小鹏 李小杏 姚先丽 孙平鸽 窦祖林 Li Kunbin;Wu Zhiyuan;Wen Xiaopeng;Li Xiaoxing;Yao Xianli;Sun Pingge;Dou Zulin(Department of Neurological Rehabilitation Medicine,Zhengzhou Central Hospital,Zhengzhou University,Zhengzhou 450006,China;Department of Rehabilitation Medicine,The Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China)

机构地区：[1]郑州大学附属郑州中心医院,郑州450006 [2]中山大学附属第三医院,广州510630

出　　处：《中华物理医学与康复杂志》2021年第12期1100-1104,共5页Chinese Journal of Physical Medicine and Rehabilitation

基　　金：国家自然科学基金(81972159);广东省自然科学基金(2020A1515010881);河南省医学科技攻关计划(201702309)。

摘　　要：目的研究小脑间歇性θ短阵脉冲刺激(iTBS)对小脑卒中后吞咽功能障碍的影响及机制。方法选取小脑卒中后合并吞咽障碍的患者62例,采用随机数字表法将其分为观察组(32例)和对照组(30例),观察组和对照组分别剔除3例、1例,最终均纳入29例。2组患者均予以常规吞咽康复训练,观察组在此基础上给予iTBS治疗,对照组给予假刺激。治疗前、治疗4周后,记录2组患者双侧舌骨上肌群运动诱发电位(MEP)的潜伏期和波幅;对反射性吞咽和自主性吞咽状态下,2组患者不同大脑部位的非线性指数近似熵(ApEn)进行比较;采用渗漏-误吸量表(PAS)对2组患者的吞咽功能进行评估。结果观察组治疗4周后双侧舌骨上肌群MEP潜伏期下降(P<0.05)。2组患者治疗4周后双侧舌骨上肌群MEP波幅较治疗前升高(P<0.05)。与对照组治疗4周后比较,观察组双侧舌骨上肌群MEP潜伏期较低、波幅较高(P<0.05)。2组患者治疗4周后反射性吞咽、自主性吞咽状态下C3、C4、P3、P4、T5、T6 ApEn升高(P<0.05)。观察组治疗4周后反射性吞咽、自主性吞咽状态下C3、C4、P3、P4、T5、T6 ApEn高于对照组(P<0.05)。治疗4周后,2组患者吞咽功能改善(P<0.05)。与对照组比较,观察组治疗4周后PAS分级[(1.83±0.72)级]较为优异(P<0.05)。结论iTBS治疗可改善小脑卒中后吞咽障碍患者的吞咽功能,其机制可能是iTBS刺激提高了小脑卒中患者的大脑皮质兴奋性,增加了吞咽肌群的运动控制能力。Objective To observe any effect of intermittent theta burst stimulation(iTBS)of the cerebellum on swallowing dysfunction after cerebellar infarction,and to explore its mechanism.Methods Sixty-two cerebellar stroke survivors with dysphagia were randomly divided into an observation group and a control group,each of 29.In addition to the routine swallowing rehabilitation training,the observation group was treated with iTBS,while the control group was given sham iTBS.The incubation and amplitude of the bilateral suprahyoid muscle motor evoked potential(MEP)were recorded before and after 4 weeks of treatment.The exponential approximate entropy(ApEn)of different brain regions was compared between the two groups during reflex and autonomous swallowing.Swallowing function was evaluated using the penetration-aspiration scale(PAS).Results MEP incubation in the bilateral suprahyoid muscles had decreased significantly after 4 weeks of treatment in the observation group,and the MEP amplitude in the bilateral suprahyoid muscles of the two groups had increased significantly.The average improvement in the amplitude and incubation in the observation group was significantly greater than in the control group.The average ApEn at C3,C4,P3,P4,T5 and T6 had increased significantly in both groups during both reflex and spontaneous swallowing,with the improvement in the observation group significantly greater.Swallowing function had improved significantly in both groups,but the average PAS grade of the observation group was again significantly better.Conclusions iTBS can improve the swallowing function of dysphagic cerebellar stroke survivors.This may be due to iTBS improving the excitability of the cerebral cortex and improving motor control of the swallowing muscles.

关 键 词：小脑间歇性θ短阵脉冲刺激 小脑卒中 运动诱发电位 大脑皮质兴奋性 吞咽功能 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R493[医药卫生—临床医学]