双侧重复经颅磁刺激联合肌电生物反馈治疗脑卒中吞咽障碍的临床研究  

Clinical study of bilateral repetitive transcranial magnetic stimulation combined with electromyographic biofeedback in the treatment of dysphagia after stroke

作　　者：吴晶 张伟 陈焱强 徐婷 文妮 段璨 李正良 郑婵娟 Wu Jing;Zhang Wei;Chen Yanqiang(Hubei Provincial Hospital of Integrated Chinese and Western Medicine,Wuhan 430015,China)

机构地区：[1]湖北省中西医结合医院康复医学中心,武汉430015

出　　处：《中国康复》2023年第6期323-327,共5页Chinese Journal of Rehabilitation

基　　金：湖北省自然科学基金项目(2021CFB359);湖北省卫健委中医面上项目(ZY2021M101)。

摘　　要：目的:探讨健侧低频加患侧高频重复经颅磁刺激(rTMS)联合肌电生物反馈疗法治疗脑卒中后吞咽障碍(PSD)患者的临床疗效。方法:将100例脑卒中吞咽障碍患者随机分为对照组和观察组各50例。2组均予以常规内科药物治疗和吞咽康复训练,对照组予以肌电生物反馈训练、rTMS假刺激,观察组予以肌电生物反馈训练和rTMS治疗,分别为健侧1Hz和患侧10Hz刺激。使用洼田饮水试验分级,Rosenbek渗漏-误吸评分(PAS)和功能性经口摄食分级(FOIS)评估患者的吞咽功能,采用吞咽生命质量量表(SWAL-QOL)评估病人的生活质量,并于治疗结束后评估2组的临床疗效。结果:经过2周治疗,观察组总有效率为93.88%,对照组总有效率为73.47%,观察组总有效率明显高于对照组(P<0.05);2组患者PAS、FOIS及SWAL-QOL评分与治疗前比较明显提高(P<0.05),且观察组的PAS、FOIS及SWAL-QOL评分均高于对照组(P<0.05);治疗后洼田饮水评估比较观察组优于对照组(P<0.05)。结论:双侧rTMS联合表面肌电生物反馈能较好地改善脑卒中患者的吞咽功能和生活质量。Objective:To observe the clinical efficacy of low-frequency repetitive transcranial magnetic stimulation(rTMS)acting on the healthy hemisphere and high-frequency rTMS acting on the affected hemisphere combined with electromyographic(EMG)biofeedback therapy in patients with post-stroke dysphagia(PSD).Methods:A total of 100 stroke patients were randomly divided into the control group and the experimental group with 50 patients in each group.Both groups were all treated with routine medication and swallowing rehabilitation training,the control group was treated with EMG biofeedback training and sham rTMS,and the experimental group was treated additionally with rTMS and EMG biofeedback training.The low-frequency of rTMS acting on the healthy hemisphere was 1 Hz,and the high-frequency of rTMS acting on the affected hemisphere was 10 Hz.The swallowing function of patients was evaluated by the water swallowing test,and the Rosenbek Penetration-Aspiration Scale(PAS)and the functional oral intake scale(FOIS).The swallowing quality of life scale(SWAL-QOL)was used to evaluate the patients’swallowing quality of life.The clinical efficacy of the two groups was evaluated at the end of treatment.Results:After 2 weeks of treatment regimens,the total effective rate was 93.88%in the experimental group,and 73.47%in the control group(P<0.05).The scores of swallowing function and quality of life in the two groups were significantly improved as compared with those before treatment(P<0.05).The scores of PAS,FOIS and SWAL-QOL in the experimental group were better than those in the control group(P<0.05).The water swallowing test in the experimental group was better than in the control group after treatment.Conclusion:The rTMS acting on the bilateral brain combined with EMG biofeedback can improve the swallowing function and swallowing quality of life of stroke patients.

关 键 词：双侧重复经颅磁刺激 肌电生物反馈 脑卒中 吞咽障碍 

分 类 号：R49[医药卫生—康复医学] R743.3[医药卫生—临床医学]