高频重复经颅磁刺激对脑梗死吞咽功能障碍的影响及相关机制研究  

Effect of high-frequency repetitive transcranial magnetic stimulation on dysphagia in cerebral infarction and its mechanism study

作　　者：林广勇 叶慧敏 黎月桃 宋琴琴 LIN Guang-yong;YE Hui-min;LI Yue-tao(The Second People's Hospital of Foshan(Foshan Hospital Affiliated to Southern Medical University),Foshan 528000,China)

机构地区：[1]佛山市第二人民医院(南方医科大学附属佛山医院),528000

出　　处：《中国实用医药》2024年第1期11-14,共4页China Practical Medicine

基　　金：佛山市科技创新项目(项目编号:2020001005654)。

摘　　要：目的观察高频重复经颅磁刺激(rTMS)对脑梗死患者吞咽功能障碍的影响,并探讨其可能的作用机制。方法10例单侧大脑半球脑梗死伴吞咽功能障碍患者,采用5 Hz高频rTMS刺激患侧大脑半球下颌舌骨肌群的大脑皮质运动代表区。治疗前和治疗2周后,采用标准吞咽功能评价量表(SSA)及视频透视吞咽功能检查(VFSS)对患者吞咽功能进行评估,比较病例组治疗前后吞咽功能。另选取同期在医院体检的11例健康志愿者作为健康人组,比较病例组治疗前后与健康人组的低频振幅(ALFF)。结果治疗后,病例组患者的SSA评分为(20.60±2.20)分,低于治疗前的(24.70±2.93)分,差异有统计学意义(t=3.539,P=0.002<0.05)。治疗后,病例组患者的VFSS评分为(8.20±0.60)分,高于治疗前的(7.10±0.83)分,差异有统计学意义(t=3.396,P=0.003<0.05)。治疗前与健康人组比较,病例组患侧中央前回、辅助运动区的ALFF值降低,差异有统计学意义(P<0.05)。治疗后,病例组患侧中央前回、辅助运动区的ALFF值较治疗前增强,差异有统计学意义(P<0.05)。结论5 Hz高频rTMS作用于患侧大脑半球下颌舌骨肌皮层代表区,可有效改善急性期脑梗死患者的吞咽功能,潜在的康复机制可能与调节了大脑皮质的兴奋性相关。Objective To observe the effect of high-frequency repetitive transcranial magnetic stimulation(rTMS)on dysphagia in patients with cerebral infarction and to explore its possible mechanism.Methods 10 dysphagia patients after unilateral cerebral cerebral infarction were selected,and 5 Hz high-frequency rTMS was used to stimulate the cerebral cortical motor representative area of the mylohyoid muscle group in the affected cerebral hemisphere.Before and 2 weeks after treatment,the swallowing function of the patients was evaluated by standard swallowing assessment(SSA)and video fluoroscopic swallowing study(VFSS),and the swallowing function of patients in case group was compared before and after treatment.In addition,11 healthy volunteers were selected as healthy group.All subjects underwent fMRI examination.The amplitude of low-frequency fluctuations(ALFF)was compared between case group before and after treatment and healthy group.Results After treatment,SSA score in the case group was(20.60±2.20)points,which was lower than that of(24.70±2.93)points before treatment,and the difference was statistically significant(t=3.539,P=0.002<0.05).After treatment,the VFSS score in the case group was(8.20±0.60)points,which was higher than that of(7.10±0.83)points before treatment,and the difference was statistically significant(t=3.396,P=0.003<0.05).Before treatment,the ALFF of the anterior central gyrus and supplementary motor area of the affected hemisphere were weaker than those of healthy group,and the difference was statistically significant(P<0.05).After treatment,the ALFF of the anterior central gyrus and supplementary motor area were higher than those before treatment,and the difference was statistically significant(P<0.05).Conclusion The effect of 5 Hz high-frequency rTMS on the representative region of mylohyoid cortex in the affected cerebral hemisphere can effectively improve the swallowing function of patients with cerebral infarction,and the potential recovery mechanism may be related to the regulation of cerebr

关 键 词：高频 重复经颅磁刺激 脑梗死 吞咽功能障碍 磁共振 

分 类 号：R743.33[医药卫生—神经病学与精神病学]