不同电磁刺激方案干预脑卒中后假性球麻痹吞咽障碍的对比研究  

A comparative study of different electromagnetic stimulation schemes in the intervention of post stroke pseudobulbar paralysis swallowing disorders

作　　者：罗雅丽[1] 陈劲松[1] 陈莎莎 苏牟潇[1] 白洁[1] 刘双[1] LUO Yali;CHEN Jinsong;CHEN Shasha;SU Mouxiao;BAI Jie;LIU Shuang(Rehabilitation Medicine Department,Mianyang Central Hospital,Mianyang,Sichuan 621000,China)

机构地区：[1]绵阳市中心医院康复医学科,四川绵阳621000

出　　处：《中华全科医学》2024年第4期669-673,共5页Chinese Journal of General Practice

基　　金：康复医学四川省重点实验室开放课题(KFYX-SZDSYS-06)。

摘　　要：目的对比不同组合的电磁刺激方案治疗假性球麻痹的疗效,为治疗方案的优化提供借鉴。方法选择2022年1月—2023年3月绵阳市中心医院脑卒中后假性球麻痹患者120例,采用随机数字表法分为对照组、经颅直流电刺激(tDCS)+表面神经肌肉电刺激(NMES)组、重复经颅磁刺激(rTMS)+NMES组、tDCS+rTMS组,每组30例。对照组给予常规治疗,其余3组进行不同组合的电磁刺激。评估藤岛一郎吞咽疗效评分、标准吞咽功能量表(SSA)、吞咽困难生活质量量表(SWAL-QOL);纤维光学内镜检查(FEES)下的PAS分级;舌骨喉复合体动度;平均肌电值(AEMG)。结果治疗后rTMS+NMES组藤岛一郎评分[(5.04±0.79)分]高于对照组[(3.51±0.64)分]、tDCS+NMES组[(4.19±0.79)分]、tDCS+rTMS组[(3.96±0.73)分];rTMS+NMES组SSA均低于其余3组(P<0.05)。而SWAL-QOL评分,rTMS+NMES组仅高于对照组,与其余2组差异无统计学意义;PAS分级rTMS+NMES组均优于其余3组(P<0.05);在骨喉复合体动度,rTMS+NMES组舌骨上移和前移距离均高于其余3组(P<0.05);在sEMG检查中,rTMS+NMES组高于对照组和tDCS+NMES组(P<0.05)。结论rTMS+NMES组合治疗假性球麻痹的整体效果更优。Objective To compare the efficacy of different combinations of electromagnetic stimulation schemes in the treatment of pseudobulbar palsy,and provide reference for the optimization of treatment plans.Methods A total of 120 patients with pseudobulbar palsy after stroke were selected at Mianyang Central Hospital from January 2022 to March 2023.They were randomly divided into four groups:a control group,a group receiving transcranial direct current stimulation(tDCS)+neuromuscular electrical stimulation(NMES),a group receiving repetitive transcranial magnetic stimulation(rTMS)+NMES,and a group receiving tDCS+rTMS.Each group consisted of 30 cases.The control group received routine treatment,while the other three groups received different combinations of electromagnetic stimulation.The evaluation included the swallowing efficacy score of Ichiro Fujishima,the standardized swallowing assessment(SSA),the swallowing-quality of life(SWAL-QOL),PAS grading under fiberoptic endoscopic evaluation of swallowing(FEES),hyoid laryngeal complex motility,and average surface electromyography(AEMG).Results After treatment,the rTMS+NMES group exhibited significantly higher Ichiro Fujishima's swallowing efficacy scores(5.04±0.79)compared to the control group(3.51±0.64),tDCS+NMES group(4.19±0.79),and tDCS+rTMS group(3.96±0.73).The rTMS+NMES group also demonstrated a significantly lower SSA than the other three groups(P<0.05).In terms of SWAL-QOL,the rTMS+NMES group only showed improvement compared to the control group,with no difference when compared to the other two groups.However,in PAS assessment,the rTMS+NMES group was superior to the other three groups(P<0.05).Regarding mobility of the bone throat complex,the rTMS+NMES group displayed a greater distance of upward and forward movement of the hyoid bone compared to all other groups(P<0.05).Additionally,rTMS+NMES group revealed higher sEMG than both control and tDCS+NMES groups(P<0.05).Conclusion The combination of rTMS+NMES has the best overall effect in the treatment of pseudobulb

关 键 词：电磁刺激 脑卒中 假性球麻痹 吞咽障碍 “中枢-外周” 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R454.1[医药卫生—临床医学]