rTMS联合温针灸治疗脑卒中后吞咽障碍疗效观察  

Therapeutic efficacy of rTMS combined with warm acupuncture on post-stroke dysphagia

作　　者：任慧 张思鈺 魏衍旭 李映彩 陈怡婷 冷军[2] REN Hui;ZHANG Siyu;WEI Yanxu;LI Yingcai;CHEN Yiting;LENG Jun(School of Rehabilitation,Shandong University of Traditional Chinese Medicine,Jinan 250000,Shandong,China;The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine,Jinan 250000,Shandong,China)

机构地区：[1]山东中医药大学康复医学院,山东济南250000 [2]山东中医药大学第二附属医院,山东济南250000

出　　处：《现代中西医结合杂志》2024年第8期1081-1085,共5页Modern Journal of Integrated Traditional Chinese and Western Medicine

基　　金：齐鲁医派中医学术流派传承项目(鲁卫涵[2022]93号);福建省国家中医临床研究基地专项科研课题(JDZX201915)。

摘　　要：目的观察重复经颅磁刺激(rTMS)联合温针灸治疗脑卒中后吞咽障碍的疗效。方法选取2021年1月—2022年8月在山东中医药大学第二附属医院住院治疗的脑卒中后吞咽障碍患者60例,按随机数字表法分为rTMS组、温针灸组和联合组,每组20例。3组患者均进行常规吞咽康复训练,rTMS组在此基础上增加rTMS治疗,温针灸组增加温针灸治疗,联合组增加rTMS和温针灸治疗,3组均连续治疗4周。于治疗前、治疗4周后分别对3组患者进行Rosenbek渗漏/误吸量表(PAS)、标准吞咽功能评估量表(SSA)、吞咽生活质量量表(SWAL-QOL)和洼田饮水试验评估,比较3组临床疗效。结果治疗4周后与治疗前相比,3组患者PAS评分、SSA评分降低,SWAL-QOL评分提高,洼田饮水试验分级改善,且联合组上述各项评分及洼田饮水试验分级改善情况均明显优于rTMS组和温针灸组,差异均有统计学意义(P均<0.05)。联合组总有效率明显高于rTMS组和温针灸组[85%(17/20)比55%(11/20)、50%(10/20),P均<0.05]。结论在常规吞咽康复训练基础上增加rTMS联合温针灸治疗,能够显著改善脑卒中患者吞咽功能障碍。Objective It is to observe the efficacy of repetitive transcranial magnetic stimulation(rTMS)combined with warm acupuncture in the treatment of post-stroke dysphagia.Methods Sixty patients with post-stroke dysphagia who were hospitalized in the Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine from January 2021 to August 2022 were selected and divided into rTMS group,warm acupuncture group and combination group according to randomized number table method,with 20 patients in each group.The patients of the three groups were all given conventional swallowing rehabilitation,additionally,the rTMS group was treated with rTMS,the warm acupuncture group was treated with warm acupuncture,and the combination group was treated with rTMS combined with warm acupuncture,all the three groups were continuously treated for 4 weeks.The patients of the three groups were evaluated by Rosenbek Penetration-Aspiration Scale(PAS),Standardized Swallowing Assessment Scale(SSA),Swallowing Quality of Life(SWAL-QOL)and Kubota Drinking Water Test before and after 4 weeks of treatment,the clinical efficacies of the three groups were compared.Results After 4 weeks of treatment,the PAS scores,SSA scores of patients of the three groups were decreased,while the SWAL-QOL scores were increased,and Kubota Drinking Water Test classifications were improved compared with before treatment,and the improvements of the above scores and Kubota Drinking Water Test classification in the combination group were significantly better than those in the rTMS group and warm acupuncture group,the differences were all statistically significant(all P<0.05).The total effective rate of the combination group was significantly higher than those of the rTM S group and warm acupuncture group[85%(17/20)VS.55%(11/20)and 50%(10/20),both P<0.05].Conclusion rTMS combined with warm acupuncture based on routine swallowing rehabilitation training can significantly improve the swallowing dysfunction in patients with stroke.

关 键 词：吞咽障碍 脑卒中 重复经颅磁刺激 温针灸 

分 类 号：R743.33[医药卫生—神经病学与精神病学]