重复经颅磁刺激联合励-协夫曼言语治疗对脑卒中后吞咽障碍联合嗓音障碍患者嗓音质量的影响研究  

Effect of Repeated Transcranial Magnetic Stimulation Combined with Lee Silverman Voice Treatment on Vocal Quality in Patients with Post-Stroke Dysphagia Combined with Voice Disorders

作　　者：吉莉 周蓓 吕翔 居月 陈宏梅 贺磊 刘萍 JI Li;ZHOU Bei;LYU Xiang;JU Yue;CHEN Hongmei;HE Lei;LIU Ping(Department of Neurology,Northern Jiangsu People's Hospital,Yangzhou 225001,China;School of Public Health and Nursing,Yangzhou University,Yangzhou 225001,China)

机构地区：[1]苏北人民医院神经内科,江苏省扬州市225001 [2]扬州大学护理学院·公共卫生学院,江苏省扬州市225001

出　　处：《实用心脑肺血管病杂志》2024年第11期120-124,共5页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：江苏省医学科研项目面上项目(M2022059);江苏省人兽共患病学重点实验室“护馨基金”(HX2207);扬州市卫生健康委2023年医学科研立项指导性项目(2023-4-04);江苏省苏北人民医院院级护理研究专项基金(SBHL23029)。

摘　　要：目的探讨重复经颅磁刺激(rTMS)联合励-协夫曼言语治疗(LSVT)对脑卒中后吞咽障碍(PSD)联合嗓音障碍患者嗓音质量的影响。方法前瞻性选取2023年苏北人民医院收治的PSD联合嗓音障碍患者80例为研究对象,采用随机数字表法将患者分为联合组和对照组,每组40例。对照组患者接受LSVT,联合组患者接受rTMS联合LSVT,均持续干预3个月。干预前、干预后即刻及干预后30 d评估患者嗓音障碍指数(VHI)评分、嗓音声学客观评估指标(基频、基频微扰、振幅微扰、谐噪比)、汉密尔顿焦虑量表(HAMA)评分。结果干预方法与时间在功能、生理、情感维度得分及VHI总分上存在交互作用(P<0.05),干预方法、时间在功能、生理、情感维度得分及VHI总分上主效应显著(P<0.05)。干预后即刻及干预后30 d联合组功能、生理、情感维度得分及VHI总分低于对照组(P<0.05)。干预方法与时间在基频、基频微扰、振幅微扰、谐噪比上存在交互作用(P<0.05),干预方法、时间在基频、基频微扰、振幅微扰、谐噪比上主效应显著(P<0.05)。干预后即刻及干预后30 d联合组基频、谐噪比高于对照组,基频微扰、振幅微扰低于对照组(P<0.05)。干预方法与时间在HAMA评分上存在交互作用(P<0.05),干预方法、时间在HAMA评分上主效应显著(P<0.05)。干预后即刻及干预后30 d联合组HAMA评分低于对照组(P<0.05)。结论rTMS联合LSVT能改善PSD联合嗓音障碍患者的VHI评分、基频、基频微扰、振幅微扰、谐噪比,缓解其焦虑情绪。Objective To explore the effect of repeated transcranial magnetic stimulation(rTMS)combined with Lee Silverman voice treatment(LSVT)on vocal quality in patients with post-stroke dysphagia(PSD)combined with voice disorders.Methods A total of 80 patients with PSD admitted to Northern Jiangsu People's Hospital in 2023 were prospectively selected as the study subjects.A randomized numbeRtable method was used to divide the patients into the combined group and the control group,with 40 cases in each group.Patients in the control group received LSVT.and patients in the combined group received rTMS combined with LSVT,both foR3 months.Voice Handicap Index(VHI)score,objective assessment indices foRnoise acoustic(fundamental frequency,fundamental frequency perturbation,amplitude perturbation,harmonic-to-noise ratio),and Hamilton Anxiety Scale(HAMA)score were assessed before intervention,immediately afteRintervention and 30 d afteRintervention.Results There was an interaction between treatment method and time on the functional,physical,and emotional dimension scores and the total VHI score(P<0.05),treatment method and time produced significant main effects on the functional,physical,and emotional dimension scores and the total VHI score(P<0.05).Immediately afteRintervention and 30 d afteRintervention,the functional,physical,and emotional dimension scores and the total VHI score in the combined group were loweRthan those in the control group(P<0.05).There was an interaction between treatment method and time on the fundamental frequency,fundamental frequency perturbation,amplitude perturbation,and harmonic-to-noise ratio(P<0.05),treatment method and time produced significant main effects on the fundamental frequency,fundamental frequency perturbation,amplitude perturbation,and harmonicto-noise ratio(P<0.05).Immediately afteRintervention and 30 d afteRintervention,the fundamental frequency and harmonic-tonoise ratio in the combined group were higheRthan those in the control group,and fundamental frequency perturbation,amplitude

关 键 词：卒中 吞咽障碍 嗓音障碍 经颅磁刺激 励-协夫曼言语治疗 

分 类 号：R743[医药卫生—神经病学与精神病学] R571[医药卫生—临床医学] R767.64