超低频重复经颅磁刺激治疗老年人急性脑梗死吞咽障碍的疗效及对生存质量的影响

Effect of ultra-low frequency repetitive transcranial magnetic stimulation on dysphagia in elderly patients with acute cerebral infarction and quality of life

目的:探讨超低频重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)治疗老年人急性脑梗死吞咽障碍的临床疗效及对生存质量的影响。方法:将60例老年急性脑梗死吞咽障碍患者随机分为rTMS组和对照组,每组30例,两组均进行常规药物治疗和吞咽功能训练,rTMS组另加超低频(10 MHz)重复经颅磁刺激治疗,疗程14 d。观察比较两组治疗前后国立卫生研究院卒中量表(national institutes of health stroke scale,NIHSS)评分、日常生活活动(activity of daily living,ADL)能力评定量表评分、神经元特异性烯醇化酶(neuron-specific enolase,NSE)血清水平、洼田饮水试验、藤岛一郎吞咽障碍量表评分、吞咽障碍特异性生活质量量表(swallowing related quality of life,SWAL-QOL)及中文版生活质量量表简表(medical outcomes study short form 36 scale,SF-36)评分变化情况。采用洼田饮水实验评估患者的临床疗效。结果:rTMS组治疗后临床有效率较对照组明显提升(P<0.05),NIHSS评分、血清NSE水平较对照组显著降低(P<0.05),ADL评分、藤岛一郎吞咽障碍评分、SWAL-QOL评分、SF-36各维度评分及总评分较对照组显著上升(P<0.05)。治疗后SF-36总评分及SWAL-QOL评分与NSE血清水平、NIHSS量表评分呈负相关,与ADL评分、藤岛一郎吞咽障碍评分呈正相关。结论:超低频rTMS治疗可降低血清NSE水平、有效改善老年人急性脑梗死吞咽障碍以及显著提高老年患者的生存质量。

Objective:To investigate the effect of ultra-low frequency repetitive transcranial magnetic stimulation on dysphagia in elderly patients with acute cerebral infarction and quality of life.Methods:A total of 60 elderly patients with dysphagia caused by acute cerebral infarction were randomly divided into rTMS group and control group,30 cases in each group.Both groups received routine drug therapy and swallowing function training.rTMS group was additionally treated with ultra-low frequency(10 MHz)repetitive transcranial magnetic stimulation for 14 d.The changes of NIHSS score,ADL score,NSE serum level,Wada drinking water test,Fujishima Ichiro swallowing disorder scale score,SWAL-QOL score and SF-36 score were observed and compared between the two groups before and after treatment.The clinical effect was evaluated by Wada drinking water experiment.Results:After treatment,the clinical effective rate in rTMS group was significantly higher compared with that in the control group(P<0.05),NIHSS score and serum NSE level were significantly reduced(P<0.05),while ADL score,Fujishima Ichiro swallowing disorder score,SWAL-QOL score,SF-36 scores were significantly increased compared with the control group(P<0.05).After treatment,SF-36 score and SWAL-QOL score were negatively correlated with NSE serum level and NIHSS score,but positively correlated with ADL score and Fujishima Ichiro swallowing disorder score.Conclusion:Ultra-low frequency rTMS therapy can reduce NSE level,effectively alleviate dysphagia in elderly patients with acute cerebral infarction and significantly improve the quality of life of elderly patients.