高频rTMS联合舌三针治疗卒中后吞咽障碍伴抑郁疗效

目的探讨高频重复经颅磁刺激(rTMS)结合舌三针治疗卒中后吞咽障碍伴抑郁患者的临床疗效。方法脑卒中吞咽功能障碍伴抑郁患者86例,均行常规吞咽康复训练,并随机接受rTMS±舌三针治疗(rTMS+舌三针组)和单纯舌三针治疗(舌三针组),1次/d,5次/周,疗程1个月。应用X线荧光透视检查(VFSS)、吞咽标准吞咽功能评定量表(SSA)及汉密尔顿抑郁量表(HAMD)评价疗效。结果治疗后rTMS+舌三针组SSA评分(38.19±2.72)vs(24.56±3.95)和舌三针组SSA得分(38.30±2.34)vs(29.91±4.46)均下降(P<0.05),rTMS±舌三针组VFSS评分(5.72±0.76)vs(8.40±0.90)与舌三针组VFSS得分(5.74±0.82)vs(7.58土1.03)均增加(P<0.05),rTMS+舌三针组HAMD评分(22.21±6.07)vs(9.53±3.32)和舌三针组HAMD(22.40±6.50)vs(14.28±5.30)均下降(P<0.01)。治疗后,rTMS+舌三针组VFSS评分高于舌三针组(P<0.05),SSA及HAMD评分低于舌三针组(P<0.05)。结论rTMS和舌三针联合治疗在改善抑郁,提高吞咽功能方面均优于单纯舌三针,两者结合治疗脑卒中表现出协同增效的潜在应用价值。

Objective To study the clinical effect of high frequency rTMS combined with three tongue acupuncture in the treatment of post-stroke dysphagia with depression.Methods 86 cases of stroke patients with dysphagia and depression were treated with routine swallowing rehabilitation training,and randomly received rTMS+tongue three needle group(rTMS+tongue three needle group,43 cases)and simple tongue three needle therapy(tongue three needle group),once a day,five times a week,for one month.VFSS,SSA and HAMD were used as evaluation indexes.The data were analyzed by spss20.0.Results Compared with the same group,the SSA score of rTMS+three tongue acupuncture group(38.19±2.72)vs(24.56±3.95)and SSA score(38.30±2.34)vs(29.91±4.46)decreased after treatment(P<0.05),VFSS score of rTMS+tongue three needle group(5.72±0.76)vs(8.40±0.90)and VFSS score of three tongue acupuncture group(5.74±0.82)vs(7.58±1.03)increased(P<0.05),while HAMD of rTMS+three tongue acupuncture group increased(5.74+0.82)vs(7.58±1.03)(P<0.05)The scores of HAMD(22.21±6.07)vs(9.53±3.32)and HAMD(22.40±6.50)vs(14.28±5.30)in the three tongue acupuncture group decreased(P<0.01).After treatment,VFSS score of rTMS+tongue three needle group was higher than that of tongue three needle group(P<0.05),SSA and HAMD score were lower than that of tongue three needle group(all P<0.05).Conclusion rTMS combined with three tongue acupuncture is superior to single tongue three needle in improving depression and swallowing function.The combination of rTMS and three tongue acupuncture has synergistic potential application value in the treatment of stroke.