重复经颅磁刺激联合动作观察疗法对单侧大脑半球卒中后吞咽障碍的影响

Effect of repetitive transcranial magnetic stimulation combined with action observation therapy on dysphagia after unilateral stroke

目的:探讨重复经颅磁刺激联合动作观察疗法对单侧大脑半球卒中后吞咽障碍患者的吞咽功能和吞咽生命质量的影响。方法:将60例卒中后吞咽障碍(PSD)患者随机分成对照组、重复经颅磁刺激(rTMS)组、动作观察疗法(AOT)组和重复经颅磁刺激结合动作观察疗法(rTMS+AOT)组,每组15例。每组患者均进行常规吞咽功能训练。对照组只接受常规吞咽训练,其余3组在常规吞咽训练的基础上分别接受rTMS或(和)AOT治疗,治疗均为每日1次,每次20min,1周5d,持续4周。治疗前后进行电视透视吞咽检查(VFSS)、标准吞咽功能评估(SSA)和吞咽生命质量量表(SWAL-QOL)评估。结果:治疗4周后,4组患者口腔运送时间(OTT)、吞咽反应时间(SRT)、咽传递时间(PTT)、喉关闭时间(LCT)和SSA评分均较治疗前下降(P<0.05),且SWAL-QOL评分升高(P<0.05)。与对照组比较,其余3组OTT、SRT、PTT、LCT和SSA评分均明显下降(P<0.05),SWAL-QOL评分明显增高(P<0.05)。其中rTMS组和AOT组差异无统计学意义,但是rTMS+AOT组与rTMS组和AOT组比较,OTT、SRT、PTT、LCT和SSA评分均明显下降(P<0.05),SWAL-QOL评分明显增高(P<0.05)。结论:rTMS和AOT均能提高PSD患者的吞咽功能和吞咽生命质量,但是rTMS结合AOT的效果优于单一的rTMS和AOT。

Objective:To investigate the effect of repetitive transcranial magnetic stimulation(rTMS)combined with action observation therapy(AOT)on swallowing function and swallowing quality of life in patients with dysphagia after unilateral cerebral hemisphere stroke.Methods:A total of 60 patients with post-stroke dysphagia(PSD)were randomly divided into control group,rTMS group,AOT group and (rTMS+AOT)group,n=15 in each group.Each group received routine swallowing function training,once a day,20 min each time,5 days a week,for 4 weeks.The control group only received routine swallowing training,and the other three groups received rTMS or(and)AOT on the basis of routine swallowing training,respectively.The rTMS and AOT were treated once a day,20 min each time,5 days a week,for 4 weeks.Videofluoroscopic Swallowing Study(VFSS),Standardized Swallowing Assessment(SSA)and Swallow Quality-of-Life Questionnaire(SWAL-QOL)were evaluated before and after treatment.Results:After 4 weeks of treatment,oral transport time(OTT),swallowing reaction time(SRT),pharyngeal transport time(PTT),laryngeal closure time(LCT)and SSA scores in four groups were decreased as compared with those before treatment,and SWAL-QOL scores increased(P<0.05).As compared with the control group,OTT,SRT,PTT,LCT and SSA scores were significantly decreased in the other three groups,and SWAL-QOL scores were significantly increased(P<0.05).There was no statistically significant difference between the rTMS group and the AOT group,but the effect of rTMS+AOT group was significantly better than that of the rTMS group and the AOT group(P<0.05).Conclusion:Both rTMS and AOT can improve the swallowing function and swallowing quality of life of PSD patients,but the effect of rTMS combined with AOT is better than that of single rTMS and AOT.