经颅直流电刺激联合吞咽康复训练治疗脑卒中恢复期咽期吞咽困难的临床疗效观察

Clinical efficacy of transcranial direct current stimulation combined with rehabilitation training in the treatment of pharyngeal dysphagia in convalescent stroke patients

目的探讨经颅直流电刺激(tDCS)联合吞咽康复训练治疗脑卒中恢复期咽期吞咽困难的临床效果。方法收集2017年8月至2020年3月杭州市中医院脑卒中恢复期咽期吞咽困难患者42例,随机分为观察组和对照组,每组各21例,共治疗3周。对照组患者接受常规吞咽康复训练,观察组患者在对照组的基础上加用tDCS治疗。治疗前和治疗后3周,分别评估两组患者的洼田饮水试验(WST)、Rosenbek渗透/误吸量表(PAS)、电视透视吞咽困难量表(VDS)。结果治疗前,两组患者WST、PAS和VDS评分比较,差异无统计学意义(P>0.05)。治疗3周后,两组患者WST、PAS和VDS评分较组内治疗前均有好转,差异有统计学意义(P<0.05);且同时间点观察组患者的WST、PAS和VDS评分优于对照组患者,差异有统计学意义(P<0.05)。结论在常规吞咽康复治疗基础上,联合tDCS治疗可有效改善脑卒中恢复期咽期吞咽困难患者的吞咽功能,进一步提高临床疗效,具有操作简单、安全可靠等特点,为脑卒中后吞咽困难的治疗与临床研究提供新思路。

Objective To investigate the clinical efficacy of transcranial direct current stimulation(tDCS)combined with rehabilitation training in treating pharyngeal dysphagia in convalescent stroke patients.Methods From August 2017 to March 2020,42 patients with pharyngeal dysphagia in convalescent stage of stroke in Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University were selected and randomly divided into two groups by random number table,with 21 cases in each group.The patients were treated for three weeks.The control group was treated with conventional swallowing rehabilitation training,and the treatment group was treated with basic tDCS based on the control group.The Water swallow test,videofluoroscopic dysphagia scale(VDS),and Rosenbek penetration/aspiration scale(PAS)were assessed in both groups before and three weeks after treatment.Results Before treatment,there was no significant difference in Water swallow test,VDS,and PAS scores between the two groups(P>0.05).After treatment for three weeks,the Water swallow test,VDS,and PAS scores of the two groups were improved compared with those before treatment.The differences had statistical significance(P<0.05).The improvement of the Water swallow test,VDS,and PAS scores was more significant in the treatment group,and the differences had statistical significance(P<0.05).Conclusion tDCS based on conventional rehabilitation can effectively improve the swallowing function of patients with pharyngeal dysphagia in the convalescent stage of stroke,and can further improve the clinical efficacy.It has the characteristics of simple operation,safety,and reliability,providing new ideas for the clinical research and treatment of pharyngeal dysphagia after stroke.