神经肌肉电刺激单独或联合不同频率经颅磁刺激治疗脑卒中吞咽障碍的疗效观察

Effects of neuromuscular electrical stimulation alone or in a combination with transcranial magnetic stimulation of different frequencies in the treatment of dysphagia in stroke patients

目的研究神经肌肉电刺激(NMES)和不同频率重复经颅磁刺激(rTMs)单独或联合方案治疗脑卒中患者吞咽功能障碍的效果。方法将90例脑卒中后吞咽障碍患者根据随机数字表法平均分为A组(常规吞咽功能训练组)、B组(NMES组)、C组(低频rTMS组)、D组(高频TMS组)、E组(NMES+低频rTMS组)及F组(NMES+高频rTMS组)。洼田饮水实验、标准吞咽功能评价量表和视频透视下吞咽功能检查评估吞咽功能,血红蛋白和血清白蛋白水平评估营养状况。结果各组治疗后吞咽功能均较治疗前有所改善。治疗后B组~F组的洼田饮水实验评分和标准吞咽功能评价量表得分均低于A组(P<0.05),E组、F组的2项评分均低于B组、C组和D组(P<0.05)。各组治疗前血红蛋白和白蛋白水平差异无统计学意义(P>0.05)。治疗后B组~F组血红蛋白和白蛋白水平均高于A组(P<0.05),B组~F组血红蛋白水平差异无统计学意义(P>0.05),E组~F组白蛋白高于B组和D组(P<0.05)。结论NMES、低频或高频rTMS均能改善脑卒中患者吞咽功能障碍,NMES和rTMS联合治疗效果优于单独NMES或rTMS。

Objective To study the effects of neuromuscular electrical stimulation(NMES)alone or in combination with repetitive transcranial magnetic stimulation(rTMs)of different frequencies on swallowing dysfunction in stroke patients.Methods Ninety patients with post-stroke dysphagia were divided into 6 groups according to the random number table:group A(regular swallowing function training),group B(NMES),group C(low-frequency rTMS),group D(high-frequency TMS),group E(NMES+low-frequency rTMS)and group F(NMES+high-frequency rTMS).The Watian drinking water test,the standard scale for evaluating swallowing function and the swallowing function test under video fluoroscopy were carried out to evaluate the swallowing function.Levels of hemoglobin and serum albumin were detected to evaluate nutritional status.Results The swallowing function of each group all improved after treatment.After treatment,group B~F had lower scores than group A in Watian test and the swallowing function scale(P<0.05),and these scores of group E and group F were all lower than those of group B,C and D(P<0.05).There were no significant differences in hemoglobin and albumin levels among all groups before treatment(P>0.05).After treatment,the levels of hemoglobin and albumin in group B~F were all higher than those in group A(P<0.05).There was no significant difference in the levels of hemoglobin among group B~F(P>0.05).The levels of albumin in group E and group F were higher than those in groups B and D(P<0.05).Conclusion NMES,low-frequency or high-frequency rTMS can improve the swallowing dysfunction in stroke patients,and the combined treatment with NMES and rTMS has better effect than NMES or rTMS alone.