认知康复训练配合高频重复经颅磁刺激对脑卒中后认知障碍伴吞咽障碍的疗效分析

Effect of cognitive rehabilitation training combined with high frequency repetitive transcranial magnetic stimulation on cognitive impairment with dysphagia after stroke

目的 观察脑卒中后认知功能障碍伴吞咽困难患者通过高频重复经颅磁刺激(rTMS)与认知康复训练对吞咽功能的改善情况。方法 58例脑卒中后认知障碍伴吞咽困难且能应用高频重复经颅磁刺激及认知康复训练的患者随机分为试验组(29例)和对照组(29例)。对照组在吞咽训练基础上联合认知康复训练,试验组在对照组治疗方法基础上加入高频rTMS。使用标准的吞咽功能评估量表(SSA)对治疗前后的吞咽功能变化进行比较,治疗前后采用蒙特利尔认知评估量表(MoCA)、连线测试(TMT)、数字广度测试(DST)及Stroop色词测试(SCWT)评估两组患者的认知功能。对比两组吞咽功能、认知功能及不良反应发生率。结果 两组患者治疗前认知及吞咽功能比较无统计学意义(P>0.05)。治疗8周后两组吞咽及认知功能均较治疗前提高,且试验组高于对照组(P<0.05)。副作用发生率在两组之间差异无统计学意义(P>0.05)。结论 联合高频rTMS治疗的认知康复训练能有效改善脑卒中后认知相关的吞咽障碍患者的吞咽功能。

Objective To observe the improvement of swallowing function in patients with cognitive dysfunction and dysphagia after stroke by high frequency repetitive transcranial magnetic stimulation(rTMS)and cognitive rehabilitation training.Methods 58 patients with post-stroke cognitive impairment and dysphagia who could apply high-frequency repetitive transcranial magnetic stimulation and cognitive rehabilitation training were randomly divided into experimental group(29 cases)and control group(29 cases).The control group was combined with cognitive rehabilitation training on the basis of swallowing training, and the experimental group was added with high-frequency rTMS.The standard swallowing function assessment scale(SSA)was used to compare and distinguish the changes of swallowing function before and after treatment.The cognitive function of the two groups of patients was assessed by Montreal Cognitive Assessment Scale(MoCA),connection test(TMT),digit span test(DST)and Stroop Color Word Test(SCWT)before and after treatment.The swallowing function, cognitive function and the incidence of adverse reactions were compared between the two groups.Results There was no significant difference in the cognitive and swallowing function between the two groups before treatment(P>0.05).After 8 weeks of treatment, the swallowing and cognitive functions of the two groups were improved compared with those of the control group(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Cognitive rehabilitation training combined with high-frequency rTMS can effectively improve the swallowing function of patients with cognitive related swallowing disorder after stroke.