高频重复经颅磁刺激联合舌压抗阻反馈训练促进脑梗死后吞咽障碍康复的效果评价

Rehabilitation effectiveness of high-frequency repetitive transcranial magnetic stimulation combined with tongue pressure resistance feedback training for dysphagia of cerebral infarction

目的探讨脑梗死(CI)患者吞咽障碍现状,并分析高频重复经颅磁刺激(rTMS)联合舌压抗阻反馈训练对CI后吞咽功能障碍患者的康复效果。方法选择2017年2月至2021年10月接受治疗的120例CI后吞咽障碍患者作为研究对象,按病历单双号分组,将单号患者纳入对照组(n=60),将双号患者纳入观察组(n=60)。对照组采取常规吞咽训练,观察组采取rTMS联合舌压抗阻反馈训练。比较2组患者干预前、干预4周后洼田饮水试验分级、舌压(舌压峰值、舌压平均值、舌压持续时间)及表面肌电图(sEMG)最大波幅值、吞咽障碍恢复情况[视频透视吞咽检查(VFSS)、误咽误吸评定量表(PAS)、功能性经口进食量表(FOIS)]。结果干预4周后,2组洼田饮水试验分级均有所降低,观察组1级、2级患者占比高于对照组,差异有统计学意义(P<0.05);干预4周后,2组舌压峰值、舌压平均值、sEMG最大波幅值高于干预前,舌压持续时间长于干预前,观察组舌压峰值、舌压平均值、sEMG最大波幅值高于对照组,压持续时间长于对照组,差异有统计学意义(P<0.05);干预4周后,2组VFSS、FOIS高于干预前,PAS低于干预前,观察组VFSS、FOIS高于对照组,PAS低于对照组,差异有统计学意义(P<0.05)。结论rTMS联合舌压抗阻反馈训练能够有效改善CI后吞咽障碍患者舌肌力量,降低吞咽后误吸风险,改善吞咽情况。

Objective To evaluate rehabilitation effectiveness of high-frequency repetitive transcranial magnetic stimulation(rTMS)+tongue pressure resistance feedback training based on the status quo of dysphagia in patients with cerebral infarction(CI).Methods From February 2017 to October 2021,120 CI patients with dysphagia admitted to the hospital were grouped using the odd or even number of medical records.they receive either to conventional swallowing training(control group,odd number,n=60)or rTMS+tongue pressure resistance feedback training(observation group,even number,n=60).The aim was to compare water swallowing test(WST)grade,tongue pressure(TP)[maximum TP(MTP),average TP,duration of TP],surface electromyography(sEMG)peak amplitude,recovery of dysphagia[video fluoroscopic swallowing study(VFSS),penetration-aspiration scale(PAS),functional oral intake scale(FOIS)]on weeks 0,4.Results After intervention,WST grade on week 4 in groups was decreased,the proportion of patients with levelⅠandⅡfor WST increased notably in the observation group compared with the control group(P<0.05).MTP,average TP,sEMG peak amplitude,duration of TP in groups were increased on week 4 vs week 0,which in the observation group was more prevalent(P<0.05).VFSS,FOIS on week 4 in groups were increased,while PAS was decreased,the observation group was superior to the control group(P<0.05).Conclusion For CI patients with dysphagia,rTMS+tongue pressure resistance feedback training are capable effectively improving the tongue muscle strength,reducing the aspiration risk,with improvement of swallowing situation.