间断性θ爆发式磁刺激对缺血性脑卒中后吞咽障碍患者吞咽功能、认知功能和皮质兴奋性的影响

Effects of intermittent theta burst magnetic stimulation on swallowing function,cognitive function,and cortical excitability of dysphagia patients after ischemic stroke

目的探究间断性θ爆发式磁刺激(iTBS)对缺血性脑卒中后吞咽障碍患者吞咽功能、认知功能和皮质兴奋性的影响。方法选取89例缺血性脑卒中后吞咽障碍患者,将其随机分为对照组(44例)和观察组(45例)。对照组行假低频重复经颅磁刺激治疗,观察组行iTBS治疗,两组均治疗2周。比较两组患者治疗前后的吞咽功能、认知功能和皮质兴奋性。结果治疗前,两组标准吞咽功能评价(SSA)量表评分、功能性经口摄食量表(FOIS)评分、洼田饮水试验分级差异均无统计学意义(均P>0.05);治疗2周后,观察组SSA量表评分、洼田饮水试验分级均低于对照组,FOIS评分高于对照组(均P<0.05)。治疗前,两组简易精神状态检查(MMSE)量表、蒙特利尔认知评估(MoCA)量表评分差异均无统计学意义(均P>0.05);治疗2周后,观察组MMSE量表、MoCA量表评分均高于对照组(均P<0.05)。治疗前,两组患侧静息运动阈值(RMT)、运动诱发电位(MEP)差异均无统计学意义(均P>0.05);治疗2周后,观察组的患侧RMT、MEP均高于对照组(均P<0.05)。结论iTBS治疗可改善缺血性脑卒中后吞咽障碍患者的吞咽功能和认知功能和皮质层兴奋性。

Objective To investigate the effects of intermittent theta burst magnetic stimulation(iTBS)on swallowing function,cognitive function,and cortical excitability of dysphagia patients after ischemic stroke.Methods A total of 89 dysphagia patients after ischemic stroke were selected and randomly divided into a control group(44 cases)or an observation group(45 cases).The control group underwent pseudo low-frequency repetitive transcranial magnetic stimulation,while the observation group underwent iTBS,and both groups were treated for 2 weeks.The swallowing function,cognitive function,and cortical excitability before and after treatment were compared between the two groups.Results Before treatment,there was no statistically significant difference in standardized swallowing assessment(SSA)scale score,Functional Oral Intake Scale(FOIS)score,or Kubota water drinking test grade between the two groups(all P>0.05).After 2 weeks of treatment,the SSA scale score and the Kubota water drinking test grade in the observation group were lower than those in the control group,and the FOIS score was higher than that in the control group(all P<0.05).Before treatment,there was no statistically significant difference in the Mini-Mental Status Examination(MMSE)scale score or the Montreal Cognitive Assessment(MoCA)scale score between the two groups(all P>0.05).After 2 weeks of treatment,the MMSE and MoCA scales scores in the observation group were higher than those in the control group(all P<0.05).Before treatment,there was no statistically significant difference in resting motor threshold(RMT)on the affected side or motor evoked potential(MEP)between the two groups(all P>0.05).After 2 weeks of treatment,the RMT on the affected side and MEP in the observation group were higher than those in the control group(all P<0.05).Conclusion The iTBS treatment can improve cortical excitability,swallowing function and cognitive function in dysphagia patients after ischemic stroke.