配对关联刺激治疗脑卒中后吞咽障碍的临床研究

Clinical study of paired associative stimulation in the treatment of post-stroke dysphagia

目的探讨配对联合刺激(PAS)治疗脑卒中后吞咽障碍(PSD)的临床疗效。方法选取2021年1-12月该院首次发生脑卒中的PSD患者60例,根据损伤部位及治疗方式分为PAS皮质组、皮质对照组、PAS脑干组、脑干对照组,各15例,PAS皮质组、PAS脑干组在常规吞咽治疗基础上行PAS治疗,皮质对照组、脑干对照组在常规吞咽治疗基础上联合低频电刺激+rTMS治疗。比较各组表面肌电图(sEMG)最大波幅及标准吞咽功能评定量表(SSA)评分。结果4组治疗前SSA评分及sEMG最大波幅比较,差异无统计学意义(P>0.05)。各组治疗后SSA评分及sEMG最大波幅较治疗前提高,差异有统计学意义(P<0.05)。4组治疗后SSA评分及sEMG最大波幅比较,差异有统计学意义(P<0.05),其中,PAS皮质组与其余各组比较,差异有统计学意义(P<0.05),而其余各组间比较,差异无统计学意义(P>0.05)。结论PAS治疗PSD效果显著,可更好地改善患者吞咽功能障碍。

Objective To explore the clinical effect of paired associative stimulation(PAS)in the treatment of post-stroke dysphagia(PSD).Methods 60 PSD patients with the first stroke in this hospital from January to December 2021 were selected and divided into the PAS cortex group,the cortex control group,the PAS brainstem group and the brainstem control group according to the injury site and treatment method,with 15 cases in each group.The PAS cortex group and the PAS brainstem group were treated with PAS on the basis of conventional swallowing treatment,while the cortex control group and the brainstem control group were treated with low-frequency electrical stimulation+repetitive transcranial magnetic stimulation(rTMS)on the basis of conventional swallowing treatment.The maximum amplitude of surface electromyography(sEMG)and the score of standardized swallowing assessment(SSA)were compared in each group.Results There were no statistically significant differences in SSA score and sEMG maximum amplitude among the four groups before treatment(P>0.05).After treatment,SSA score and sEMG maximum amplitude were significantly higher than those before treatment in each group,and the differences were statistically significant(P<0.05).There were statistically significant differences in SSA score and sEMG maximum amplitude among the four groups after treatment(P<0.05),among which,there were statistically significant differences between the PAS cortex group and the other groups(P<0.05),but there were no statistically significant differences among the other groups(P>0.05).Conclusion PAS is effective in the treatment of PSD and can better improve swallowing dysfunction in patients.