不同时序rTMS联合常规吞咽治疗对缺血性脑卒中吞咽障碍的临床研究

Clinical study on different time sequence repetitive transcranial magnetic stimulation combined with routine swallowing therapy for dysphagia in ischemic stroke

目的:观察不同时序rTMS刺激联合常规吞咽治疗对缺血性脑卒中患者吞咽障碍疗效的影响。方法:选取2020年10月~2021年10月在徐州医科大学第二附属医院神经内科住院的缺血性脑卒中患者60例,用随机数字表法分为常规组、rTMS-常规组、常规-rTMS组,每组20例。分别给予常规康复治疗、rTMS-常规顺序治疗以及常规-rTMS顺序治疗。rTMS刺激患侧运动皮质代表区,采用频率10Hz,治疗强度为80%的静息运动阈值,每次治疗2s,间隔10s,时间20min。3组患者均每日治疗1次,每周5d,连续治疗4周,治疗干预前后分别进行洼田饮水试验、标准吞咽功能评价量表(SSA)以及表面肌电图检查(sEMG)。结果:治疗4周后,3组洼田饮水试验评级较治疗前明显降低(P<0.05),rTMS-常规时序组和常规-rTMS时序组相比常规组洼田饮水试验评级明显降低(P<0.05),与常规-rTMS时序组相比rTMS-常规时序组洼田饮水试验评分明显降低(P<0.05);3组的SSA评分数值较治疗前降低(P<0.05),RMS值较治疗前提高(P<0.05),rTMS-常规组和常规-rTMS组相比常规组,SSA评分明显降低(P<0.05),RMS值明显提高(P<0.05),rTMS-常规治疗时序和常规-rTMS时序相比,RMS数值提高更明显(P<0.05),但是SSA评分差异无统计学意义。结论:rTMS刺激联合常规治疗比单纯常规治疗对于改善脑卒中后的吞咽障碍的效果更好,其中rTMS-常规时序的治疗方案最佳。

Objective:To observe the effectiveness of different time sequence repetitive transcranial magnetic stimulation(rTMS)combined with routine swallowing therapy in the rehabilitation of patients with dysphagia after ischemic stroke.Methods:Totally,60 patients with dysphagia after ischemic stroke who were hospitalized in our hospital from October 2020 to October 2021 were randomly divided into three groups:routine group,rTMS-routine timing group and routine-rTMS timing group.There were 20 cases in each group.Each group received routine rehabilitation training.The rTMS-routine timing group was given rTMS followed by routine rehabilitation training.The routine-rTMS timing group was subjected to routine rehabilitation training followed by rTMS.The frequency of rTMS was 10Hz,stimulation intensity was 80%RMT,stimulation time was 2 s,interval was 10 s,treatment time was 10 min.All the three groups were treated once a day,5 days a week for 4 weeks.Before and after treatment,we evaluated the effectiveness by Wa Tian drinking water test,standardized swallowing assessment(SSA)and surface electromyography(sEMG).Results:After 4 weeks of treatment,the grading of Wa Tian drinking water test in the 3 groups was reduced as compared with that before treatment(P<0.05).The scores in rTMS-routine timing group and the routine-rTMS timing group were significantly lower than those in routine group(P<0.05),and those in rTMS-routine timing group was significantly lower than in routine-rTMS timing group(P<0.05).The SSA score in all groups after treatment was lower than before(P<0.05),and the RMS value was higher than before(P<0.05).rTMS-routine timing group and routine-rTMS timing group had significantly lower SSA scores(P<0.05)and higher RMS values than the routine group(P<0.05).As compared with routine-rTMS timing group,the RMS value in rTMS-routine timing group increased significantly(P<0.05),but there was no significant difference in SSA score.Conclusion:rTMS combined with routine treatment is more effective than routine treatment alone in improving dys-phagia after stroke,and the treatment plan of rTMS-routine timing series is the best.