重复经颅磁刺激联合酸冰刺激疗法对脑卒中后吞咽障碍的干预作用

Intervention treatment of repeated transcranial magnetic stimulation combined with acid-ice stimulation therapy for swallowing disorders after stroke

目的探讨重复经颅磁刺激与酸冰刺激相结合治疗对脑卒中后吞咽障碍的干预作用。方法选取2019年1月—2021年1月我院收治的100例脑卒中吞咽障碍患者,将患者随机分为对照组和观察组,每组50例。对照组在常规治疗的基础上采用酸冰刺激治疗,观察组在对照组基础上使用重复经颅磁刺激治疗。分析治疗前后两组患者血清前蛋白(PAB)、转铁蛋白(TRF)、白蛋白(ALB)、血清淀粉样前体蛋白(APP)、β-淀粉样蛋白(Aβ1-42)、神经肽Y(NPY)、锥蛋白样蛋白1(VILIP-1)、神经特异性烯醇化酶(NSE)水平、吞咽功能评分、神经功能评分以及临床疗效。结果两组患者PAB、TRF、ALB均较治疗前升高(P<0.05),观察组PAB、TRF、ALB升高水平较对照组更为显著(P<0.05);两组VFSS评分较治疗前升高、NIHSS评分降低(P<0.05),观察组VFSS/NIHSS升高/降低水平较对照组更显著(P<0.05);与治疗前比较,两组APP降低、Aβ1-42升高(P<0.05),观察组APP/Aβ1-42降低/升高水平较对照组更为显著(P<0.05);两组NPY、VILIP-1、NSE较治疗前均有所降低(P<0.05),观察组NPY、VILIP-1、NSE降低水平较对照组更显著(P<0.05)。治疗后比较发现,观察组治疗总有效率较对照组更高(P<0.05)。结论重复经颅磁刺激联合酸冰刺激疗法有利于脑卒中患者吞咽障碍的改善,同时可改善患者营养状态,降低神经损伤,可提高临床疗效。

Objective The intervention of repeated TMS with acid ice stimulation on swallowing disorders after stroke.Methods The 100 patients with stroke swallowing disorder received by our hospital from January 2019 to January 2021 were selected,and all the patients were randomly divided into two groups,with 50 patients each in the control group and the observation group.The control group was treated with acid-ice stimulation on the basis of conventional treatment,and the observation group used repeated TMS on a control basis.Analysis of serum protein before and after treatment(prealbumin,PAB),transferrin(Transferrin,TRF),albumin(albumin,ALB),and the serum amyloid precursor protein(amyloid precursor protein,APP),-amyloid(beta-amyloid,A 1-42),and the neuropeptide Y(Neuropeptide Y,NPY),cone in-like protein 1(Visinin-like protein-1,VILIP-1),nerve-specific enolase(Neurospecific enolase,NSE)levels,swallowing function score,neurological function score,and clinical efficacy.Results Post-treatment,PAB,TRF,and ALB were increased in both groups(P<0.05).The elevated levels of PAB,TRF and ALB were more significant in the observation group(P<0.05).Higher VFSS score and decreased NIHSS score(P<0.05).The level of VFSS/NIHSS was more significant in the observation group(P<0.05).Reduced APP and increased Aβ1-42(P<0.05).The level of APP/Aβ1-42 was more significant in the observation group(P<0.05).NPY,VILIP-1,and NSE were all reduced(P<0.05).The reduction levels of NPY,VILIP-1,and NSE were more significant(P<0.05).Posttreatment comparison showed the overall higher treatment efficiency in the observation group(P<0.05).Conclusion Repeated transcranial magnetic stimulation combined with acid-ice stimulation therapy is beneficial to the improvement of dysphagia in stroke patients,as well as improve the nutritional status of patients,reduce nerve damage,and improve clinical efficacy.