重复经颅磁刺激结合多重吞咽刺激对脑卒中后吞咽障碍患者吞咽功能 营养指标的影响

Effect of repeated transcranial magnetic stimulation combined with multiple swallowing stimulation on swallowing function and nutritional indicators in swallowing patients after stroke

目的观察重复经颅磁刺激结合多重吞咽刺激对脑卒中后吞咽障碍患者吞咽功能、营养指标的影响。方法选取四川大学华西医院2020-03—2022-04收治的152例脑卒中后吞咽障碍患者作为研究对象,分为观察组和对照组。对照组75例采用多重吞咽刺激治疗,观察组77例采用重复经颅磁刺激结合多重吞咽刺激治疗。比较2组患者治疗效果、吞咽功能、营养指标。结果观察组总有效率97.40%,高于对照组的89.33%(P<0.05)。2组患者干预前视频荧光造影检查(VFG)及饮水试验(WST)评分对比,差异无统计学意义(P>0.05),干预后2组VFG评分比干预前升高且观察组[(6.77±1.25)分]高于对照组[(5.65±1.03)分](P<0.05),干预后2组WST评分低于干预前且干预后观察组[(1.81±0.44)分]低于对照组[(2.63±0.40)分](P<0.05)。干预前2组患者吞咽波幅及吞咽时程对比差异无统计学意义(P>0.05),干预后2组吞咽时程比干预前下降且观察组[(1.48±0.21)s]低于对照组[(1.65±0.26)s](P<0.05),干预后2组吞咽波幅比干预前升高且观察组[(0.40±0.11)mV]高于对照组[(0.35±0.09)mV](P<0.05)。干预前2组血清白蛋白、血红蛋白等营养指标比较差异无统计学意义(P>0.05),干预后2组血清各营养指标高于干预前且干预后观察组血清白蛋白[(35.59±7.12)g/L]、血红蛋白[(125.64±9.21)g/L]、血清总蛋白[(67.26±7.34)g/L]高于对照组[血清白蛋白(32.67±6.94)g/L,血红蛋白(121.29±8.54)g/L,血清总蛋白(62.86±6.94)g/L](P<0.05)。结论对脑卒中后吞咽障碍患者采用重复经颅磁刺激结合多重吞咽刺激治疗效果明显,能有效改善患者吞咽障碍,提高患者营养指标水平。

Objective To observe the effect of repetitive transcranial magnetic stimulation combined with multiple swallowing stimulation on swallowing function and nutritional indicators in patients with post-stroke dysphagia.Methods Totally 152 patients with post-stroke dysphagia admitted to the West China Hospital,Sichuan University from March 2020 to April 2022 were selected as the research subjects and were divided into the observation group and the control group.Seventy-five cases in the control group were treated by multiple swallowing stimulation,and 77 cases in the observation group were treated by repetitive transcranial magnetic stimulation combined with multiple swallowing stimulation.The treatment effects,swallowing function,and nutritional indicators between the two groups were compared.Results The total effective rate of the observation group was 97.40%,which was higher than the 89.33%of the control group(P<0.05).There were no statistically significant differences in the video fluorography(VFG)and water drinking test(WST)scores of the two groups before intervention(P>0.05).After the intervention,the VFG scores of the two groups were higher than those before the intervention,and the observation group((6.77±1.25)points)was higher than the control group((5.65±1.03)points)(P<0.05).After the intervention,the WST scores of the two groups were lower than those before the intervention,and the observation group((1.81±0.44)points)after the intervention was lower than the control group((2.63±0.40)points)(P<0.05).There were no statistically significant differences in the swallowing amplitude and swallowing duration between the two groups before the intervention(P>0.05).After the intervention,the swallowing duration of the two groups decreased compared with that before the intervention,and the observation group((1.48±0.21)s)was lower than the control group((1.65±0.26)s)(P<0.05).After the intervention,the swallowing amplitude of the two groups was higher than that before the intervention,and the observation group((0.40±0.11)mV)was higher than the control group((0.35±0.09)mV)(P<0.05).There were no significant differences in nutritional indicators,such as serum albumin and hemoglobin between the two groups before the intervention(P>0.05).After the intervention,the serum nutritional indicators of the two groups were higher than those before the intervention,the serum albumin of the observation group after the intervention was(35.59±7.12)g/L,hemoglobin was(125.64±9.21)g/L,and serum total protein was(67.26±7.34)g/L,which were higher than those in the control group(serum albumin(32.67±6.94)g/L,hemoglobin(121.29±8.54)g/L,serum total protein(62.86±6.94)g/L)(P<0.05).Conclusion The therapeutic effect of repetitive transcranial magnetic stimulation combined with multiple swallowing stimulation is obvious in patients with post-stroke dysphagia.It can effectively improve the patients’dysphagia and improve the patients’nutritional index level.