不同频率重复经颅磁刺激对卒中后认知障碍伴摄食吞咽困难患者的影响

Effect of different frequency of repeated transcranial magnetic stimulation on post-stroke cognitive impairment

目的探讨不同频率重复经颅磁刺激(rTMS)对卒中后认知障碍伴摄食吞咽困难患者的影响。方法选取江苏省徐州市中心医院2021年9月至2023年2月收治的60例卒中后认知障碍合并摄食吞咽困难的患者,按照随机数字表法将其划分为对照组、低频组、高频组,每组各20例。对照组给予常规吞咽功能训练及认知功能恢复训练,而低频组则给予常规吞咽功能训练及右侧低频rTMS治疗,高频组则给予常规吞咽功能训练及左侧高频rTMS治疗;治疗4周后评估三组治疗前后认知功能评分、吞咽功能评分及营养状况评分的改善情况。结果治疗后,三组吞咽造影评分量表、Roenbek渗漏-误吸量表评分低于治疗前,且高频组低于低频组、对照组,低频组低于对照组,差异有统计学意义(P<0.05)。治疗后,三组简易智能状态评分量表、蒙特利尔认知评估量表、微型营养评估评分高于治疗前,且高频组高于低频组、对照组,低频组高于对照组,差异有统计学意义(P<0.05)。结论高频rTMS较低频rTMS及常规认知功能恢复训练,可更好地改善卒中后认知障碍伴摄食吞咽困难患者的认知功能及吞咽功能。

Objective To investigate the effect of different frequency of repetitive transcranial magnetic stimulation(rTMS)on post-stroke cognitive impairment.Methods A total of 60 patients with post-stroke cognitive impairment combined with dysphagia were selected from Xuzhou Central Hospital,Jiangsu Province from September 2021 to February 2023,and were divided into control group,low frequency group,and high frequency group according to random number table method,with 20 cases in each group.The control group was given routine swallowing function training and cognitive function recovery training,the low-frequency group was given routine swallowing function training and right low-frequency rTMS treatment,and the high-frequency group was given routine swallowing function training and left high-frequency rTMS treatment.After four weeks of treatment,the improvement of cognitive function score,swallowing function score,and nutritional status score of the three groups before and after treatment were assessed.Results After treatment,the videofluoroscopic dysphagia scale and penetration aspiration scale scores of the three groups were lower than those before treatment,and those of the high frequency group were lower than those of the low frequency group and the control group,while those of the low frequency group were lower than those of the control group,and the differences were statistically significant(P<0.05).After treatment,mini-mental state examination,Montral cognitive assessment,and mini nutritional assessment scores in the three groups were higher than those before treatment,and those of the high frequency group were higher than those of the low frequency group and the control group,and those of the low frequency group were higher than those of the control group,and the differences were statistically significant(P<0.05).Conclusion High-frequency rTMS can better improve the cognitive function and swallowing function of patients with post-stroke cognitive impairment and dysphagia than lowfrequency rTMS and conventional cognitive function recovery training.