高频经颅磁刺激联合康复训练对脑卒中后吞咽障碍患者表面肌电图的影响

Effect of high-frequency transcranial magnetic stimulation combined with rehabilitation training on surface electromyography in patients with dysphagia after stroke

目的探讨高频经颅磁刺激(TMS)联合康复训练对脑卒中后吞咽障碍患者表面肌电图(sEMG)的影响。方法选取南京医科大学附属淮安第一医院神经内科2022年1月~2023年1月收治的脑卒中后吞咽障碍患者100例,采用随机数表法分为观察组和对照组,各50例。对照组给予常规吞咽康复训练,观察组在对照组基础上联合高频TMS治疗。比较两组患者临床疗效;评估两组患者洼田饮水试验等级以及标准吞咽功能评定量表(SSA)和吞咽障碍严重度评估量表(DOSS)评分;检测两组患者舌骨上、下肌群最大波幅值及吞咽时程;评估两组患者吞咽生存质量问卷(SWAL-QOL)评分。结果观察组总有效率96.00%显著高于对照组82.00%,差异有统计学意义(χ2=5.005,P<0.05);治疗后,两组患者洼水试验评估等级改善显著优于治疗前,且观察组改善显著优于对照组,差异有统计学意义(Z=4.157,P<0.05)。治疗后,两组患者SSA评分低于治疗前,DOSS评分高于治疗前,且观察组SSA评分低于对照组,DOSS评分高于对照组[(23.15±3.51)分vs.(28.21±4.59)分、(6.11±0.78)分vs.(5.16±0.89)分],差异有统计学意义(t=6.192、5.676,P<0.05)。治疗后,两组患者舌骨上、下肌群最大波幅值均显著高于治疗前,吞咽时程短于治疗前,且观察组治疗后舌骨上、下肌群最大波幅值均显著高于对照组,吞咽时程短于对照组[(752.46±94.56)μg vs.(605.45±65.48)μg、(732.12±82.15)μg vs.(594.56±55.89)μg、(1.83±0.42)s vs.(2.15±0.62)s、(1.87±0.41)s vs.(2.32±0.54)s],差异有统计学意义(t=9.038、9.790、3.022、4.693,P<0.05);两组治疗后SWAL-QOL评分显著高于治疗前,且观察组显著高于对照组[(185.45±14.41)分vs.(164.45±15.21)分],差异有统计学意义(t=26.258,P<0.05)。结论高频振幅值增加可促进脑卒中后吞咽障碍患者大脑神经元兴奋性增加,致使其引起更多神经元发放行动电位,促进神经元之间的连接和信息传递,不仅可有效改善患者临床症状以及吞咽功能,还能改善其舌骨上、下肌群最大波幅值、吞咽时程以及生活质量。

Objective To explore the effect of high-frequency transcranial magnetic stimulation(TMS)combined with rehabilitation training on surface electromyography(sEMG)in patients with dysphagia after stroke.Methods 100 patients with dysphagia after stroke admitted to our hospital from January 2022 to January 2023 were randomly divided into an observation group and a control group with 50 patients in each group.The control group received routine swallowing rehabilitation training,while the observation group received high-frequency TMS treatment on the basis of the control group.The clinical efficacy of the two groups was compared,and the watian drinking water test grade and the scores of the standard swallowing function assessment scale(SSA)and the dysphagia severity assessment scale(DOSS)were evaluated at the same time.In addition,the maximum amplitude value of the upper and lower hyoid muscle groups and the swallowing duration of the two groups were measured,and finally the swallowing quality of life questionnaire(SWAL-QOL)scores of the two groups were evaluated.Results The total effective rate of 96.00%in the observation group was significantly higher than 82.00%in the control group,with a statistically significant difference(χ^(2)=5.005,P<0.05).The improvement in the evaluation level of the depression test after treatment in the two groups was significantly better than before treatment,and the observation group was significantly better than that in the control group,with a statistically significant difference(Z=4.157,P<0.05).After treatment,the SSA score of the two groups was lower than before treatment,and the DOS score was higher than before treatment,and the SSA score of the observation group was lower than the control group,and the DOS score was higher than the control group,with a statistically significant difference(t=6.192,5.676,P<0.05).After treatment,the maximum amplitude values of the superior and inferior hyoid muscle groups in both groups were significantly higher than before treatment,and the swallowing duration was shorter than before treatment,and the maximum amplitude values of the superior and inferior hyoid muscle groups in the observation group were significantly higher than in the control group,the swallowing duration was shorter than in the control group,with a statistically significant difference(t=9.038,9.790,3.022,4.693,P<0.05).The SWAL-QOL scores of the two groups after treatment were significantly higher than before treatment,and the SWAL-QOL scores of the observation group were significantly higher than those of the control group,with a statistically significant difference(t=26.258,P<0.05).Conclusion An increase in high-frequency amplitude values can increase the excitability of brain neurons in patients with swallowing disorders after stroke,cause more neurons to emit action potentials,promote connections and information transmission between neurons.This not only effectively improves clinical symptoms and swallowing function of patients,but also improves the maximum amplitude values of the superior and inferior hyoid muscle groups,swallowing duration,and quality of life.