不同频率重复经颅磁刺激对单侧大脑半球脑卒中后吞咽障碍患者的影响

Effects of Different Frequencies of Repetitive Transcranial Magnetic Stimulation on Patients with Dysphagia After Unilateral Hemispheric Stroke

目的 探讨不同频率重复经颅磁刺激(rTMS)对单侧大脑半球脑卒中后吞咽障碍患者吞咽功能、神经功能及血清脑源性神经营养因子(BDNF)水平的影响。方法 纳入2020年5月至2023年5月泉州市第一医院收治的140例单侧大脑半球脑卒中后吞咽障碍患者,并依据1∶1简单随机数字表法分为高频组(频率5 Hz)与低频组(频率1 Hz),每组70例,治疗时间均为2周。治疗结束后比较两组总有效率、不良事件,并对比治疗前后吞咽功能、神经功能水平变化。结果 高频组与低频组总有效率比较差异无统计学意义(95.71%vs 87.14%,χ^(2)=3.281,P=0.070)。治疗后,高频组患者SSA评分、sEMG振幅、sEMG时程、NIHSS评分、NSE水平分别为(21.34±4.36)分、(30.36±4.47)μV、(1 204.65±215.34)ms、(9.05±2.12)分、(26.75±5.13)mg/L,均低于低频组的(23.15±4.87)分、(32.83±4.88)μV、(1 317.26±263.79)ms、(10.18±2.33)分、(29.14±5.81)mg/L(P<0.05)。治疗后,两组患者BDNF比治疗前升高,且高频组高于低频组(P<0.05)。两组患者不良事件发生率比较差异无统计学意义(4.05%vs 5.41%,x^(2)=0.150,P=0.698)。结论 高频率rTMS对单侧大脑半球脑卒中后吞咽障碍患者吞咽功能、神经功能及血清BDNF水平的改善效果更好。

Objective To explore the effects of different frequencies of repetitive transcranial magnetic stimulation(rTMS)on the swallowing function,nerve function and level of serum brain-derived neurotrophic factor(BDNF)in patients with dysphagia after unilateral hemispheric stroke.Methods A total of 140 patients with dysphagia after unilateral hemispheric stroke admitted to Quanzhou First Hospital from May 2020 to May 2023 were enrolled as the research objects.According to simple random number table method,they were divided into either a high frequency group(5 Hz,n=70)or a low frequency group(1 Hz,n=70).All were treated for 2 weeks.The total response rate and incidence of adverse events after treatment,changes of swallowing function and nerve function before and after treatment were compared between the two groups.Results There was no significant difference in total response rate between the high frequency group and the low frequency group(95.71%vs 87.14%,χ^(2)=3.281,P=0.070).After treatment,the Standardized Swallowing Assessment(SSA)score,surface electromyography(sEMG)amplitude,sEMG duration,National Institutes of Health Stroke Scale(NIHSS)score and neuron-specific enolase(NSE)level in both groups decreased,and those in the high frequency group[(21.34±4.36)points,(30.36±4.47)μV,(1204.65±215.34)ms,(9.05±2.12)points and(26.75±5.13)mg/L,respectively]were lower than those in the low frequency group[(23.15±4.87)points,(32.83±4.88)μV,(1317.26±263.79)ms,(10.18±2.33)points,and(29.14±5.81)mg/L,respectively](P<0.05).After treatment,BDNF in both groups increased,and that in the high-frequency group was higher than that in the low-frequency group(P<0.05).There was no significant difference in the incidence of adverse events between the two groups(4.05%vs 5.41%,χ^(2)=0.150,P=0.698).Conclusion High-frequency rTMS is more effective than low-frequency rTMS in improving the swallowing function,nerve function and serum BDNF level in patients with dysphagia after unilateral hemispheric stroke.