补阳还五汤冰刺激联合rTMS对脑卒中后吞咽障碍疗效研究

Effect of Yanghuanwu Decoction Ice Stimulation Combined with RTMS onDysphagia after Stroke

目的评估中药补阳还五汤冰刺激联合重复经颅磁刺激(rTMS)对脑卒中后吞咽障碍的疗效。方法选取在我院康复科和神经内科住院的患者,诊断为脑卒中合并吞咽障碍的患者45例进行6周的治疗及随访观察。采用随机数字表法将入组患者分为对照组(假经颅磁刺激+常规冰刺激+常规治疗)、中药组(补阳还五汤冰刺激+假经颅磁刺激+常规治疗)和联合组(补阳还五汤冰刺激+高频rTMS+常规治疗)。用标准吞咽功能评估量表(SSA)和吞咽造影检查(VFSS)评估三组治疗前后的吞咽功能。结果治疗后联合组的疗效优于中药组和对照组(P<0.05),三组患者均优于治疗前(P<0.05),中药组和对照组之间的疗效差异无统计学意义(P>0.05)。结论补阳还五汤冰刺激联合高频(5Hz)重复经颅磁刺激可有效改善脑卒中后吞咽障碍,单纯中药冰刺激疗效好于单纯冰刺激。

Objective To evaluate the effect of Buyang Huanwu decoction ice stimulation combined with repetitive transcranial magnetic stimulation(rTMS)on dysphagia after stroke.Methods 45 stroke patients with dysphagia were selected from the Department of Rehabilitation and Department of Neurology.The patients were randomly divided into control group(sham transcranial magnetic stimulation+routine ice stimulation+routine treatment),traditional Chinese medicine group(Buyang Huanwu decoction ice stimulation+sham transcranial magnetic stimulation+routine treatment)and combination group(Buyang Huanwu decoction ice stimulation+high frequency rTMS+routine treatment).The deglutition function before and after treatment was evaluated by means of standardized swallowing assessment(SSA)and videofluoroscopic swallowing study(VFSS).Results after treatment,the curative effect of the combined group was better than that of the traditional Chinese medicine group and the control group(P<0.05),and that of the three groups was better than that before treatment(P<0.05).There was no significant difference in the curative effect between the traditional Chinese medicine group and the control group.Conclusion Chinese medicine ice stimulation combined with high frequency(5Hz)repetitive transcranial magnetic stimulation can effectively improve dysphagia after stroke,and the effect of chinese medicine ice stimulation alone is better than that of ice stimulation alone.