重复经颅磁刺激对脑卒中吞咽障碍患者的临床疗效观察

Clinical efficacy of repetitive transcranial magnetic stimulation in patients with dysphagia in stroke

目的探讨重复经颅磁刺激(rTMS)对脑卒中吞咽障碍患者的临床治疗效果。方法选取2019年10月至2022年10月于福建中医药大学附属第三人民医院收治的60例脑卒中后吞咽困难患者作为研究对象。按照随机数字表法分为对照组(20例)、试验A组(20例)和试验B组(20例)。对照组接受传统吞咽困难治疗,对试验A组和试验B组在传统治疗基础上分别在受累区、未受累区施加5 Hz rTMS,均干预3周。通过检测血清炎症因子以及使用光纤内窥镜吞咽困难严重程度量表(FEDSS)、渗漏误吸量表(PAS)、标准吞咽功能评价量表(SSA)评估干预前后的各组临床吞咽功能以及炎症因子变化。结果干预后,试验A组和试验B组的FEDSS、PAS和SSA评分低于对照组,差异有统计学意义(P<0.05),试验A组和试验B组的FEDSS、PAS和SSA评分比较,差异无统计学意义(P>0.05);试验A组的γ干扰素、肿瘤坏死因子-α、白细胞介素6低于试验B组与对照组,差异有统计学意义(P<0.05),试验B组仅γ干扰素低于对照组,差异有统计学意义(P<0.05)。结论5 Hz高频rTMS刺激正常脑半球、受累脑半球对脑卒中后吞咽困难患者均有积极疗效,但刺激受累区域对于改善患者炎症因子表达更具优势。

Objective To explore the clinical therapeutic effects of repetitive transcranial magnetic stimulation(rTMS)on normal and affected cerebral hemispheres of patients with dysphagia after stroke.Methods A total of sixty patients with dysphagia after stroke who were admitted to the Third People's Hospital Affiliated to Fujian University of Chinese Medicine from October 2019 to October 2022 were selected as the study objects.According to random number table method,they were divided into control group(20 cases),trial group A(20 cases)and trial group B(20 cases).The control group received conventional dysphagia treatment,and 5 Hz rTMS was applied to the affected or unaffected area on the basis of conventional treatment in the test A and test B groups,respectively,and both intervened for 3 weeks.The clinical swallowing function and inflammatory factor changes in each group before and after the intervention were assessed by measuring serum inflammatory factors and using the fiberoptic endoscopic dysphagia severity scale(FEDSS),the penetration aspiration scale(PAS),and the standardized swallowing assessment(SSA).Results After intervention,FEDSS,PAS and SSA scores of trial group A and trial group B were lower than those of control group,with statistical significance(P<0.05).There was no significant difference in FEDSS,PAS and SSA scores between trial group A and trial group B(P>0.05).The levels of interferon-γ,tumor necrosis factor-αand interleukin 6 in trial group A were lower than those in trial group B and control group,and the difference was statistically significant(P<0.05),while only interferon-γin trial group B was lower than that in control group,and the difference was statistically significant(P<0.05).Conclusion 5 Hz high-frequency rTMS stimulation of normal and affected hemispheres has positive effects on post-stroke dysphagia patients,but stimulation of the affected area is more advantageous for improving the expression of inflammatory factors in patients.