双侧小脑间歇性θ爆发刺激治疗脑梗死后吞咽障碍的临床研究

Intermittent theta burst stimulation of the bilateral cerebellum can relieve post-stroke dysphagia

目的观察双侧小脑间歇性θ爆发刺激(iTBS)治疗脑卒中后吞咽障碍的临床疗效。方法将脑梗死后吞咽障碍患者40例随机分为对照组和iTBS组, 每组患者20例。2组患者均接受常规吞咽康复训练和营养指导, iTBS组在此基础上给予双侧小脑iTBS刺激(iTBS治疗每日1次, 每周6次, 连续治疗3周), 对照组在此基础上给予双侧小脑假性磁刺激。治疗前和治疗3周后(治疗后), 采用洼田饮水试验分级对2组患者的吞咽情况进行分级和临床疗效评估, 同时采用标准吞咽功能评价量表(SSA)对2组患者的吞咽功能进行评分, 并检测其下颌舌骨肌MEP的潜伏期和波幅。采用Pearson相关系数分析2组患者治疗后的SSA评分与下颌舌骨肌MEP波幅的相关性。结果治疗后, 2组患者洼田饮水试验分级较组内治疗前均显著改善(P<0.05), 且iTBS组的洼田饮水试验分级优于对照组(Z=-2.207, P<0.05)。治疗后, iTBS组临床有效率为(95%), 明显高于对照组的80%(P<0.05)。治疗后, 2组患者的SSA评分较组内治疗前均明显降低, 差异均有统计学意义(P<0.05), 且iTBS组治疗后的SSA评分显著低于对照组治疗后(P<0.01)。治疗后, iTBS组患者下颌舌骨肌MEP的潜伏期和波幅均显著优于组内治疗前和对照组治疗后, 差异均有统计学意义(P<0.05), 而对照组只有波幅较组内治疗前显著升高(P<0.05)。经Pearson相关系数分析, 2组患者治疗后的SSA评分与其下颌舌骨肌MEP波幅不相关。结论双侧小脑间歇性θ爆发刺激可显著地改善脑梗死后吞咽障碍患者的吞咽功能。

ObjectiveTo evaluate the clinical efficacy of intermittent theta burst stimulation(iTBS)of the bilateral cerebellum in treating post-stroke dysphagia.MethodsForty patients with dysphagia after a cerebral infarction were randomly divided into a control group and an iTBS group,with 20 cases in each group.In addition to routine swallowing rehabilitation training and nutritional guidance,the iTBS group underwent daily bilateral cerebellar iTBS 6 times a week for 3 weeks,while the control group was given sham stimulation.Before and after the treatment,both groups were evaluated by using the water-swallowing test and the standardized swallowing assessment(SSA),and the latency and amplitude of the mylohyoid muscle′s motor evoked potential(MEP)were also recorded.The SSA scores and MEP amplitudes of the mylohyoid muscle after treatment were tested for any correlation.ResultsThe treatment improved the water-swallowing test results in both groups,with that of the iTBS group significantly better than that of the control group.The clinical efficacy in the iTBS group was 95%,significantly higher than the control group′s 80%.The SSA scores decreased significantly in both groups after the treatment,with the iTBS group′s average score then significantly lower than that of the control group.The average latency and amplitude of the mylohyoid muscle′s MEP was also significantly better in the iTBS group after the treatment.In the control group only the average amplitude was significantly greater than before the treatment.Pearson correlation analysis showed that the SSA scores and the MEP amplitudes of the mylohyoid muscle after treatment were uncorrelated in both groups.ConclusionsBilateral intermittent theta burst stimulation can effectively improve the swallowing of patients with post-stroke dysphagia.