间歇性Theta爆发式脉冲模式重复经颅磁刺激联合神经肌肉电刺激治疗卒中后吞咽障碍的临床研究

Effects of repetitive transcranial magnetic stimulation with intermittent Theta burst stimulation combined with neuromuscular electrical stimulation in post-stroke dysphagia

目的探讨间歇性Theta爆发式脉冲模式(iTBS)的重复经颅磁刺激联合神经肌肉电刺激(NMES)在卒中后吞咽障碍(PSD)中的临床治疗价值。方法选取2022年11月—2023年10月在徐州市中心医院康复科住院治疗的60例PSD患者为研究对象,采用随机数字表法分为NMES组及NMES+iTBS联合组,每组30例。两组患者均接受常规吞咽康复训练,NMES组在此基础上接受NMES治疗,而NMES+iTBS联合组则在NMES组的基础上,于患者健侧大脑舌骨上肌群皮质代表区行iTBS重复经颅磁刺激治疗。两组均连续治疗2周。于治疗前后,对患者行吞咽障碍造影检查,根据检查情况评估吞咽障碍造影评分量表(VDS)评分和Rosenbek渗透/误吸量表(PAS)分级,以标准吞咽功能评估量表(SSA)评分和洼田饮水试验(WST)分级评估患者的吞咽功能情况。结果治疗前,两组患者VDS评分、PAS分级、SSA评分和WST分级比较,差异均无统计学意义(Z=-0.371、-0.718、-0.507、-1.104;均P>0.05)。治疗后,两组患者VDS评分、PAS分级、SSA评分、WST分级低于治疗前且NMES+iTBS联合组患者评分和分级优于NMES组,差异均有统计学意义(Z=-5.412~-3.884;均P<0.05)。结论iTBS重复经颅磁刺激联合NMES可有效地促进PSD患者的吞咽功能恢复。

Objective To explore the clinical therapeutic value of repetitive transcranial magnetic stimulation with intermittent Theta burst stimulation(iTBS)combined with neuromuscular electrical stimulation(NMES)in post-stroke dysphagia(PSD).Methods From November 2022 to October 2023,60 PSD patients admitted to the rehabilitation department of Xuzhou Central Hospital were selected as research subjects.Patients were randomly divided into NMES group and NMES+iTBS group using a random number table method,with 30 cases in each group.Both groups of patients were treated with routine swallowing rehabilitation training.NMES group received NMES on this basis,while NMES+iTBS group received repetitive transcranial magnetic stimulation with iTBS in the cortical representative area of the superior hyoid muscle group on the healthy side of the patient's brain on the basis of NMES group.Both groups carried out continuous treatment for two weeks.Before and after treatment,swallowing disorder imaging was performed on the patient,and the Videofluoroscopic Dysphagia Scale(VDS)score and Rosenbek Penetration-Aspiration Scale(PAS)grading were evaluated based on the examination results.The swallowing function was assessed using the Standardized Swallowing Assessment Scale(SSA)and Water Swallow Test(WST)grading.Results Before treatment,there was no statistically significant difference in VDS score,PAS grading,SSA score,and WST grading between the two groups of patients(Z=-0.371、-0.718、-0.507、-1.104;all P>0.05).After treatment,the VDS score,PAS grading,SSA score,and WST grading of the two groups of patients were lower than before treatment,and the score and grading of patients in the NMES+iTBS group were better than those in NMES group,and the differences were statistically significant(Z=-5.412--3.884;all P<0.05).Conclusions The combination of repetitive transcranial magnetic stimulation with iTBS and NMES can effectively promote the recovery of swallowing function in PSD patients.