不同频次经颅直流电刺激对脑卒中后吞咽障碍的临床疗效研究

Clinical Effect Study of Different Frequency Transcranial Direct Current Stimulation Therapy on Dysphagia after Stroke

目的:探讨不同频次经颅直流电刺激(tDCS)治疗对脑卒中后吞咽障碍患者的临床效果。方法:将2022年1月—2023年12月南昌市第一医院收治的60例脑卒中后吞咽障碍患者以随机数字表法分为三组,每组20例。试验A组采用经颅直流电刺激仪对脑患侧半球口舌区实施tDCS(2次/d),试验B组采用经颅直流电刺激仪对脑患侧半球口舌区实施tDCS(1次/d),对照组采用经颅直流电刺激仪假刺激。均治疗4周。评估比较三组临床疗效、吞咽功能评分、脑损伤标志物、不良反应发生率、家属满意度。结果:试验A组总有效率高于对照组,差异有统计学意义(P<0.05)。治疗后,试验A组标准吞咽功能评定量表(SAA)、功能性吞咽障碍量表(FDS)、进食评估问卷调查工具-10(EAT-10)评分均低于试验B组、对照组,差异均有统计学意义(P<0.05)。治疗后,试验A组神经元特异性烯醇化酶(NSE)、胶质纤维酸性蛋白(GFAP)、S100钙结合蛋白β(S100β)水平均低于试验B组、对照组,差异均有统计学意义(P<0.05)。三组不良反应发生率比较,差异无统计学意义(P>0.05)。试验A组家属满意度高于对照组,差异有统计学意义(P<0.05)。结论:2次/d tDCS治疗脑卒中后吞咽障碍有良好效果,可改善患者吞咽功能,降低脑损伤标志物水平,提高家属满意度,且安全性良好。

Objective:To investigate clinical effect of different frequency transcranial direct current stimulation(tDCS)therapy on patients with dysphagia after stroke.Method:A total of 60 patients with dysphagia after stroke admitted to the First Hospital of Nanchang from January 2022 to December 2023 were divided into three groups by the random number table method,with 20 cases in each group.The experimental group A was performed with tDCS(2 times/d)on the mouth and tongue area of the affected cerebral hemisphere by transcranial direct current stimulator.The experimental group B was performed with tDCS(1 time/d)on the mouth and tongue area of the affected cerebral hemisphere by transcranial direct current stimulator.The control group received sham stimulation by transcranial direct current stimulator.Three groups were treated for 4 weeks.The clinical efficacy,swallowing function scores,brain injury markers,incidence of adverse reactions and family satisfaction of the three groups were evaluated and compared.Result:The total effective rate of experimental group A was higher than that of control group,the difference was statistically significant(P<0.05).After treatment,the scores of standardized swallowing assessment(SAA),functional dysphagia scale(FDS)and the eating assessment tool-10(EAT-10)in experimental group A were lower than those in experimental group B and control group,the differences were statistically significant(P<0.05).After treatment,the levels of neuron specific enolase(NSE),glial fibrillary acidic protein(GFAP)and S100 calcium binding proteinβ(S100β)in experimental group A were lower than those in experimental group B and control group,the differences were statistically significant(P<0.05).There was no significant difference in the incidence of adverse reactions among the three groups(P>0.05).The family satisfaction in experimental group A was higher than that in control group,the difference was statistically significant(P<0.05).Conclusion:Two times per day tDCS has a good effect in the treatment of dysphagia after stroke,which can improve the swallowing function of patients,reduce the levels of brain injury markers,improve family satisfaction,and has good safety.