摘要
目的 观察重复经颅磁刺激(repetitive transcranial magnetic stimulation, rTMS)联合球囊扩张术及常规吞咽训练对脑卒中后环咽肌功能障碍所致吞咽障碍的临床疗效。方法 选取2022年1月—2023年2月在湖北省中西医结合医院住院的脑卒中后吞咽障碍患者。采用随机数字表法将纳入患者分为试验组和对照组。对照组给予球囊扩张术及常规吞咽训练,试验组在对照组的基础上给予rTMS治疗,均连续治疗3周,分别于治疗前、治疗3周后采用吞咽造影检查(videofluoroscopic swallowing study, VFSS)、渗漏误吸量表(Penetration Aspiration Scale, PAS)和功能性经口摄食量表(Functional Oral Intake Scale, FOIS)对患者吞咽功能改善情况进行疗效评估。结果 共纳入患者49例,其中试验组25例,对照组24例。两组患者的年龄、性别、病程、卒中类型和治疗前的吞咽功能比较,差异均无统计学意义(P>0.05)。治疗3周后,试验组和对照组的VFSS吞咽障碍程度评分(Z=-4.465、-4.327,P<0.001)均较治疗前提高,且试验组优于对照组(t=2.099,P=0.041);试验组和对照组的PAS评分(Z=-4.179、-3.729,P<0.001)及FOIS评分(Z=-4.476、-4.419,P<0.001)均较治疗前改善,且试验组的PAS评分(t=-2.088,P=0.042)和FOIS评分(Z=-2.134,P=0.033)的改善均优于对照组。在研究过程中无患者出现严重不良反应。结论 rTMS联合球囊扩张术及常规吞咽训练可显著改善脑卒中后环咽肌功能障碍所致吞咽障碍患者的吞咽功能,可进一步提高临床疗效,值得临床应用。
Objective To observe the clinical effect of repetitive transcranial magnetic stimulation(rTMS)combined with balloon dilatation and routine swallowing training on dysphagia caused by cricopharyngeal dysfunction(CPD)after stroke.Methods Patients with dysphagia after stroke who were hospitalized at Hubei Provincial Hospital of Integrated Chinese and Western Medicine between January 2022 and February 2023 were selected.The patients were divided into the trial group and the control group by random number table method.The control group received balloon dilatation and routine swallowing training,and the trial group received rTMS based on the treatment plan of the control group.All patients were treated for 3 weeks.The videofluoroscopic swallowing study(VFSS),Penetration Aspiration Scale(PAS),and Functional Oral Intake Scale(FOIS)were used at pre-therapy and 3 weeks after treatment to assess the improvement of swallowing function.ResultsA total of 49 patients were included,including 25 in the trial group and 24 in the control group.There was no statistically significant difference in age,gender,course of disease,stroke type,and swallowing function before treatment between the two groups of patients(P>0.05).After 3 weeks of treatment,the VFSS dysphagia scores(Z=-4.465,-4.327,P<0.001)of the trial group and the control group were higher than those before treatment,and the trial group was better than that in the control group(t=2.099,P=0.041).The PAS scores(Z=-4.179,-3.729,P<0.001)and FOIS scores(Z=-4.476,-4.419,P<0.001)of the trial and control groups were improved after treatment,and the improvement of the PAS score(t=-2.088,P=0.042)and FOIS score(Z=-2.134,P=0.033)in the trial group were more significant(P<0.05).No serious adverse reactions were observed in patients during the study process.ConclusionThe rTMS combined with balloon dilatation and routine swallowing training can significantly improve the swallowing function of patients with dysphagia caused by CPD after stroke,and further improve its clinical efficacy,worthyo
作者
王娟
郑婵娟
徐婷
华强
崔晓阳
卢容
夏文广
WANG Juan;ZHENG Chanjuan;XU Ting;HUA Qiang;CUI Xiaoyang;LU Rong;XIA Wenguang(Department of Rehabilitation Medicine,Hubei Provincial Hospital of Integrated Chinese and Western Medicine,Wuhan,Hubei 430015,P.R.China;Hospitals Directly Under the Government of Hubei Province(Rehabilitation Hospital of Hubei Province),Wuhan,Hubei 430061,P.R.China)
出处
《华西医学》
CAS
2023年第6期843-849,共7页
West China Medical Journal
关键词
重复经颅磁刺激
球囊扩张术
脑卒中
环咽肌功能障碍
吞咽障碍
Repetitive transcranial magnetic stimulation
balloon dilatation
stroke
cricopharyngeal dysfunction
dysphagia
