| 张瑜,薛建琴,王俐杰,张抗,朱竹君,丁卓文.重复外周磁刺激联合重复经颅磁刺激治疗对脑卒中后吞咽障碍的疗效[J].中国康复,2025,40(6):344-348 |
| 重复外周磁刺激联合重复经颅磁刺激治疗对脑卒中后吞咽障碍的疗效 |
| Effectiveness of repeated peripheral magnetic stimulation combined with repeated transcranial magnetic stimulation for swallowing disorders after stroke |
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| DOI：10.3870/zgkf.2025.06.004 |
| 中文关键词: 重复外周磁刺激 重复经颅磁刺激 脑卒中 吞咽障碍 |
| 英文关键词: repetitive peripheral magnetic stimulation repetitive transcranial magnetic stimulation stroke swallowing disorders |
| 基金项目:江苏大学临床医学科技发展(JLY2021094) |
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| 中文摘要: |
| 目的：探索舌骨上肌群的重复外周磁刺激（rPMS）及健侧舌骨上肌群运动皮质代表区的低频重复经颅磁刺激（rTMS）对脑卒中后吞咽障碍患者吞咽功能的影响。方法：选取80例亚急性脑卒中后吞咽障碍患者，随机分为对照组、rTMS组、rPMS组、联合组，每组20例。所有患者均接受常规吞咽训练，在此基础上，rTMS组加以健侧舌骨上肌群运动皮质代表区低频重复磁刺激治疗，rPMS组给予舌骨上肌群的高频重复磁刺激治疗，均治疗2周，联合组在第1周应用rTMS组的治疗，第2周应用rPMS组的治疗。治疗前及治疗2周后分别采用洼田饮水试验（WST）、反复唾液吞咽试验（RSST）、Murray分泌物评估量表（MSS）、罗森贝克渗透-误吸量表渗透/误吸量表（PAS）、耶鲁咽残留物评定量表（YPRS）进行评估。结果：治疗2周后，4组的WST分级及RSST结果在组内治疗前后及治疗后组间差异无统计学意义；而rTMS组、rPMS组、联合组的MSS、PAS、YPRS评定结果均显著地优于对照组（P<0.05），且联合组仅YPRS评定显著优于rTMS组和rPMS组（P<0.05）。结论：rTMS、rPMS相较于单纯康复治疗可更好地改善卒中后吞咽功能，而二者结合相对于单一的磁刺激治疗，可明显减少吞咽后咽部分泌物及食物残留量。 |
| 英文摘要: |
| Objective: To explore the effects of high-frequency repetitive magnetic stimulation (rPMS) on the suprahyoid muscles and low-frequency rPMS on the motor cortex representation area of the unaffected side’s suprahyoid muscles on swallowing function in patients with swallowing disorders after stroke. Methods: A total of 80 subacute stroke patients with swallowing disorders were randomly assigned to four groups: the control group, the repetitive transcranial magnetic stimulation (rTMS) group, the rPMS group, and the combined treatment group, with 20 patients in each group. All patients received routine swallowing training. The rTMS group received low-frequency rTMS targeting the motor cortex representation area of the unaffected side’s suprahyoid muscles, while the rPMS group received high-frequency rPMS on the suprahyoid muscles. The combined treatment group received rTMS treatment at the first week and rPMS treatment at the second week. Before and two weeks after treatment, Wada drinking water test (WST) and repeated saliva swallowing test (RSST) were performed, and the Murray secretion assessment scale (MSS), Rosenbek Penetration-Aspiration Scale (PAS), and Yale pharyngeal residue assessment scale (YPRS) were evaluated. Results: After two weeks of treatment, there were no significant differences in the Wada drinking test grading and repeated saliva swallowing test scores across the four groups. The Murray secretion assessment, infiltration/aspiration grading, and Yale pharyngeal residue assessment in the rTMS group, rPMS group, and combined group were significantly better than those in the control group (P<0.05), and the Yale pharyngeal residue level in the combined group was significantly lower than that in the rTMS group and rPMS group (P<0.05). Conclusion: For stroke patients with dysphagia, both rPMS and rTMS treatments can more effectively improve swallowing function than conventional swallowing rehabilitation training. Furthermore, the combination of rPMS and rTMS may yield better results than single magnetic stimulation treatments, significantly reducing secretion and food residue. |
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