【摘要】 目的探讨3Hz重复经颅磁刺激(rTMS)治疗脑卒中后吞咽障碍的效果。方法选取2016年7月至2018年2月脑卒中恢复期吞咽障碍患者60例,随机分为观察组(重复经颅磁刺激+常规吞咽训练)和对照组(常规吞咽训练组)两组,每组30例。常规吞咽训练主要为间接摄食训练和直接摄食训练,重复经颅磁刺激采用频率3Hz,刺激强度80%静息态运动阈值(RMT),刺激时间2s,间歇10s,左右交替,每侧治疗10min,总治疗20min,共600个脉冲,1次/d,每周6d为1个疗程,休息1d后继续治疗,共5个疗程。采用洼田饮水试验评价标准及改良曼恩吞咽能力评估量表(MMASA)评价治疗前及治疗5个疗程后两组患者的临床疗效。结果观察组和对照组总有效率分别为100%和90%,比较差异无统计学意义(P>0.05);基本痊愈和显效率比较差异有统计学意义(P<0.05)。两组患者治疗前各项评分比较差异均无统计学意义(均P>0.05),治疗后观察组各项评分均高于治疗前(均P<0.05),且除表达性言语障碍和构音障碍2项外其余各项均高于对照组(均P<0.05),对照组治疗后呼吸、构音障碍、舌肌运动范围、舌肌力量、咽反射及软腭运动方面均高于治疗前(均P<0.05)。结论 3Hz r TMS结合常规吞咽训练可以明显改善脑卒中患者的吞咽功能。更多还原

【Abstract】 Objective To evaluate the effect of 3Hz repeated transcranial magnetic stimulation(rTMS) on swallowing function in patients with post-stroke dysphagia. Methods Sixty patients with post-stroke dysphagia were randomly assigned to study group and control group with 30 cases in each group. All patients received routine swallowing training, patients in study group received additional repeated transcranial magnetic stimulation on the basis of routine swallowing training. Both groups were assessed with Water Swallow test and the Modified Mann Assessment of Swallowing Ability(MMASA) before treatment and after 5 treatment courses. Results In water swallow test there was no significant difference in the overall effective rate between two groups(100% vs 90%, P >0.05) after the treatment; but the excellent rate in study group was significantly higher than that in control group(93.3 vs 66.7%, P<0.05). After 5 treatment courses, the total MMASA score of study group was significantly higher than that of control group(92.63±6.88 vs 81.60±7.98, P<0.05); while the scores of all items in study group were higher than those of control group(P<0.05) except two items(expressive speech disorder and articulation disorder). All items in study group were improved after treatment(P<0.05); while in control group, the respiratory function, dystonia, range of lingual muscle movement, force of lingual muscle, pharyngeal reflex and palatal movement were improved(P<0.05). Conclusion 3Hz r TMS combined with conventional swallowing training can significantly improve the swallowing function of patients with post-stroke dysphagia.更多还原