高頻重復(fù)經(jīng)顱磁刺激對后遺癥期腦卒中后吞咽功能障礙的療效觀察

包娜娜　劉超

摘 要：目的 探討高頻重復(fù)經(jīng)顱磁刺激對后遺癥期腦卒中后吞咽功能障礙患者療效。方法 選取2017年1月～2018年6月本院收治的40例后遺癥期腦卒中后吞咽功能障礙患者為研究對象，采用電腦產(chǎn)生隨機(jī)數(shù)字法將患者分為觀察組和對照組，各20例。兩組患者均接受常規(guī)吞咽功能訓(xùn)練，觀察組患者在此基礎(chǔ)上加用經(jīng)顱磁刺激治療，對照組患者接受同樣刺激參數(shù)的假刺激線圈給予的治療，比較兩組患者吞咽功能評分及環(huán)咽肌表面肌電圖最大波幅變化情況。結(jié)果 治療后，對照組、觀察組患者吞咽功能評分分別為（4.10±0.59）分、（4.65±0.64）分，差異無統(tǒng)計(jì)學(xué)意義（P>0.05）；環(huán)咽肌表面肌電圖最大波幅值分別為（668.00±39.33）μV、（761.00±43.61）μV，組間比較，差異無統(tǒng)計(jì)學(xué)意義（P>0.05）。結(jié)論 高頻重復(fù)經(jīng)顱磁刺激對后遺癥期腦卒中后吞咽功能障礙患者的吞咽功能無明顯改善。

關(guān)鍵詞：重復(fù)經(jīng)顱磁刺激；腦卒中；吞咽功能障礙；表面肌電圖

中圖分類號：R743.3 文獻(xiàn)標(biāo)識碼：A DOI：10.3969/j.issn.1006-1959.2018.22.028

文章編號：1006-1959（2018）22-0104-03

Therapeutic Effect of High Frequency Repetitive Transcranial Magnetic Stimulation on Deglutition Disorders after Sequelae Stroke

BAO Na-na1，LIU Chao2

（1.Institute of Neurological Diseases，North Sichuan Medical College，Nanchong 637000，Sichuan，China；

2.Department of Neurology，Affiliated Hospital of North Sichuan Medical College，Nanchong 637000，Sichuan，China）

Abstract：Objective To investigate the efficacy of high-frequency repetitive transcranial magnetic stimulation in patients with deglutition disorders after stroke in sequelae.Methods 40 patients with deglutition disordersafter stroke in our hospital from January 2017 to June 2018 were enrolled. The patients were divided into observation group and control group by computer-generated random number method.20 cases each. Both groups of patients received routine swallowing function training.The patients in the observation group were treated with transcranial magnetic stimulation. The patients in the control group received the same stimulation parameters and the stimulation was given. The swallow function scores and the maximal amplitude of the surface electromyogram of the pharyngeal muscle were compared between the two groups. Results After treatment， the swallowing function scores of the control group and the observation group were（4.10±0.59）score and （4.65±0.64）score， respectively，the difference was not statistically significant （P>0.05）.The maximum amplitude of the surface electromyogram of the pharyngeal muscle was （668.00±39.33）μV， （761.00±43.61）μV， and there was no significant difference between the groups（P>0.05）. Conclusion High-frequency repetitive transcranial magnetic stimulation has no significant improvement in swallowing function in patients with deglutition disorders after sequelae.

Key words：Repetitive transcranial magnetic stimulation；Stroke；Deglutition disorders；Surface electromyography

吞咽功能障礙（deglutition disorders）是腦卒中患者常見并發(fā)癥。據(jù)統(tǒng)計(jì)，41%～78%的腦卒中患者合并吞咽功能障礙[1]。吞咽功能障礙不僅直接影響患者進(jìn)食、進(jìn)飲，導(dǎo)致患者營養(yǎng)不良和水電解質(zhì)紊亂；還可引起誤吸、誤咽，導(dǎo)致患者肺部感染，嚴(yán)重時(shí)危及生命。經(jīng)顱磁刺激是一種快速起效的一種神經(jīng)調(diào)控技術(shù)。研究表明，高、低頻重復(fù)經(jīng)顱磁刺激（repetitive transcranial magnetic stimulation，rTMS）對急性期、亞急性期腦卒中后吞咽功能障礙均有良好療效，但對后遺癥期患者是否有效，尚存在爭議[1-3]。因此，本研究對高頻rTMS對后遺癥期腦卒中后吞咽功能障礙患者吞咽功能及其表面肌電圖的影響進(jìn)行了探討，現(xiàn)報(bào)道如下。