高频重复经颅磁刺激联合神经肌肉电刺激治疗卒中后吞咽障碍：随机对照研究

被引：24

作者：

郑秀琴

于苏文

崔红霞

金犇

朱甜

薛阳

机构：

[1] 解放军第一〇二医院神经内科

来源：

国际脑血管病杂志 | 2017年 / 25卷 / 01期

关键词：

卒中; 吞咽障碍; 经颅磁刺激; 电刺激疗法; 治疗结果;

D O I：

暂无

中图分类号：

R743.3 [急性脑血管疾病（中风）];

学科分类号：

100204 [神经病学];

摘要：

目的评价高频重复经颅磁刺激(repetitive transcranial magnetic stimulation, rTMS)联合神经肌肉电刺激(neuromuscular electrical stimulation, NMES)对卒中后吞咽障碍的治疗作用。方法共纳入卒中后吞咽障碍患者90例, 随机分为NMES+rTMS组和NMES+假rTMS组, 每组各45例。采用洼田饮水试验和吞咽功能评定量表(Standardized Swallowing Assessment, SSA)评价吞咽功能。结果治疗前、治疗1个疗程、治疗2个疗程和治疗后3个月时NMES+rTMS组洼田饮水试验评分(F=82.001, P<0.001)和SSA评分(F=33.743, P<0.001)均存在显著差异, 治疗1个疗程(分别为P<0.01和P<0.05)、治疗2个疗程(P均<0.01)和治疗后3个月时(P均<0.01)均较治疗前显著改善;NMES+假rTMS组洼田饮水试验评分(F=53.647, P<0.001)和SSA评分(F=19.178, P<0.001)也存在显著差异, 治疗1个疗程(P均<0.05)、治疗2个疗程(分别为P<0.05和P<0.01)和治疗后3个月时(P均<0.01)均较治疗前显著改善。治疗1个疗程、治疗2个疗程及治疗后3个月时, NMES+rTMS组洼田饮水试验评分(治疗1个疗程:t=2.217, P=0.02;治疗2个疗程:t=2.406, P=0.019;治疗后3个月:t=2.128, P=0.037)和SSA评分(治疗1个疗程:t=2.196, P=0.030;治疗2个疗程:t=2.425, P=0.016;治疗后3个月:t=2.512, P=0.013)均显著优于NMES+假rTMS组。结论高频rTMS联合NMES可显著改善卒中患者的吞咽功能, 其疗效优于NMES。

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相关论文

共 20 条

[1]

Repetitive transcranial magnetic stimulation for rehabilitation of poststroke dysphagia: A randomized, double-blind clinical trial [J].

Du, Juan ;

Yang, Fang ;

Liu, Ling ;

Hu, Jingze ;

Cai, Biyang ;

Liu, Wenhua ;

Xu, Gelin ;

Liu, Xinfeng .

CLINICAL NEUROPHYSIOLOGY, 2016, 127 (03) :1907-1913

[2]

Effects of non-invasive brain stimulation on post-stroke dysphagia: A systematic review and meta-analysis of randomized controlled trials [J].

Pisegna, Jessica M. ;

Kaneoka, Asako ;

Pearson, William G., Jr. ;

Kumar, Sandeep ;

Langmore, Susan E. .

CLINICAL NEUROPHYSIOLOGY, 2016, 127 (01) :956-968

[3]

Effect of Low-Frequency rTMS and NMES on Subacute Unilateral Hemispheric Stroke With Dysphagia [J].

Lim, Kil-Byung ;

Lee, Hong-Jae ;

Yoo, Jeehyun ;

Kwon, Yong-Geol .

ANNALS OF REHABILITATION MEDICINE-ARM, 2014, 38 (05) :592-602

[4]

Neurostimulation as an Approach to Dysphagia Rehabilitation: Current Evidence [J].

Michou E. ;

Hamdy S. .

Current Physical Medicine and Rehabilitation Reports, 2013, 1 (4) :257-266

[5]

Effect of Repetitive Transcranial Magnetic Stimulation on Patients with Brain Injury and Dysphagia [J].

Kim, Leesuk ;

Chun, Min Ho ;

Kim, Bo Ryun ;

Lee, Sook Joung .

ANNALS OF REHABILITATION MEDICINE-ARM, 2011, 35 (06) :765-771

[6]

Repetitive transcranial magnetic stimulation: a tool for human cerebellar plasticity [J].

Koch, Giacomo .

FUNCTIONAL NEUROLOGY, 2010, 25 (03) :159-163

[7]

Adjunctive Functional Pharyngeal Electrical Stimulation Reverses Swallowing Disability After Brain Lesions [J].

Jayasekeran, Vanoo ;

Singh, Salil ;

Tyrrell, Pippa ;

Michou, Emilia ;

Jefferson, Samantha ;

Mistry, Satish ;

Gamble, Ed ;

Rothwell, John ;

Thompson, David ;

Hamdy, Shaheen .

GASTROENTEROLOGY, 2010, 138 (05) :1737-U22

[8]

Poststroke Dysphagia Rehabilitation by Repetitive Transcranial Magnetic Stimulation: A Noncontrolled Pilot Study [J].

Verin, E. ;

Leroi, A. M. .

DYSPHAGIA, 2009, 24 (02) :204-210

[9]

Induction of long-term plasticity in human swallowing motor cortex following repetitive cortical stimulation [J].

Gow, D ;

Rothwell, J ;

Hobson, A ;

Thompson, D ;

Hamdy, S .

CLINICAL NEUROPHYSIOLOGY, 2004, 115 (05) :1044-1051

[10]

Cricopharyngeal sphincter muscle responses to transcranial magnetic stimulation in normal subjects and in patients with dysphagia [J].

Ertekin, C ;

Turman, B ;

Tarlaci, S ;

Celik, M ;

Aydogdu, I ;

Secil, Y ;

Kiylioglu, N .

CLINICAL NEUROPHYSIOLOGY, 2001, 112 (01) :86-94