高频小脑rTMS联合呼吸肌训练用于脑卒中后吞咽障碍患者的效果分析

毛建昊; 郑红建; 雷兵; 董锦疆

doi:10.16766/j.cnki.issn.1674-4152.003797

高频小脑rTMS联合呼吸肌训练用于脑卒中后吞咽障碍患者的效果分析

doi: 10.16766/j.cnki.issn.1674-4152.003797

1.
淳安县第一人民医院(浙江省人民医院淳安分院)神经外科，浙江杭州 311700
2.
浙江省人民医院神经外科，浙江杭州 310014

基金项目:

浙江省教育厅科研项目 Y202146057

详细信息

通讯作者:
雷兵，E-mail：mjhzjhz@163.com

中图分类号: R743.3
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- 文章访问数: 7
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出版历程
- 收稿日期: 2024-03-28
- 网络出版日期: 2025-01-20

Effect analysis of high-frequency cerebellar rTMS combined with respiratory muscle training on post-stroke dysphagia patients

1.
Department of Neurosurgery, Chun'an Branch of Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang 311700, China

摘要

摘要: 目的分析高频小脑重复经颅磁刺激(rTMS)联合呼吸肌训练在脑卒中后吞咽障碍(PSD)患者中的应用效果，为临床康复训练及治疗提供依据。方法回顾性选取浙江省人民医院淳安分院2021年5月—2023年11月期间诊治的118例PSD患者，根据入院时间先后将其分为2组，每组各59例，对照组接受常规呼吸肌训练，研究组在其基础上加以高频小脑rTMS治疗。比较2组吞咽功能、下颌舌骨肌运动诱发电位(MEP)、脑干听觉诱发电位(BAEP)以及吸入性肺炎、误吸发生率。结果干预3周后，研究组标准吞咽功能评估量表(SSA)评分[(21.47±2.51)分]低于对照组[(24.25±2.38)分]，洼田饮水试验Ⅰ~Ⅱ级(84.75%)高于对照组(32.71%)，差异有统计学意义(P < 0.05)；研究组MEP潜伏期低于对照组，MEP波幅高于对照组，差异有统计学意义(P < 0.05)；研究组Ⅰ、Ⅲ、Ⅴ各波潜伏期及Ⅰ~Ⅲ、Ⅲ~Ⅴ、Ⅰ~Ⅴ各波峰间潜伏期均明显短于对照组，差异有统计学意义(P < 0.05)；研究组吸入性肺炎、误吸发生率低于对照组，差异有统计学意义(P < 0.05)。结论在PSD患者中采用高频小脑rTMS联合呼吸肌训练具有一定的效果，能够缩短BAEP，调节下颌舌骨肌MEP，改善患者吞咽功能，一定程度降低吸入性肺炎、误吸发生风险。
- 脑卒中吞咽障碍 /
- 重复经颅磁刺激 /
- 呼吸肌训练 /
- 脑干听觉诱发电位 /
- 下颌舌骨肌运动诱发电位
Abstract: Objective To analyze the application effect of high-frequency repetitive transcranial magnetic stimulation (rTMS) combined with respiratory muscle training in patients with post-stroke dysphagia (PSD), and provide a basis for clinical rehabilitation training and treatment. Methods A total of 118 PSD patients diagnosed and treated in Chun'an Branch of Zhejiang Provincial People's Hospital from May 2021 to November 2023 were selected retrospectively. They were divided into two groups according to the admission time, with 59 cases in each group. The control group received routine respiratory muscle training, and the research group was treated with high-frequency cerebellar rTMS on the basis of it. The swallowing function, mandibular hyoid muscle motor evoked potential (MEP), brainstem auditory evoked potential (BAEP), aspiration pneumonia, and incidence of aspiration were compared between the two groups. Results After three weeks of intervention, the standardized swallowing assessment (SSA) score of the study group (21.47±2.51) was lower than that of the control group (24.25±2.38), and the grade Ⅰ-Ⅱ (84.75%) of Wadian drinking water test was higher than that of the control group (32.71%), with statistical significance (P < 0.05). The latency of MEP in the study group was lower than that in the control group, and the amplitude of MEP was higher than that in the control group, with statistical significance (P < 0.05). The latency of Ⅰ, Ⅲ, and Ⅴ waves and the latency between the peaks of Ⅰ-Ⅲ, Ⅲ-Ⅴ, and Ⅰ-Ⅴ in the study group were significantly shorter than those in the control group, with statistical significance (P < 0.05). The total incidence of aspiration pneumonia and aspiration in the study group was lower than that in the control group, and the difference was statistically significant (P < 0.05). Conclusion High-frequency cerebellar rTMS combined with respiratory muscle training has a certain effect in PSD patients, which can shorten BAEP, regulate MEP of mandibular hyoid muscle, improve swallowing function of patients, and reduce the risk of aspiration pneumonia and aspiration to some extent.

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表 1 2组PSD患者一般资料比较

Table 1. Comparison of general data between the two groups of PSD patients

组别	例数	性别[例(%)]		年龄 (x±s，岁)	PSD病程 (x±s，周)	卒中部位[例(%)]
组别	例数	男性	女性	年龄 (x±s，岁)	PSD病程 (x±s，周)	基底节/丘脑	脑叶	脑干	其他
研究组	59	31(52.54)	28(47.46)	62.89±4.72	3.69±0.42	29(49.15)	14(23.73)	13(22.03)	3(5.09)
对照组	59	34(57.62)	25(42.37)	63.25±4.47	3.57±0.48	27(45.76)	15(25.42)	11(18.64)	6(10.18)
统计量		0.308^a		0.425^b	1.445^b	1.273^a
P值		0.579		0.671	0.151	0.736
注：^a为χ²值，^b为t值。

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表 2 2组PSD患者干预前后吞咽功能比较

Table 2. Comparison of swallowing function between the two groups of PSD patients before and after intervention

组别	例数	SSA(x±s，分)		洼田饮水试验[例(%)]
组别	例数	干预前	干预3周后	Ⅰ级	Ⅱ级	Ⅲ级	Ⅳ级	Ⅴ级
研究组	59	37.58±3.61	21.47±2.51^b	32(54.24)	18(30.51)	5(8.47)	4(6.78)	0
对照组	59	37.82±3.25	24.25±2.38^b	20(33.90)	17(28.81)	15(25.42)	6(10.17)	1(1.70)
统计量		0.380^a	6.173^c			2.055^d
P值		0.705	< 0.001			0.040
注：^a为t值，^c为F值，^d为Z值；与同组干预前比较，^bP < 0.05。

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表 3 2组PSD患者干预前后下颌舌骨肌MEP比较(x±s)

Table 3. Comparison of mandibular hyoid muscle MEP between the two groups of PSD patients before and after intervention (x±s)

组别	例数	MEP潜伏期(ms)		MEP波幅(μV)
组别	例数	干预前	干预3周后	干预前	干预3周后
研究组	59	11.62±1.27	8.93±1.11^b	100.53±10.87	137.33±20.90^b
对照组	59	11.25±1.84	9.98±1.37^b	101.42±9.77	122.96±19.99^b
统计量		1.271^a	19.763^c	0.468^a	14.640^c
P值		0.207	< 0.001	0.641	< 0.001
注：^a为t值，^c为F值；与同组干预前比较，^bP < 0.05。

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表 4 2组PSD患者干预前后波潜伏期BAEP比较(x±s，ms)

Table 4. Comparison of BAEP latency periods between the two groups of PSD patients before and after intervention (x±s, ms)

组别	例数	Ⅰ		Ⅲ		Ⅴ
组别	例数	干预前	干预3周后	干预前	干预3周后	干预前	干预3周后
研究组	59	2.11±0.15	1.52±0.15^b	4.19±0.25	3.63±0.14^b	6.21±0.23	5.28±0.13^b
对照组	59	2.09±0.16	1.88±0.13^b	4.17±0.22	3.90±0.19^b	6.18±0.25	5.89±0.18^b
统计量		0.700^a	199.893^c	0.461^a	72.293^c	0.678^a	437.744^c
P值		0.485	< 0.001	0.645	< 0.001	0.499	< 0.001
注：^a为t值，^c为F值；与同组干预前比较，^bP < 0.05。

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表 5 2组PSD患者干预前后波峰间潜伏期BAEP比较(x±s，ms)

Table 5. Comparison of peak to peak latency BAEP between the two groups of PSD patients before and after intervention (x±s, ms)

组别	例数	Ⅰ~Ⅲ		Ⅲ~Ⅴ		Ⅰ~Ⅴ
组别	例数	干预前	干预3周后	干预前	干预3周后	干预前	干预3周后
研究组	59	2.46±0.19	2.03±0.19^b	2.31±0.27	1.64±0.18^b	4.58±0.22	4.04±0.17^b
对照组	59	2.42±0.21	2.32±0.16^b	2.29±0.25	1.98±0.14^b	4.55±0.21	4.31±0.21^b
统计量		1.085^a	80.759^c	0.417^a	127.975^c	0.758^a	54.855^c
P值		0.280	< 0.001	0.677	< 0.001	0.450	< 0.001
注：^a为t值，^c为F值；与同组干预前比较，^bP < 0.05。

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表 6 2组PSD患者吸入性肺炎、误吸发生率比较[例(%)]

Table 6. Comparison of incidence rates of aspiration pneumonia and aspiration between the two groups of PSD patients before and after intervention [cases (%)]

组别	例数	吸入性肺炎	误吸
研究组	59	0	2(3.39)
对照组	59	6(10.17)	8(13.56)
χ²值		4.390^a	3.933^a
P值		0.036	0.047

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