成家雯,王先斌,吴霜
CHENG Jiawen,WANG Xianbin,WU Shuang

• 1:贵州医科大学附属医院康复医学科
• 2:贵州医科大学临床医学院

摘要(Abstract)：

目的 探讨高频重复经颅磁刺激（rTMS）和间歇性Theta节律爆发式刺激（iTBS）对单侧大脑半球脑卒中后吞咽障碍患者吞咽功能电生理指标的影响。方法 30例单侧大脑半球脑卒中后吞咽障碍患者均分为对照组（常规康复训练）、rTMS组（健侧舌骨上肌群皮质代表区10 Hz rTMS刺激+常规康复训练）及iTBS组（健侧舌骨上肌群皮质代表区10 Hz iTBS刺激+常规康复训练），连续治疗2周；收集3组患者治疗前的一般资料[年龄、性别、病程、病变性质、病变部位及功能性经口摄食分级（FOIS）评分]，采用舌骨上肌群表面肌电图（sEMG）、渗透-误吸量表（PAS）、舌骨上抬和前移运动速度测定评估3组患者治疗前后的吞咽功能，用患侧舌骨上肌群运动诱发电位（MEP）波幅评价3组患者治疗前后的皮层兴奋性。结果 与治疗前比较，3组患者治疗后吞咽时程缩短、MEP最大波幅增高、PAS评分降低、舌骨上抬及前移运动速度增快，差异均有统计学意义（P<0.05）；与对照组比较，治疗后rTMS组和iTBS组单侧大脑半球脑卒中后吞咽障碍患者的吞咽时程缩短、MEP最大波幅增高、PAS评分降低、舌骨上抬及前移运动速度增快均更明显（P<0.05），但rTMS组和iTBS组组间比较差异无统计学意义（P> 0.05）。结论 健侧舌骨上肌群皮质代表区予10 Hz iTBS或rTMS刺激均可显著改善单侧大脑半球脑卒中后吞咽障碍患者的吞咽功能，其机制可能与两种电刺激方式均可改善患者吞咽功能相关肌群的电生理指标有关。
Objective To observe the difference between high frequency repetitive transcranial magnetic stimulation(rTMS) and intermittent theta burst stimulation(iTBS) on the electrophysiological indexes of swallowing function in patients with dysphagia after unilateral hemisphere stroke.Methods A total of 30 patients with dysphagia after unilateral cerebral hemispheric stroke was divided into control group( routine rehabilitation training), rTMS group(10 Hz rTMS on cortical representative area of contralateral suprahyoid muscle + routine rehabilitation training) and iTBS group(10 Hz iTBS on cortical representative area of contralateral suprahyoid muscle + routine rehabilitation training). All patients were treated continuously for 2 weeks. General data, such as age, gender,course of disease, nature of lesion, location of lesion, and functional oral intake scale(FOIS) score,of three groups before treatment were collected. The surface electromyography(sEMG) of suprahyoid muscles, a penetration-aspiration scale(PAS), the superior and anterior excursion velocity of hyoid bone were used to evaluate the swallowing function of the three groups before and after treatment; the amplitude of motor evoked potential(MEP) of suprahyoid muscles on the affected hemisphere were collected to evaluate the cortical excitability in the three groups.Results Compared with those before treatment, the swallowing time was shortened, the maximum amplitude increased, PAS score decreased, the superior and anterior excursion velocity of hyoid bone increased after treatment in the three groups, and the differences were statistically significant(P< 0. 05). Compared with the control group, the patients in rTMS group and iTBS group had shorter swallowing time, higher maximum amplitude, lower PAS score, higher superior and anterior excursion velocity of hyoid bone after treatment(P< 0. 05). There was no significant difference between the rTMS group and iTBS group(P> 0. 05).Conclusion Treatment with 10 Hz rTMS or iTBS on contralateral hemisphere suprahyoid muscles motor cortex can significantly improve the swallowing function of patients after unilateral hemisphere stroke. The mechanism may be explained by the fact that both magnetic stimulation methods can improve the electrophysiological indexes of swallowing-related muscles in patients.

关键词(KeyWords)： 吞咽障碍;卒中;康复;重复经颅磁刺激;Theta爆发式经颅磁刺激;吞咽训练
deglutition disorders;stroke;rehabilitation;repetitive transcranial magnetic stimulation (rTMS);theta burst stimulation (iTBS);swallowing training

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金（82060419）;; 贵州省科技计划项目[（黔科合基础-ZK[2022]重点045），（黔科合基础-ZK[2022]一般438）];; 贵州医科大学附属医院博士科研启动基金项目（gxfybsky-2021-5）

作者(Author): 成家雯,王先斌,吴霜
CHENG Jiawen,WANG Xianbin,WU Shuang

DOI: 10.19367/j.cnki.2096-8388.2022.06.010

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