高低频重复经颅磁刺激对卒中后认知障碍伴摄食吞咽困难患者的疗效观察

目的：探讨高低频重复经颅磁刺激(rTMS)对卒中后认知障碍伴摄食吞咽困难患者的疗效。方法：将在徐州市中心医院康复医学科住院的60例经简易精神状态量表(MMSE)评估为认知障碍和吞咽造影检查(VFSS)证实存在吞咽障碍的脑卒中患者，随机分为对照组与观察组，每组30例。2组患者均予基础药物治疗、常规吞咽康复训练、常规认知功能训练，在此基础上，观察组给予高低频rTMS，对照组给予高低频rTMS假刺激。2组患者接受3周治疗后，分别评估脑神经营养指标、脑部血流动力学指标、MMSE量表及吞咽功能。结果：治疗后2组脑源性神经营养因子（BDNF）、神经生长因子（NGF）水平均较治疗前提高（P＜0.05），且观察组低于对照组（P＜0.05）；治疗后2组最大峰值流速（MPV）、平均流速（Vm）均较治疗前增快（P＜0.05），血管阻力指数（RI）较治疗前降低（P＜0.05），且观察组MPV、Vm均快于对照组（P＜0.05），RI低于对照组（P＜0.05）；治疗后2组患者MMSE量表评分提高(P<0.05),观察组评分高于对照组(P<0.05)；治疗后2组患者吞咽困难量表(VDS)评分降低(P<0.05),观察组更低于对照组评分(P<0.05)；治疗后2组患者口腔运送时间(OTT)、软颚上抬时间(SET)均缩短(P<0.05),观察组较对照组缩短更明显(P<0.05)。结论：高低频rTMS可更好地改善脑卒中后认知障碍伴摄食吞咽困难患者的认知及吞咽功能。

Efficacy of high- and low-frequency rTMS in patients with poststroke cognitive impairment with feeding dysphagia

Objective: To investigate the efficacy of high- and low-frequency repeated transcranial magnetic stimulation (rTMS) in patients with post-stroke cognitive impairment and feeding dysphagia. Methods: A total of 60 stroke patients hospitalized in the Rehabilitation Medicine Department of Xuzhou Central Hospital evaluated as cognitive impairment and swallowing graphy (VFSS) were randomly divided into control group and observation group, 30 patients in each group. All the patients were given basic drug therapy, routine swallowing rehabilitation training, and routine cognitive function training. On this basis, the observation group was sabjected to high- and low-frequency rTMS, and the control group received high- and low-frequency rTMS pseudostimulation. After 3 weeks of treatment, all patients were evaluated for the cerebral neurotrophic index, cerebral hemodynamics index, MMSE scale, and swallowing function, respectively. Results: The levels of brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF) were increased after the treatment (P<0.05), and those in the observation group were lower than those in the control group (P<0.05). The maximum peak flow velocity (MPV) and mean flow velocity (Vm) after treatment were faster (P<0.05), and vascular resistance index (RI) was lower (P<0.05) than those before treatment. MPV and Vm in the observation group were faster than those in the control group (P<0.05). The RI was lower in the observation group than that in the control group (P<0.05). MMSE scale scores in both groups after treatment were increased (P<0.05), and those in the observation group were higher than in the control group (P<0.05). The dysphagia scale (VDS) score decreased after treatment in both groups(P<0.05), and the score in the observation group was significantly lower than in the control group (P<0.05). Oral delivery time (OTT) and soft jaw braces time (SET) after treatment in both groups were shortened (P<0.05), and those in the observation group were significantly shorter than in the control group (P<0.05). Conclusion: High- and low-frequency rTMS can better improve the cognitive impairment and swallowing function in patients with feeding dysphagia after stroke.