经颅直流电刺激治疗脑干卒中后吞咽障碍的疗效观察

目的：探讨经颅直流电刺激（tDCS）治疗脑干卒中后吞咽障碍的疗效。方法：将47例吞咽功能障碍的脑卒中患者随机分为观察组23例和对照组24例。2组患者均进行脑卒中基础治疗、吞咽康复训练和针刺治疗，观察组再给予tDCS阳极交替刺激双侧口咽部皮层感觉区域，对照组以tDCS阳极假刺激同一区域。治疗前及治疗3周后，采用标准吞咽功能评估（SSA）、电视荧光透视检查（VFSS）及渗透 误吸指数（PAS）对2组患者进行评估。结果：治疗3周后，2组SSA评分各阶段较组内治疗前的同一阶段比较均明显降低（均P＜0.05），且治疗后总分较治疗前明显降低（P＜0.05）；观察组咽期、误吸情况评分及总分较治疗前及对照组均明显提高（均P＜0.05），且观察组PAS分级情况明显优于对照组（P＜0.05）。结论：经颅直流电刺激双侧口咽部感觉皮层能更好地改善吞咽功能，对治疗脑干卒中后吞咽障碍有一定的疗效。

Effectiveness of transcranial direct current stimulation for dysphagia after brainstem stroke

Objective: To investigate the effectiveness of transcranial direct current stimulation (tDCS) for dysphagia after brainstem stroke. Methods: Forty seven stroke patients with dysphagia were randomly divided into treatment group (n=23) and control group (n=24). Basic stroke treatment, swallowing rehabilitation training, acupuncture treatment were given to both groups. In the treatment group, tDCS and anode were given alternately to stimulate the sensory region of bilateral oropharynx cortex. The control group received false stimulus with tDCS and anode. Standardized swallowing assessment (SSA), the videofluoroscophic swallowing study (VFSS) and penetration aspiration scale (PAS) were used to evaluate the patients in the two groups before and after treatment for 3 weeks. Results: Three weeks after treatment, the SSA scores in the two groups were significantly lower than those before treatment (all P<0.05), and the total score after treatment was significantly lower than before treatment (P<0.05). The scores of pharyngeal stage, aspiration and total score in the treatment group were significantly higher than those in the control group (all P<0.05), and the PAS classification in the treatment group was significantly better than that in the control group (P<0.05). Conclusion: The tDCS of bilateral oropharyngeal sensory cortex can better improve swallowing function and has certain curative effect on dysphagia after brainstem stroke.