颌下肌群重复周围磁刺激对卒中后吞咽障碍患者吞咽功能的影响

目的探讨颌下肌群重复周围磁刺激对亚急性期卒中后吞咽障碍患者吞咽功能的影响。方法选取40例亚急性期卒中后吞咽障碍患者,随机分配到治疗组和对照组,治疗组给予常规吞咽训练和颌下肌群重复周围磁刺激治疗,对照组仅给予常规吞咽训练,治疗前后分别行藤岛一郎吞咽障碍评分、才藤氏7级评价和表面肌电图检查。治疗2周后对比两组患者吞咽功能变化,包括藤岛一郎吞咽障碍评分、才藤氏7级评价、颌下肌群表面肌电图中吞咽时程及最大振幅的改变。结果两组各入组20例患者,治疗2周后吞咽功能均有改善。组内比较:两组患者治疗后较本组治疗前藤岛一郎吞咽障碍评分、才藤氏7级评价法评分改善,差异具有显著性(均P0.05),表面肌电图最大振幅增高,吞咽时程缩短,差异具有显著性(均P0.05)。组间比较:治疗后治疗组藤岛一郎吞咽障碍评分高于对照组,差异具有显著性(P=0.043);才藤氏7级评价法较对照组改善,差异具有显著性(P=0.028)。治疗组表面肌电图吞咽时程较对照组显著缩短(P=0.005);两组最大振幅无显著差异。结论重复周围磁刺激联合常规吞咽训练较单纯吞咽训练可以更好地改善卒中后吞咽障碍患者吞咽功能,主要表现为提高患者吞咽肌群的灵活性、协调性,因此临床上可选择重复周围磁刺激治疗卒中后吞咽障碍。

Effects of Repetitive Peripheral Magnetic Stimulation on Submandibular Muscles in Post-stroke Patients with Dysphagia

Objective To study the effect of repetitive peripheral magnetic stimulation (rPMS) on the submandibular muscles in post-stroke patients with dysphagia during subacute stage. Methods Forty subacute post-stroke patients with dysphagia were selected in the study which were randomly allocated into treatment group and control group. The treatment group was given conventional swallowing treatment combined with rPMS, and the control group was given conventional swallowing treatment only. Severity of the swallow disorders (STSD), saitoh seven stage scale (SSSS), and the surface electromyographic signals were performed before and after treatment. The change of swallowing function of 2 groups were compared 2 weeks later to observe the changes of Severity of STSD, SSSS, and the surface electromyographic signals, and the swallowing duration and maximal amplitude. Results The swallowing function of both groups got improved after 2 weeks of therapy. The intragroup comparison showed that the STSD and the SSSS improved (P<0.05) and the amplitude increased and the swallow duration shortened in each group (P<0.05), which had significant difference. The intergroup comparison showed that STSD score in treatment group was significantly higher than that of control group (P=0.043); the SSSS score in treatment group was significantly improved than in control group (P=0.028); and the swallowing duration in treatment group were significantly shortened than that in control group (P=0.005). However, there was no significant difference in the change of the maximal amplitude between treatment group and the control group. Conclusion The treatment of rPMS combined with conventional swallowing treatment can help post-stroke patients with dysphagia improve the function of swallowing. It may be chosen as a good new method in regulating the harmony and lfexibility of the swallowing muscles by clinical doctors.