重复经颅磁刺激联合针刺治疗脑梗死后吞咽障碍对吞咽功能及皮质兴奋性的影响

探讨重复经颅磁刺激（rTMS）联合针刺治疗脑梗死后吞咽障碍对吞咽功能及皮质兴奋性的影响。方法:选取64例脑梗死后吞咽障碍患者，随机分为对照组和治疗组，各32例。对照组予以假rTMS联合针刺治疗，治疗组予以rTMS联合针刺治疗。比较治疗后两组患者洼田试验等级、功能性经口摄食量表（FOIS）和渗漏-误吸量表（PAS）评分、表面肌电图信号（sEMG）（最大振幅和吞咽时限）、神经功能缺损评分（NIHSS）、神经元特异性烯醇化酶（NSE）水平以及治疗期间的不良反应情况。结果:治疗后，两组洼田饮水试验等级均有改善，且治疗组洼田饮水试验等级优于对照组（P<0.05）。两组FOIS评分高于治疗前，且PAS评分低于治疗前（P<0.05）；治疗组FOIS评分高于对照组，且PAS评分低于对照组（P<0.05）。两组sEMG最大振幅高于治疗前，且吞咽时限低于治疗前（P<0.05）；治疗组sEMG最大振幅高于对照组，且吞咽时限低于对照组（P<0.05）。两组NIHSS评分和NSE水平低于治疗前，治疗组NIHSS评分和NSE水平低于对照组（P<0.05）。治疗期间，两组无明显不良反应。结论:rTMS联合针刺治疗脑梗死后吞咽障碍可以改善吞咽功能，提高皮质兴奋性，促进神经功能恢复，安全性好，值得临床应用。

Effects of rTMS combined with acupuncture on swallowing function and cortical excitability in patients with dysphagia after cerebral infarction

Abstract: Objective To explore the effects of repetitive transcranial magnetic stimulation (rTMS) combined with acupuncture for dysphagia after cerebral infarction on swallowing function and cortical excitability. Methods A total of 64 patients with dysphagia after cerebral infarction were enrolled and then randomly divided into control group and treatment group, with 32 cases in each group. Control group was treated with sham rTMS and acupuncture, while treatment group was treated with rTMS and acupuncture. After treatment, the grading of water swallow test, scores of functional oral intake scale (FOIS) and penetration-aspiration scale (PAS), surface electromyography (sEMG) (maximum amplitude and time limit for swallowing), score of National Institutes of Health Stroke Scale (NIHSS) and level of neuron-specific enolase (NSE) were compared between two groups, and moreover, the incidences of adverse reactions during treatment were also analyzed. Results The treatment improved the grading of water swallow test in both groups, and the grading in treatment group was better than that in control group (P<0.05). After treatment, FOIS score was increased, and PAS score was decreased in both groups (P<0.05). Compared with those in control group, FOIS score in treatment group was higher, while PAS score was lower (P<0.05). The treatment also increased the maximum amplitude of sEMG, while reduced the time limit for swallowing in both groups (P<0.05). The maximum amplitude of sEMG in treatment group was larger than that in control group, and time limit for swallowing was shorter in treatment group (P<0.05). Moreover, NIHSS score and NSE level in both groups were decreased after treatment, and they were lower in treatment group than control group (P<0.05). During treatment, there were no obvious adverse reactions in either group. Conclusion The rTMS combined with acupuncture is safe for the treatment of dysphagia after cerebral infarction, and it can improve swallowing function, enhance cortical excitability and promote the recovery of nerve functions, worthy of clinical application.