双侧重复经颅磁刺激联合常规康复训练治疗脑卒中后吞咽障碍效果观察

目的 观察双侧重复经颅磁刺激(rTMS)在单侧脑卒中后吞咽障碍患者康复治疗中的效果.方法 前瞻性选取2018年8月～2019年11月于四川大学华西医院住院的单侧脑卒中后吞咽障碍患者90例,用随机数表法将患者分为双侧rTMS组、单侧rTMS组、假刺激组,每组各30例.各组均接受常规康复训练,rTMS频率为3 Hz,刺激强...

Effect of bilateral repetitive transcranial magnetic stimulation combined with routine rehabilitation training on dysphagia after stroke

Objective To observe the effect of bilateral repetitive transcranial magnetic stimulation(rTMS)in the rehabilitation of patients with dysphagia after unilateral stroke. Methods 90 patients with dysphagia after unilateral stroke who were hospitalized in our hospital from Aug.2018 to Nov.2019 were randomly divided into three groups.There were 30 cases in each group.Each group received routine rehabilitation training.The frequency of rTMS was 3 Hz,stimulation intensity was 80% RMT,stimulation time was 2 S,interval was 10 s,unilateral treatment time was 10 min. Both sides of the rTMS group were treated with true stimulation.In the unilateral rTMS group,the affected hemisphere received true stimulation,while the healthy hemisphere received false stimulation.In the sham stimulation group,both the affected side and the healthy side were treated with sham stimulation.All the three groups were treated for 4 courses.Before and after treatment,the effect was evaluated by the change of Wa Tian drinking water test,and the swallowing function was evaluated by the standard swallowing assessment(SSA),the outcome of dysphagia and severity scale(DOSS).Results The total effective rate of bilateral and unilateral rTMS groups was higher than that of sham stimulation group,the difference between the two groups was statistically significant(P < 0.05),the difference between the two groups was slightly higher than that of unilateral rTMS group,the difference between the two groups was not statistically significant(P > 0.05). Before rehabilitation treatment,there was no significant difference between the three groups in the scores of SSA and doss(P > 0.05). The difference of SSA and doss before and after rehabilitation treatment was statistically significant(P < 0.05). The SSA scores of sham stimulation group,unilateral rTMS group and bilateral rTMS group decreased in turn,and the doss scores increased in turn.The differences between unilateral rTMS group,bilateral rTMS group and sham stimulation group were statistically significant(P < 0.05). There was significant difference in SSA,doss between bilateral rTMS group and unilateral rTMS group(P < 0.05). Conclusion For the patients with dysphagia after unilateral cerebral infarction,the improvement of swallowing function is better by the combination of 3 Hz rTMS stimulation on the affected side and healthy side and routine rehabilitation training.