收稿日期: 2024-12-03
网络出版日期: 2025-04-30
基金资助
江苏省自然科学基金面上项目(BK20211088)
Application of ipsilateral high⁃frequency rTMS combined with biofeedback⁃based air swallowing training in patients with post⁃stroke dysphagia
Received date: 2024-12-03
Online published: 2025-04-30
目的 探讨健侧高频重复经颅磁刺激（rTMS）与生物反馈下空吞咽训练在脑卒中后吞咽障碍中的效果。 方法 152例医院于2022年1月至2024年1月收治的脑卒中后吞咽障碍患者，随机数字表法分为4组，各38例。生物反馈组应用生物反馈下空吞咽训练，磁刺激组应用健侧高频rTMS，联合组应用生物反馈下空吞咽训练与健侧高频rTMS，安慰剂组进行常规吞咽训练和安慰性 rTMS，均干预4周。记录临床疗效，分别在治疗前后通过多功能食道造影仪评估食管上括约肌（UES）开放时间、开放程度、咽收缩持续时间，并比较吞咽功能、营养状况、神经功能和生活质量。 结果 联合组的临床疗效比生物反馈组和磁刺激组提高，治疗后的UES 开放时间、开放程度以及咽收缩持续时间分别为（205.33 ± 29.01）ms、（1.14 ± 0.34）cm、（559.19 ± 63.48）ms，高于另3组（P < 0.05）；联合组吞咽功能评分分别为（6.04 ± 0.83）和（20.03 ± 3.26）分，吞咽功能、营养状况、神经功能和生活质量均显著改善（P < 0.05）。 结论 联合治疗可提高脑卒中后吞咽障碍的疗效。
高盼盼 , 张倩 , 刘婷慧 , 孙洁 . 健侧高频重复经颅磁刺激联合生物反馈下的空吞咽训练在脑卒中后吞咽障碍患者中的应用[J]. 实用医学杂志, 2025 , 41(8) : 1105 -1110 . DOI: 10.3969/j.issn.1006-5725.2025.08.003
Objective To investigate the impact of high-frequency repetitive transcranial magnetic stimulation （rTMS） combined with biofeedback-assisted dry swallowing training on treating dysphagia following a stroke. Methods A total of 152 patients with dysphagia after stroke， admitted to the hospital from January 2022 to January 2024， were randomly divided into four groups using a random number table， with 38 cases in each group. The biofeedback group received biofeedback-assisted dry swallowing training， the magnetic stimulation group received high-frequency rTMS on the unaffected side， the combined group received both biofeedback-assisted dry swallowing training and high-frequency rTMS on the unaffected side， and the placebo group received conventional swallowing training and sham rTMS. All interventions lasted for 4 weeks. Clinical efficacy was recorded， and pre- and post-treatment assessments of the upper esophageal sphincter （UES） opening time， opening degree， and pharyngeal contraction duration were performed using multifunctional esophageal manometry. Additionally， swallowing function， nutritional status， neurological function， and quality of life were compared. Results The clinical efficacy of the combined group was higher than that of the biofeedback and magnetic stimulation groups. Post-treatment UES opening time， opening degree， and pharyngeal contraction duration were （205.33 ± 29.01） ms， （1.14 ± 0.34） cm， and （559.19 ± 63.48） ms， respectively， which were significantly better than those in the other 3 groups （P < 0.05）. The swallowing function scores of the combined group were （6.04 ± 0.83） and （20.03 ± 3.26） points， and significant improvements were observed in swallowing function， nutritional status， neurological function， and quality of life （P < 0.05）. Conclusion High-frequency rTMS combined with biofeedback-based dry swallowing training significantly improves the efficacy in the treatment of dysphagia after stroke.
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