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

doi:10.3969/j.issn.1006-5725.2025.08.003

Abstract

Abstract:

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.

Key words: high-frequency repetitive transcranial magnetic stimulation, biofeedback, air swallowing training, stroke, dysphagia

CLC Number:

R743.3

Panpan GAO,Qian ZHANG,Tinghui LIU,Jie. SUN. Application of ipsilateral high⁃frequency rTMS combined with biofeedback⁃based air swallowing training in patients with post⁃stroke dysphagia[J]. The Journal of Practical Medicine, 2025, 41(8): 1105-1110.

Figures/Tables 6

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References 28

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组别	例数	性别（男/女）/例	年龄/岁	BMI/（kg/m²）	脑卒中病程/d	吞咽障碍病程/d	患侧/例
组别	例数	性别（男/女）/例	年龄/岁	BMI/（kg/m²）	脑卒中病程/d	吞咽障碍病程/d	左侧	右侧
生物反馈组	38	22/16	68.19 ± 7.46	23.42 ± 3.42	40.03 ± 5.21	29.32 ± 3.53	23	15
磁刺激组	38	20/18	67.68 ± 7.29	23.19 ± 3.23	38.89 ± 4.89	28.47 ± 3.24	17	21
联合组	38	23/15	67.83 ± 7.42	23.34 ± 3.29	39.57 ± 5.06	29.45 ± 3.69	20	18
安慰剂组	38	24/14	67.20 ± 7.16	22.98 ± 3.19	38.75 ± 4.77	28.68 ± 3.34	22	16
F/χ² 值		0.949	0.119	0.132	0.548	0.730	2.224
P值		0.814	0.949	0.941	0.650	0.536	0.527

组别	例数	1级	2级	3级	4级	5级
生物反馈组	38	9（26.32）	10（45.61）	13（28.07）	6（28.07）	0（0.00）
磁刺激组	38	10（36.84）	9（54.39）	14（8.77）	5（8.77）	0（0.00）
联合组	38	17（26.32）	14（26.32）	6（26.32）	1（26.32）	0（0.00）
安慰剂组	38	3（7.89）	7（18.42）	18（47.37）	9（23.68）	1（2.63）
Z值		10.163
P值		0.006

组别	例数	UES 开放时间/ms		UES 开放程度/cm		咽收缩持续时间/ms
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
生物反馈组	38	80.65 ± 9.46	173.02 ± 21.15^?	0.47 ± 0.13	0.74 ± 0.23^?	231.58 ± 36.78	414.32 ± 50.33^?
磁刺激组	38	81.19 ± 10.18	170.79 ± 22.01^?	0.47 ± 0.15	0.72 ± 0.20^?	232.49 ± 39.49	413.96 ± 50.71^?
联合组	38	80.83 ± 9.87	205.33 ± 29.01	0.48 ± 0.17	1.14 ± 0.34	233.24 ± 39.74	559.19 ± 63.48
安慰剂组	38	80.33 ± 9.42	131.78 ± 20.25^?	0.47 ± 0.15	0.59 ± 0.20^?	232.51 ± 37.46	342.58 ± 43.73^?
F值		0.052	63.072	0.042	34.595	0.012	113.795
P值		0.984	< 0.001	0.989	< 0.001	0.998	< 0.001

组别	例数	FOIS 评分		SSA 评分
组别	例数	治疗前	治疗后	治疗前	治疗后
生物反馈组	38	2.66 ± 0.63	4.56 ± 0.75^?	31.24 ± 4.72	25.90 ± 3.64^?
磁刺激组	38	2.79 ± 0.60	4.53 ± 0.71^?	30.81 ± 4.30	26.21 ± 3.58^?
联合组	38	2.73 ± 0.66	6.04 ± 0.83	31.17 ± 4.58	20.03 ± 3.26
安慰剂组	38	2.62 ± 0.59	3.78 ± 0.62^?	30.78 ± 4.51	27.48 ± 3.81^?
F值		0.559	63.632	0.106	35.701
P值		0.643	< 0.001	0.957	< 0.001

组别	例数	白蛋白		血红蛋白		前白蛋白
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
生物反馈组	38	30.69 ± 4.80	37.93 ± 5.25^?	72.84 ± 7.43	85.60 ± 8.55^?	0.21 ± 0.06	0.34 ± 0.09^?
磁刺激组	38	30.23 ± 4.36	37.45 ± 5.18^?	73.11 ± 7.74	85.42 ± 8.34^?	0.23 ± 0.07	0.35 ± 0.11^?
联合组	38	30.47 ± 4.56	45.24 ± 6.96	73.07 ± 7.62	99.84 ± 10.42	0.23 ± 0.09	0.44 ± 0.16
安慰剂组	38	31.10 ± 4.92	34.13 ± 5.01^?	73.26 ± 7.81	78.12 ± 8.02^?	0.22 ± 0.08	0.28 ± 0.10^?
F值		0.239	26.063	0.020	39.810	0.606	11.872
P值		0.869	< 0.001	0.996	< 0.001	0.612	< 0.001

Application of ipsilateral high⁃frequency rTMS combined with biofeedback⁃based air swallowing training in patients with post⁃stroke dysphagia

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组别	例数	NIHSS评分		SWAL-QOL 评分
组别	例数	治疗前	治疗后	治疗前	治疗后
生物反馈组	38	14.25 ± 2.11	8.14 ± 1.15^?	98.83 ± 10.83	150.72 ± 18.41^?
磁刺激组	38	14.69 ± 2.20	8.18 ± 1.16^?	99.30 ± 11.36	151.01 ± 18.83^?
联合组	38	14.43 ± 2.16	6.02 ± 1.03	98.71 ± 10.54	176.43 ± 20.36
安慰剂组	38	14.21 ± 2.13	10.40 ± 2.06^?	97.78 ± 11.59	131.02 ± 15.27^?
F值		0.393	60.980	0.125	39.260
P值		0.758	< 0.001	0.945	< 0.001