摘要
目的 探究舌面散刺联合经颅磁刺激技术(TMS)对脑卒中后吞咽困难患者咽运动皮质、神经功能及血清生长分化因子15(GDF-15)、可溶性蛋白-100β(S100β)的影响.方法 前瞻性选取2021年5月至2023年2月海南医学院第二附属医院康复科收治的脑卒中后吞咽困难患者104例为研究对象,按照随机数表法将其分为观察组(n=50)和对照组(n=54).所有患者进行常规治疗,对照组同时行TMS治疗,每次20 min,每天1次,每周3次,持续治疗4周;观察组在对照组的基础上联合舌面散刺治疗,每天1次,每周6次,持续治疗4周.比较两组治疗前、治疗4周后的中医证候评分、吞咽障碍造影评分量表(VDS)评分和渗透-误吸量表(PAS)评分、美国国立卫生研究院卒中量表(NIHSS)评分、洼田饮水试验量表评分.检测并比较两组患者治疗前、治疗4周后的血清GDF-15、S100β表达水平变化以及治疗期间不良反应发生情况.结果 治疗4周后,观察组的舌卷痿缩、进食缓慢、饮水发呛、舌质瘀斑/黯淡以及脉细涩证候的评分分别为(1.90±0.01)、(2.69±0.75)、(2.66±0.24)、(1.02±0.13)、(1.18±0.20)分,均低于对照组[(2.54± 0.34)、(3.05±0.24)、(3.85±0.71)、(1.17±0.22)、(1.32±0.09)分],差异均有统计学意义(P＜0.05).治疗 4 周后,两组VDS、PAS评分均较治疗前下降,且观察组VDS、PAS评分分别为(25.01±5.74)、(1.65±0.04)分,均低于对照组[(28.01±6.82)、(2.00±0.18)分],差异均有统计学意义(P＜0.05).治疗4周后,两组NIHSS评分及洼田饮水试验评分均较治疗前下降,且观察组NIHSS、洼田饮水试验评分分别为(9.86±1.50)、(1.54±0.33)分,均低于对照组[(13.24±0.92)、(1.97±0.76)分],差异均有统计学意义(P＜0.05).治疗4周后,两组GDF-15水平较治疗前降低,S100β 水平较治疗前升高,观察组 GDF-15 为(443.05±13.00)pg/mL,低于对照组[(487.24±26.51)pg/mL],S100β水平为(0.21±0.03)μg/L,高于对照组[(0.18±0.04)μg/L],差异均有统计学意义(P＜0.05).观察组与对照组患者不良反应总共发生率比较(6.00％vs.3.70％),差异无统计学意义(P＞0.05).结论 舌面散刺联合TMS治疗方案可有效改善脑卒中后吞咽困难患者的临床证候,刺激其咽运动皮质以促进其吞咽功能的修复,同时还可有效改善其神经功能及血清GDF-15、S100β蛋白表达.
Abstract
Objective To investigate the effects of tongue and facial acupuncture combined with transcranial magnetic stimulation(TMS)on pharyngeal motor cortex,nerve function,serum growth differentiation factor 15(GDF-15)and soluble protein-100β(S100β)in patients with dysphagia after stroke.Methods A total of 104 patients with dysphagia after stroke admitted to Department of Rehabilitation,the Second Af-filiated Hospital of Hainan Medical University from May 2021 to February 2023 were prospectively selected as the study subjects.They were divid-ed into an observation group(n=50)and the control group(n=54)using a random number table method.All patients received conventional treatment,the control group received TMS treatment at the same time,20 minutes each time,once a day,three times a week,continuous treat-ment for four weeks;and the observation group was combined with tongue surface loose acupuncture treatment on the basis of the control group,once a day,six times a week,and continuous treatment for four weeks.The Traditional Chinese Medicine syndrome scores,videofluoroscopic dys-phagia scale(VDS)and permeation missuction scale(PAS),National Institutes of Health Stroke Scale(NIHSS),and Wada Drinking Water Test Scale scores of the two groups before treatment,after 4 weeks of treatment were compared.The changes of serum GDF-15 and S100β protein con-centrations before treatment,after 4 weeks of treatment and the occurrence of adverse reactions during treatment were detected.Results After 4 weeks of treatment,the scores of tongue curling,slow eating,choking on drinking water,tongue bruising/dullness,and fine pulse in two groups were lower than those before treatment,the scores of tongue curling and contraction,slow eating,choking on drinking water,tongue bruising/dull-ness,and narrow pulse syndrome in the observation group were(1.90±0.01),(2.69±0.75),(2.66±0.24),(1.02±0.13),and(1.18± 0.20)points,respectively,which were lower than those in the control group[(2.54±0.34),(3.05±0.24),(3.85±0.71),(1.17±0.22),and(1.32±0.09)points],and the differences were statistically significant(P＜0.05).After 4 weeks of treatment,the VDS and PAS scores of two groups were lower than those before treatment,and the VDS and PAS scores of the observation group were(25.01±5.74)and(1.65±0.04)points,respectively,lower than those of the control group[(28.01±6.82)and(2.00±0.18)points],and the differences were statistically significant(P＜0.05).After 4 weeks of treatment,the NIHSS score and Wada drinking water test score of two groups were lower than those be-fore treatment,and the NIHSS and Wada drinking water test scores of the observation group were(9.86±1.50)and(1.54±0.33)points,re-spectively,which were lower than of the control group[(13.24±0.92)and(1.97±0.76)points],and the differences were statistically signifi-cant(P＜0.05).After 4 weeks of treatment,the levels of GDF-15 in two groups were lower than those before treatment,and the levels of S100β were higher than those before treatment,the level of GDF-15 in the observation group was(443.05±13.00)pg/mL,which was lower than that in the control group[(487.24±26.51)pg/mL],and the level of S100β was(0.21±0.03)μg/L,which was higher than that in the control group[(0.18±0.04)]μg/L,the differences were statistically significant(P＜0.05).There was no statistically significant difference in the total incidence of adverse reactions between the observation group and the control group(6.00％vs.3.70％)(P＞0.05).Conclusion Tongue and facial acupuncture combined with TMS can effectively improve the clinical syndromes of patients with dysphagia after stroke,stimulate the pharyngeal motor cortex to promote the repair of swallowing function,and also effectively improve the nerve function and serum GDF-15,S100β protein expression.
维普
万方数据