摘要
目的 探讨经颅直流电刺激(tDCS)联合口腔内低频电刺激对桥脑梗死后吞咽障碍患者的临床疗效.方法 选取2018 年6 月—2021 年6 月96 例桥脑梗死后吞咽障碍为研究对象,根据治疗方法分为对照A组、对照B组、观察组,每组32 例.对照A组予tDCS,对照B组予口腔内低频电刺激,观察组予以tDCS联合口腔内低频电刺激.比较3 组疗效、进食情况、营养状态指标[前白蛋白(PAB)、白蛋白(ALB)、转铁蛋白(TRF)、血红蛋白(Hb)]、表面肌电图、舌骨喉复合体动度及改良Mann吞咽能力评估量表(MMASA)、吞咽功能特异性生活质量量表(SWAL-QOL)、美国国立卫生院卒中量表(NIHSS)、Barthel指数(BI)评分.结果 观察组治疗总有效率为90.62%(29/32)高于对照A组的62.50%(20/32)、对照B组的65.62%(21/32)(P＜0.05).治疗2、4 周后,观察组自主进食时间长于对照A组、对照B组,实际进食比例、表面肌电图最大波幅、ALB、PAB、Hb、TRF以及MMASA、SWAL-QOL、BI评分均高于对照A组、对照B组,吞咽时程短于对照A组、对照B组,NIHSS评分低于对照A组、对照B组,舌骨及甲状软骨上移、前移距离大于对照A组、对照B组(P＜0.05).治疗2、4 周后,对照A组NIHSS评分低于对照B组,BI评分高于对照B组(P＜0.05).结论 tDCS联合口腔内低频电刺激治疗桥脑梗死后吞咽障碍,能提升疗效,增强患者营养状态与口腔肌群功能,促进神经功能好转,从而改善吞咽障碍,有助于病情恢复及生活质量的提高.
Abstract
Objective To investigate the clinical effect of transcranial direct current stimulation(tDCS)combined with intraoral low-frequency electrical stimulation on patients with swallowing dysfunction after pontocerebral infarction.Meth-ods A total of 96 patients with swallowing dysfunction after pontocerebral infarction from June 2018 to June 2021 were select-ed as the research subjects and divided into control group A(n =32),control group B(n =32)and observation group(n = 32)according to treatment methods.Control group A was given tDCS,control group B was given oral low-frequency electrical stimulation,and observation group was given tDCS combined with oral low-frequency electrical stimulation.The three groups were compared in terms of therapeutic effect,feeding status,nutritional status indicators[prealbumin(PAB),albumin(ALB),transferrin(TRF),hemoglobin(Hb)],surface electromyography,hyolaryngeal complex movement,modified Mann Swallowing Ability Assessment Scale(MMASA),Swallowing-related-Quality of Life(SWAL-QOL),National Institutes of Health Stroke Scale(NIHSS),Barthel Index(BI)score.Results The total effective rate of observation group was90.62%(29/32),which was higher than that of control group A[62.50%(20/32)]and control group B[65.62%(21/32)](P＜0.05).At 2 and4 weeks after treatment,the time of autonomous eating in observation group was longer than that in con-trol group A and control group B,the actual eating proportion,maximum amplitude of surface electromyography,ALB,PAB,Hb,TRF,MMASA,SWAL-QOL and BI scores were higher than those in control group A and control group B,and the swal-lowing time was shorter than that in control group A and control group B.The NIHSS score was lower than that of control group A and B,and the ascending and advancing distance of hyoid bone and thyroid cartilage was greater than that of control group A and control group B(P＜0.05).At 2 and 4 weeks after treatment,the NIHSS score of control group A was lower than that of control group B,and the BI score was higher than that of control group B(P＜0.05).Conclusion tDCS combined with intraoral low-frequency electrical stimulation in the treatment of swallowing dysfunction after pontocerebral infarction can im-prove the therapeutic effect,enhance the nutritional status and oral muscle function of patients,promote the improvement of neurological function,and thus improve the dysphagia,which is conducive to the recovery of disease and the improvement of quality of life.
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