目的 探讨下颌舌骨肌外周磁刺激联合中枢磁刺激对脑卒中后吞咽障碍的影响。 方法 选取脑卒中后吞咽障碍患者60例，按照随机数字表法将其分为对照组、外周磁刺激组、中枢磁刺激组、外周＋中枢磁刺激组，每组15例。对照组患者进行常规吞咽训练，外周磁刺激组在对照组基础上增加下颌舌骨肌高频重复外周磁刺激(rPMS)，中枢磁刺激组在对照组基础上增加下颌舌骨肌皮质高频重复经颅磁刺激(rTMS)，外周＋中枢磁刺激组在对照组基础上增加rPMS＋rTMS，上述治疗每日1次，每周5 d，共10次(2周)。治疗前和治疗全部结束后(治疗后)，采用功能性经口摄食量表(FOIS)、渗漏-误吸量表(PAS)、功能性吞咽障碍量表(FDS)对4组患者的吞咽功能进行评定。 结果 治疗后，4组患者的FOIS、FDS、PAS评分均较组内治疗前改善(P<0.05)。与对照组比较，外周磁刺激组[(3.86±0.86)分]、中枢磁刺激组[(3.79±0.89)分]、外周＋中枢磁刺激组[5.00分(5.00~6.00分)]治疗前后的FOIS差值较大(P<0.05)；外周磁刺激组[(36.50±6.63)分]、中枢磁刺激组[(35.29±8.96)分]、外周＋中枢磁刺激组[(46.53±7.03)分]治疗前后的FDS差值较大(P<0.05)；外周磁刺激组[(2.07±0.73)分]、中枢磁刺激组[4.00分(2.00~4.00分)]、外周＋中枢磁刺激组[4.00分(4.00~6.00分)]治疗前后的PAS差值较大(P<0.05)。外周磁刺激组与中枢磁刺激组治疗前后的FOIS差值、FDS差值、PAS差值比较，差异均无统计学意义(P>0.05)。与外周磁刺激组和中枢磁刺激组比较，外周＋中枢磁刺激组治疗前后的FOIS差值、FDS差值、PAS差值显著较大(P<0.05)。 结论 下颌舌骨肌rPMS联合皮质rTMS可以明显改善吞咽障碍，疗效较单一常规吞咽康复、下颌舌骨肌rPMS、皮质rTMS好。 Objective To explore any effect of transcranial magnetic stimulation and peripheral magnetic stimulation of the mylohyoid muscle on dysphagia among stroke survivors. Methods Sixty stroke survivors with dysphagia were randomly divided into a control group, a peripheral magnetic stimulation group, a central magnetic stimulation group, and a central + peripheral magnetic stimulation group, each of 15. In addition to routine swallowing training, the subjects were given the appropriate magnetic stimulation daily, five times a week for two weeks. Before and after the intervention, swallowing was evaluated using the Functional Oral Intake Scale (FOIS), Penetration-Aspiration Scale (PAS) and a functional dysphagia scale (FDS). Results The average FDS, PAS, and FOIS scores of all four groups had improved significantly after the treatment. Improvement significantly greater than in the control group was observed in the average FOIS, FDS and PAS scores of the other three groups. The peripheral + central magnetic stimulation group showed the greatest average improvement. Conclusion Combining mylohyoid muscle magnetic stimulation with magnetic stimulation of the cerebral cortex can significantly relieve dysphagia. It is more effective than conventional swallowing rehabilitation or either magnetic stimulation alone.
The effects of transcranial magnetic stimulation and peripheral magnetic stimulation of the mylohyoid muscle on post-stroke dysphagia
Objective To explore any effect of transcranial magnetic stimulation and peripheral magnetic stimulation of the mylohyoid muscle on dysphagia among stroke survivors. Methods Sixty stroke survivors with dysphagia were randomly divided into a control group, a peripheral magnetic stimulation group, a central magnetic stimulation group, and a central + peripheral magnetic stimulation group, each of 15. In addition to routine swallowing training, the subjects were given the appropriate magnetic stimulation daily, five times a week for two weeks. Before and after the intervention, swallowing was evaluated using the Functional Oral Intake Scale (FOIS), Penetration-Aspiration Scale (PAS) and a functional dysphagia scale (FDS). Results The average FDS, PAS, and FOIS scores of all four groups had improved significantly after the treatment. Improvement significantly greater than in the control group was observed in the average FOIS, FDS and PAS scores of the other three groups. The peripheral + central magnetic stimulation group showed the greatest average improvement. Conclusion Combining mylohyoid muscle magnetic stimulation with magnetic stimulation of the cerebral cortex can significantly relieve dysphagia. It is more effective than conventional swallowing rehabilitation or either magnetic stimulation alone.
StrokeDysphagiaMylohyoid muscleMylohyoid cortexTranscranial magnetic stimulation
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