廉泉埋针结合间歇性Theta爆发式脉冲模式经颅磁刺激对脑卒中后吞咽障碍的影响

关键词：脑卒中  吞咽障碍  咽期  间歇性Theta 爆发式脉冲模式  廉泉穴  埋针  随机对照试验

Keywords:stroke  dysphagia  pharyngeal stage  intermittent theta burst stimulation  Lianquan point  needle embedding  randomized controlled trial

摘要：

      摘要 目的：探讨廉泉穴埋针结合间歇性Theta 爆发式脉冲模式（intermittent theta burst stimulation， iTBS）脑卒中后吞咽障碍的影响。 方法：将60例脑卒中后咽期吞咽障碍患者纳入研究，数字随机法分为对照组和观察组，各30例。两组患者均接受吞咽障碍常规康复训练，对照组在常规训练基础上加用iTBS治疗，1次/日，5次/周，连续治疗2周。观察组在对照组治疗方案基础上增加廉泉穴埋针治疗，隔天更换埋针1次，连续治疗2周。比较两组患者标准吞咽功能评价量表（SSA）、功能性由口进食等级（FOIS）、改良曼恩吞咽功能评估量表（MMASA）、渗透-误吸量表评分、舌运动超声参数检测、舌骨上肌群MEP振幅的变化。 结果：与治疗前相比，两组SSA评分、渗透-误吸量表评分明显降低，FOIS评分、MMASA评分明显升高，舌运动幅度、速度、舌骨上肌群MEP振幅增加，舌运动时间明显缩短，差异均有显著性意义（P<0.05）；与治疗组治疗后相比，观察组SSA评分、渗透-误吸量表评分明显降低，FOIS评分、MMASA评分明显升高，舌运动幅度、速度明显、舌骨上肌群MEP振幅增加，舌运动时间明显缩短，差异均有显著性意义（P<0.05）。两组不良反应发生率差异无显著性意义（P>0.05）。 结论：廉泉埋针结合iTBS治疗方案符合“中枢-外周-中枢”理念，可有效改善脑卒中后咽期吞咽障碍，强化舌肌运动能力及皮层兴奋性。

Abstract:

      Abstract Objective： To explore the effect of needle embedding at Lianquan point combined with intermittent theta burst stimulation （iTBS） on dysphagia after stroke. Method： Sixty patients with pharyngeal dysphagia after stroke were included in the study and randomly divided into the control group and the observation group， with 30 cases in each group. Both groups of patients received conventional rehabilitation training for dysphagia. The control group was treated with iTBS in addition to the conventional training once a day， 5 times a week， for 2 consecutive weeks. The observation group was treated with needle embedding at Lianquan point on the basis of the treatment plan of the control group. The needle was replaced every other day and the treatment lasted for 2 consecutive weeks. The changes of standardized swallowing assessment （SSA）， Functional Oral Intake Scale （FOIS）， modified Mann Assessment of Swallowing Ability （MMASA）， Penetration-Aspiration Scale score （PAS）， ultrasonic parameters of tongue movement， and the amplitude of motor evoked potential （MEP） of suprahyoid muscles were compared between the two groups. Result： Compared with before treatment， the SSA score and PAS score of both groups were significantly reduced， the FOIS score and MMASA score were significantly increased， the amplitude and speed of tongue movement，and the amplitude of MEP of suprahyoid muscles were significantly increased， and the tongue movement time was significantly shortened， and the differences were statistically significant （P<0.05）； Compared with the control group after treatment， the SSA score and PAS score of the observation group were significantly reduced， the FOIS score and MMASA score were significantly increased， the amplitude and speed of tongue movement， and the amplitude of MEP of suprahyoid muscles were significantly increased， and the tongue movement time was significantly shortened， and the differences were statistically significant （P<0.05）. There was no significant difference in the incidence of adverse reactions between the two groups （P>0.05）. Conclusion： The treatment plan of needle embedding at Lianquan point combined with iTBS is in line with the "central-peripheral-central" concept， which can effectively improve pharyngeal dysphagia after stroke and enhance the movement ability of tongue muscles and cortical excitability.