不同电磁刺激方案干预脑卒中后假性球麻痹吞咽障碍的对比研究

罗雅丽; 陈劲松; 陈莎莎; 苏牟潇; 白洁; 刘双

doi:10.16766/j.cnki.issn.1674-4152.003476

不同电磁刺激方案干预脑卒中后假性球麻痹吞咽障碍的对比研究

doi: 10.16766/j.cnki.issn.1674-4152.003476

绵阳市中心医院康复医学科，四川绵阳 621000

基金项目:

康复医学四川省重点实验室开放课题 KFYXSZDSYS-06

详细信息

通讯作者:
苏牟潇，E-mail：Smxylyyj1023@sina.com

中图分类号: R743.3 R454.1
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- 文章访问数: 213
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- 被引次数: 0
出版历程
- 收稿日期: 2023-10-28
- 网络出版日期: 2024-05-29

A comparative study of different electromagnetic stimulation schemes in the intervention of post stroke pseudobulbar paralysis swallowing disorders

Rehabilitation Medicine Department, Mianyang Central Hospital, Mianyang, Sichuan 621000, China

摘要

摘要: 目的对比不同组合的电磁刺激方案治疗假性球麻痹的疗效，为治疗方案的优化提供借鉴。方法选择2022年1月—2023年3月绵阳市中心医院脑卒中后假性球麻痹患者120例，采用随机数字表法分为对照组、经颅直流电刺激(tDCS)+表面神经肌肉电刺激(NMES)组、重复经颅磁刺激(rTMS)+NMES组、tDCS+rTMS组，每组30例。对照组给予常规治疗，其余3组进行不同组合的电磁刺激。评估藤岛一郎吞咽疗效评分、标准吞咽功能量表(SSA)、吞咽困难生活质量量表(SWAL-QOL)；纤维光学内镜检查(FEES)下的PAS分级；舌骨喉复合体动度；平均肌电值(AEMG)。结果治疗后rTMS+NMES组藤岛一郎评分[(5.04±0.79)分]高于对照组[(3.51±0.64)分]、tDCS+NMES组[(4.19±0.79)分]、tDCS+rTMS组[(3.96±0.73)分]；rTMS+NMES组SSA均低于其余3组(P < 0.05)。而SWAL-QOL评分，rTMS+NMES组仅高于对照组，与其余2组差异无统计学意义；PAS分级rTMS+NMES组均优于其余3组(P < 0.05)；在骨喉复合体动度，rTMS+NMES组舌骨上移和前移距离均高于其余3组(P < 0.05)；在sEMG检查中，rTMS+NMES组高于对照组和tDCS+NMES组(P < 0.05)。结论 rTMS+NMES组合治疗假性球麻痹的整体效果更优。
- 电磁刺激 /
- 脑卒中 /
- 假性球麻痹 /
- 吞咽障碍 /
- “中枢-外周”
Abstract: Objective To compare the efficacy of different combinations of electromagnetic stimulation schemes in the treatment of pseudobulbar palsy, and provide reference for the optimization of treatment plans. Methods A total of 120 patients with pseudobulbar palsy after stroke were selected at Mianyang Central Hospital from January 2022 to March 2023. They were randomly divided into four groups: a control group, a group receiving transcranial direct current stimulation (tDCS)+neuromuscular electrical stimulation (NMES), a group receiving repetitive transcranial magnetic stimulation (rTMS)+NMES, and a group receiving tDCS+rTMS. Each group consisted of 30 cases. The control group received routine treatment, while the other three groups received different combinations of electromagnetic stimulation. The evaluation included the swallowing efficacy score of Ichiro Fujishima, the standardized swallowing assessment (SSA), the swallowing-quality of life (SWAL-QOL), PAS grading under fiberoptic endoscopic evaluation of swallowing (FEES), hyoid laryngeal complex motility, and average surface electromyography (AEMG). Results After treatment, the rTMS+NMES group exhibited significantly higher Ichiro Fujishima ' s swallowing efficacy scores (5.04±0.79) compared to the control group (3.51±0.64), tDCS+NMES group (4.19±0.79), and tDCS+rTMS group (3.96±0.73). The rTMS+NMES group also demonstrated a significantly lower SSA than the other three groups (P < 0.05). In terms of SWAL-QOL, the rTMS+NMES group only showed improvement compared to the control group, with no difference when compared to the other two groups. However, in PAS assessment, the rTMS+NMES group was superior to the other three groups (P < 0.05). Regarding mobility of the bone throat complex, the rTMS+NMES group displayed a greater distance of upward and forward movement of the hyoid bone compared to all other groups (P < 0.05). Additionally, rTMS+NMES group revealed higher sEMG than both control and tDCS+NMES groups (P < 0.05). Conclusion The combination of rTMS+NMES has the best overall effect in the treatment of pseudobulbar palsy.
- Electromagnetic stimulation /
- Stroke /
- Pseudobulbar paralysis /
- Swallowing disorders /
- "Central Peripheral"

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表 1 4组假性球麻痹患者一般资料比较

Table 1. Comparison of general data of 4 groups of patients with pseudobulbar paralysis

组别	例数	年龄(x±s，岁)	性别(男性/女性，例)	卒中类型(缺血/出血, 例)	病程(x±s，d)	卒中部位(皮质/小脑/皮质下, 例)
对照组	26	69.13±3.14	15/11	20/6	60.18±18.83	14/4/8
rTMS+NMES组	29	68.84±2.29	18/11	22/7	61.85±17.61	15/4/0
tDCS+rTMS组	28	68.30±2.82	17/11	21/7	62.36±17.66	14/5/9
tDCS+NMES组	28	69.16±3.67	16/12	20/8	62.46±15.50	14/4/10
统计量		0.417^a	0.196^b	0.249^b	0.559^a	0.356^b
P值		0.840	0.978	0.969	0.516	0.999
注：^a为F值, ^b为χ²值。

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表 2 4组假性球麻痹患者干预前后藤岛一郎评分、SSA和SWAL-QOL比较(x±s，分)

Table 2. Comparison of Fujishima Ichiro ' s score, SSA and SWAL-QOL in 4 groups of patients with pseudobulbar paralysis before and after intervention(x±s, points)

组别	例数	藤岛一郎评分			SSA			SWAL-QOL
组别	例数	干预前	干预后	干预前后差值	干预前	干预后	干预前后差值	干预前	干预后	干预前后差值
对照组	26	3.07±0.70	3.51±0.64^a	0.44±0.05	32.29±4.54	31.55±3.49	0.74±0.05	104.43±7.51	110.14±6.53^a	5.71±1.30
tDCS+rTMS组	28	3.11±0.73	3.96±0.73^ab	0.85±0.09^b	32.89±4.58	24.46±2.99^ab	8.43±0.92^b	103.93±9.57	113.21±6.51^ab	9.28±1.20^b
tDCS+NMES组	28	3.12±0.70	4.19±0.79^abc	1.07±0.18^bc	32.38±4.01	24.54±2.04^ab	7.84±1.05^b	103.73±7.17	113.03±5.37^ab	9.30±1.43^b
rTMS+NMES组	29	3.11±0.74	5.04±0.79^abcd	1.93±0.23^bcd	33.74±4.76	19.44±2.01^abcd	14.30±3.81^bcd	106.41±8.56	114.46±6.44^ab	8.05±1.52^b
注: 与干预前比较，^aP＜0.05;与对照组比较，^bP＜0.05;与tDCS+rTMS组比较，^cP＜0.05;与tDCS+NMES组比较，^dP＜0.05。

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表 3 4组假性球麻痹患者干预前后PAS分级比较(例)

Table 3. Comparison of PAS grading of 4 groups of patients with pseudobulbar paralysis(cases)

组别	例数	时间	PAS分级 (1级/2级/3级/4级/5级/6级/7级/8级)
对照组	26	干预前	0/2/3/4/5/6/6/0
		干预后	3/4/5/6/3/2/3/0^a
tDCS+rTMS组	28	干预前	0/2/4/5/6/5/6/0
		干预后	1/4/7/4/5/3/4/0^a
tDCS+NMES组	28	干预前	0/2/2/6/8/6/4/0
		干预后	2/5/5/5/5/3/3/0^a
rTMS+NMES组	29	干预前	0/2/3/7/5/6/5/0
		干预后	7/9/5/4/2/2/0/0^abcd
注: 与干预前比较，^aP＜0.05;与对照组比较，^bP＜0.05;与tDCS+rTMS组比较，^cP＜0.05;与tDCS+NMES组比较，^dP＜0.05。

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表 4 4组假性球麻痹患者干预前后骨喉复合体动度检查和sEMG结果比较(x±s)

Table 4. Comparison of bone throat complex motility examination and sEMG of 4 groups of patients with pseudobulbar paralysis before and after intervention(x±s)

组别	例数	时间	骨喉复合体动度检查(mm)				AEMG(μV)
组别	例数	时间	舌骨上移距离	甲状软骨上移距离	舌骨前移距离	甲状软骨前移距离	AEMG(μV)
对照组	26	干预前	12.25±1.35	16.25±1.62	4.29±1.22	4.46±1.40	237.89±24.53
		干预后	13.29±1.47^a	16.96±1.57^a	4.33±1.25	5.50±1.18^a	300.86±30.80^a
tDCS+rTMS组	28	干预前	12.18±1.44	16.11±1.47	4.46±1.59	4.32±1.17	247.68±25.68
		干预后	15.14±1.41^ab	19.75±1.21^ab	6.91±1.26^ab	7.79±1.15^ab	439.84±26.91^ab
tDCS+NMES组	28	干预前	12.04±1.79	16.23±1.38	4.27±1.56	4.50±1.08	240.08±25.19
		干预后	14.23±1.55^abc	17.35±1.13^abc	6.22±1.38^abc	5.95±1.20^abc	360.96±28.17^abc
rTMS+NMES组	29	干预前	12.15±1.63	16.30±1.49	4.30±1.44	4.52±1.23	243.37±24.52
		干预后	16.52±1.42^abcd	18.22±1.66^abcd	8.44±1.23^abcd	7.21±1.23^abcd	441.04±27.82^abd
注: 与干预前比较，^aP＜0.05;与对照组比较，^bP＜0.05;与tDCS+rTMS组比较，^cP＜0.05;与tDCS+NMES组比较，^dP＜0.05。

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