经颅直流电刺激联合常规吞咽康复训练治疗脑卒中后吞咽障碍的疗效。

Efficacy of Transcranial Direct Current Stimulation Combined with Conventional Swallowing Rehabilitation Training on Post-stroke Dysphagia.

机构信息

Department of Rehabilitation Medicine, Jinhua Hospital of TCM Affiliated to Zhejiang University of Traditional Chinese Medicine, 496# Shuangxixi Road, 321017, Jinhua, Zhejiang, China.

Electroencephalogram Room, Jinhua Hospital of TCM Affiliated to Zhejiang University of Traditional Chinese Medicine, 496# Shuangxixi Road, 321017, Jinhua, Zhejiang, China.

出版信息

Dysphagia. 2023 Dec;38(6):1537-1545. doi: 10.1007/s00455-023-10581-2. Epub 2023 May 5.

Abstract

To observe the clinical effects of transcranial direct current stimulation (tDCS) combined with conventional swallowing rehabilitation training on post-stroke dysphagia and explore its long-term efficacy. A total of 40 patients with dysphagia after the first stroke were randomly divided into a treatment group (n = 20) and a conventional group (n = 20). The treatment group received tDCS combined with conventional swallowing rehabilitation training, while the conventional group only received conventional swallowing rehabilitation training. The Standardized Swallowing Assessment (SSA) Scale and the Penetration-Aspiration Scale (PAS) were used to assess dysphagia before and after treatment, at the end of 10 treatments, and at the 3-month follow-up. The changes in infection indicators [the white blood cell (WBC), C-reactive protein (CRP) and procalcitonin (PCT)], the oxygenation indicator [arterial partial pressure of oxygen (PaO)] and nutrition-related indicators [hemoglobin (Hb) and serum prealbumin (PAB)] were compared before and after treatment. The SSA and PAS scores were lower in both groups after treatment than before treatment, and the difference was statistically significant (P < 0.01). The SSA and PAS scores of the treatment group were lower than those of the conventional group before and after treatment and during follow-up, and the difference was statistically significant (P < 0.05, P < 0.01). A within-group comparison showed that WBC, CRP and PCT after treatment were lower than those before treatment, and the difference was statistically significant (P < 0.05). The PaO, Hb and serum PAB were higher after treatment than before treatment, with a statistically significant difference (P < 0.05). The WBC, CRP and PCT of the tDCS group were lower than those of the conventional group, and PaO, Hb and serum PAB were higher in the treatment group than in the conventional group, with a statistically significant difference (P < 0.01). The tDCS combined with conventional swallowing rehabilitation training can improve dysphagia with a better effect than conventional swallowing rehabilitation training and has a certain long-term efficacy. In addition, tDCS combined with conventional swallowing rehabilitation training can improve nutrition and oxygenation and reduce infection levels.

摘要

观察经颅直流电刺激(tDCS)联合常规吞咽康复训练对脑卒中后吞咽障碍的临床疗效,并探讨其长期疗效。将首次脑卒中后吞咽障碍患者 40 例随机分为治疗组(n=20)和常规组(n=20)。治疗组给予 tDCS 联合常规吞咽康复训练,常规组仅给予常规吞咽康复训练。治疗前、治疗结束时、治疗后 10 次、3 个月随访时采用标准吞咽评估量表(SSA)和渗透-误吸量表(PAS)评估吞咽障碍,比较治疗前后感染指标[白细胞(WBC)、C 反应蛋白(CRP)、降钙素原(PCT)]、氧合指标[动脉血氧分压(PaO)]和营养相关指标[血红蛋白(Hb)、血清前白蛋白(PAB)]的变化。两组治疗后 SSA 和 PAS 评分均低于治疗前,差异有统计学意义(P<0.01)。治疗组治疗前后及随访时 SSA 和 PAS 评分均低于常规组,差异有统计学意义(P<0.05,P<0.01)。组内比较显示,治疗后 WBC、CRP、PCT 低于治疗前,差异有统计学意义(P<0.05)。治疗后 PaO、Hb、血清 PAB 高于治疗前,差异有统计学意义(P<0.05)。tDCS 组的 WBC、CRP 和 PCT 低于常规组,治疗组的 PaO、Hb 和血清 PAB 高于常规组,差异有统计学意义(P<0.01)。tDCS 联合常规吞咽康复训练治疗脑卒中后吞咽障碍的效果优于常规吞咽康复训练,且具有一定的长期疗效。此外,tDCS 联合常规吞咽康复训练可改善营养和氧合,降低感染水平。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4b2e/10611834/54cfa113212d/455_2023_10581_Fig1_HTML.jpg

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