| Objective: Post-stroke dysphagia severely affects the life and prognosis of stroke patients.Transcranial direct current stimulation,as a non-invasive treatment technique,has a good therapeutic effect on treating aphasia,depression and hemiplegia after stroke.The goal of the present study is to investigate the effect and safety of transcranial direct current stimulation for post-stroke dysphagia patients,who had dysphagia after acute cerebral infarction.Methods: A total of 107 patients with first acute cerebral infarction accompanied by swallowing disorder evaluated by Water Swallow Test were selected from January 2016 to January 2017 in the First Hospital of Hebei Medical University.According to the inclusion and exclusion standards,the patients who were accord with the above criterion were involved and randomly divided into three groups: the high dose treatment group(H-tDCS group,tDCS anode electric current was 2mA each time for 30 min,the stimulation period was 10days),low dose treatment group(L-tDCS group,tDCS anode electric current was 2mA each time for 30 min,the stimulation period was 5days,the simple rehabilitation training was underwent in the other 5days),and the simple rehabilitation training group(Control group,the treatment period was 10days).The H-tDCS group and L-tDCS group were accompanied by the simple rehabilitation training.All of the patients were followed up for 1 month and recorded their DOSS score,SSA score and SWAL-QOL score,as well as the occurrence of adverse events during tDCS before the treatment,at the end of treatment and post-treatment for 1 month.The empty stomach blood were collected in the early morning for blood routine,albumin and prealbumin.Results:1.According to the enrollment and exclusion criteria,96 patients were enrolled in the study and randomly divided into 3 groups: H-tDCS group,L-tDCS group and Control group,and each group had 32 patients.The H-tDCS group was comprised with 14 males and 18 females,and the mean age was(64.4±12.2).The 43.8% of the H-tDCS group was right hemisphere injuries.The time from injury to tDCS treatment was(32.4±13.4)hours.The NIHSS score of the H-tDCS group was(16.1± 5.6)points.The L-tDCS group was comprised with 15 males and 17 females,and the average age was(67.0±9.0).The 53.1% of the H-tDCS group was right hemisphere injuries.The time from injury to tDCS treatment was(29.1±11.5)hours.The NIHSS score of the H-tDCS group was(14.7± 6.3)points.The Control group was comprised with 17 males and 15 females,and the average age was(66.7±11.4).The 56.3% of the H-tDCS group was right hemisphere injuries.The time from injury to tDCS treatment was(31.8±9.7)hours.The NIHSS score of the H-tDCS group was(17.1±8.8)points.There was no statistically significant difference among the three groups of patients in age,sex,the time between onset to treatment,infarction position of acute cerebral infarction,and severity of acute cerebral infarction(P>0.05).2.For the swallowing disorder,the DOSS scores in the three groups were(1.9±0.8),(2.1±1.0)and(2.1±0.90),and the DOSS scores showed no significant difference among three groups(P>0.05).The SSA scores in the three groups were(39.8±7.1),(37.2±9.7)and(36.4±10.0),and the SSA score was no significant difference among three groups(P>0.05).In terms of quality of life,the three groups of SWAL-QOL scores were(44.7±12.1),(47.1±10.9)and(45.8±9.4),and the SWAL-QOL scores of the three groups was not significantly different.The three groups of hemoglobin were(102.8±16.7)g/L,(105.3±13.0)g/L and(109.1±9.7)g/L,and the former albumin was(198.4±26.8)mg/L,(207.1±23.0)mg/L and(206.7±25.5)mg/L,and the albumin was(32.4±10.4)g/L,(34.7±9.8)g/L and(31.1±9.1)g/L.There were no significant difference in hemoglobin,prealbumin and albumin among the three groups(P>0.05),indicating that the nutritional status of the three groups was not significantly different.3.After 2 weeks of treatment,no adverse events occurred.At the end of the treatment,the efficiency of the H-tDCS group,L-tDCS group and Control group was 90.6%,65.6% and 43.8%,and there were statistically significant differences between the three groups(P<0.05).4.At the end of the treatment and post-treatment for 1 month,the DOSS scores of H-tDCS group were(4.2±1.4)and(6.8±0.03).The DOSS scores of L-tDCS group were(3.4±1.2)and(5.8±1.6).The DOSS scores of Control group were(2.4±1.3)and(3.1±1.6).For the H-t DCS group and L-tDCS,the scores post-treatment for 1 month and at the end of treatment was higher than that at the beginning of treatment(both P<0.05),and was significantly higher than that in the control group(both P<0.05),and the H-tDCS group was significantly higher than that in the L-tDCS group(P<0.05).Similarly,at the end of the treatment and post-treatment for 1 month,the SSA scores for H-tDCS were(28.4±10.7)and(20.3±4.0).The SSA scores for L-tDCS group were(27.1±8.6)and(21.1±3.4).The SSA score for Control group were(31.7±11.7)and(29.7±12.6).For the H-tDCS group and L-tDCS,the scores post-treatment for 1 month and at the end of treatment was lower than that at the beginning of treatment(both P<0.05),and was significantly lower than that in the control group(both P<0.05).5.At the end of the treatment and post-treatment for 1 month,the SWAL-QOL scores of H-tDCS group were(50.0±13.4)and(71.7±20.4).The SWAL-QOL scores of L-tDCS group were(52.0±11.7)and(65.1±18.4).The SWAL-QOL scores of Control group were(48.7±8.1)and(52.7±15.4).For the H-t DCS group and L-tDCS,the scores post-treatment for 1 month and at the end of treatment was higher than that at the beginning of treatment(both P<0.05),and was significantly higher than that in the control group(both P<0.05).6.At post-treatment for 1 month,the hemoglobin of H-tDCS was(125.4±11.9)g/L.The hemoglobin of L-tDCS was(128.9±10.4)g/L.The hemoglobin of Control group was(112.7±17.4)g/L.For the H-tDCS group and L-tDCS,the hemoglobin post-treatment for 1 month was higher than that at the beginning of treatment(both P<0.05),and was significantly higher than that in the control group(both P<0.05).At post-treatment for 1 month,the prealbumin of H-tDCS was(271.1±20.9)mg/L.The prealbumin of L-tDCS was(262.5±19.8)mg/L.The prealbumin of Control group was(237.3±29.7)mg/L.For the H-tDCS group and L-tDCS,the prealbumin post-treatment for 1 month was higher than that at the beginning of treatment(both P<0.05),and was significantly higher than that in the control group(both P<0.05).At post-treatment for 1 month,the albumin of H-tDCS was(38.7±6.2)g/L.The albumin of L-tDCS was(36.9±7.1)g/L.The albumin of Control group was(33.0±7.7)g/L.For the H-tDCS group and L-tDCS,the albumin posttreatment for 1 month was higher than that at the beginning of treatment(both P<0.05),and was significantly higher than that in the control group(both P<0.05).7.The DOSS scores after the treatment three months in the H-tDCS group,L-tDCS group,and Control group were(7.2±0.5)points,(6.3±1.2)points,and(3.3±1.2)points respectively,and the DOSS scores in the H-tDCS group and L-t DCS group were higher than those in the control group(both P<0.05).The SSA scores after the treatment three months in the H-tDCS group,L-tDCS group,and Control group were(19.7±4.3)points,(20.8±3.6)points,and(28.7±10.4)points respectively,and the SSA scores in the H-tDCS group and L-tDCS group were lower than those in the control group(both P<0.05).Conclusion:1.Transcranial direct current stimulation can obviously improve swallowing function in patients with dysphagia after acute cerebral infarction,and H-tDCS group had the best benefit.This treatment method has good security.2.Transcranial direct current stimulation can obviously improve the quality of life and nutritional status,we speculated that this effect is associated with feeding ability enhancement after dysphagia improving.3.In view of the excellent safety and efficacy of transcranial direct current stimulation in the treatment of acute cerebral infarction patients with moderate or severe dysphagia,it is worth application in clinical practice. |
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