| Objective:Dysphagia is one of the common complications after stroke,Patients cannot normally eat,drink,choke or cough,which seriously affects their daily life,physical and mental health,and even induces aspiration pneumonia,leading to suffocation and death.At present,the treatment methods for dysphagia include direct training,indirect training,traditional Chinese medicine,etc.Although there are many methods,they are not very specific.Repetitive transcranial magnetic stimulation(rTMS)is a non-invasive treatment technique.Existing studies have confirmed that rTMS has therapeutic effects on patients with motor,swallowing,cognitive and other dysfunction after stroke,and has good safety.Professor he tianyou regarded the "the orifice of the throat is disordered" as the target in his treatment.In point selection,acupuncture direction and other aspects of the gas to the disease: "Target",is the root of the tongue for the purpose,so called "targeted acupuncture" method.The purpose of this study was to investigate the efficacy of rTMS combined with targeted acupuncture in the treatment of stroke patients with dysphagia,with a view to finding a new therapeutic model.Methods: Patients with dysphagia after stroke treated in the rehabilitation department and neurology department of hebei general hospital of civil affairs from December 2016 to December 2018 were collected.1 Inclusion criteria1)meeting the criteria for stroke as revised by the 4th national conference on cerebrovascular diseases,patients with first stroke;2)head CT or MRI diagnosis;3)duration of illness: 1-24 months;4)WST was preliminarily selected as level 3-5;5)aged 20-75;6)MMSE>24 points,can cooperate with patients;7)patients or their family members sign the informed consent.2 Exclusion criteria1)patients with dysphagia after non-stroke;2)the patient is older than 75 years or younger than 20 years;3)patients with arrhythmia,fever,infection,history of epilepsy or use of sedative drugs;4)unable to cooperate with the study due to severe aphasia or cognitive impairment;5)contraindications to rTMS exist;6)Patients with bleeding tendency;7)poor blood pressure control;8)patients with cardiac,liver and kidney dysfunction or malignant tumors;9)stroke patients with multiple attacks.3 GroupingSixty patients with dysphagia after stroke were randomly divided into conventional treatment group,control group and experimental group.There were 20 patients in the routine treatment group,including 12 males and 8 females.The average age was(42.67±14.82)years.There were 9 cases of cerebral hemorrhage and 11 cases of cerebral infarction.The lesions were located in the right hemisphere in 10 cases,the left hemisphere in 8 cases,and the brain stem in 2 cases.The course of the disease was 7-92 days,with an average of 45.21 days.The control group included 20 patients,9 males and 11 females.They were aged between 24 and 71,with an average age of(45.37±13.04).There were 12 cases of cerebral hemorrhage and 8 cases of cerebral infarction.The lesions were located in the right hemisphere in 8 cases,the left hemisphere in 9 cases,and the brain stem in 3 cases.The course of the disease was 2-65 days,with an average of 39.65 days.There were 20 patients in the experimental group,including 13 males and 7 females.The average age was(41.35±15.79)years old.There were 13 cases of cerebral hemorrhage and 7 cases of cerebral infarction.The lesions were located in the right hemisphere in 7 cases,the left hemisphere in 11 cases,and the brain stem in 2 cases.The course of the disease was 11-90 days,with an average of 42.21 days.There was no significant difference in clinical data of gender,age,course of disease and type of disease among the three groups(P>0.05),which was comparable.4 TreatmentConventional treatment group: conventional drug therapy was used to improve cerebral blood supply and nourish brain cells,and direct eating method,indirect behavior therapy,acupuncture and moxibustion were also used.60 minutes/time,1 time/day,5 days/week for 4 weeks.Control group: on the basis of conventional treatment,targeted acupuncture was conducted by a senior acupuncturist,and points such as wind pool,yifeng and liyan were selected.The needle was kept for 25 minutes,during which the needle was given once every 10 minutes,1 minute each time.Once a day,5 days a week,a total of 4 weeks of treatment.Experimental group:on the basis of the control group,ccy-ia type high performance magnetic stimulator manufactured by wuhan yirui medical equipment co.,ltd.was used for treatment.methods: The "8" coils are aligned with the projection area of the skull of the swallowing center,that is,the central "K" point on the top of the head is 3 cm forward,and then the coils are horizontally removed to the healthy side by 7.5 cm.The frequency was 5Hz,the stimulation intensity was 80% MT(motor domain value),the stimulation interval was 20 S,the stimulation time was 1S,20 minutes/time,1 time/day,5 days/week,and the total treatment was 4 weeks.5 Methods for clinical efficacy evaluation5.1 Drinking water experiment in bottomland(WST).WST is divided into 5 levels,normal: 1 level,within 5 seconds;Suspected dysphagia: grade 1 or more than 5 seconds or grade 2;Exception: level 3 to 5.5.2 Standard swallowing assessment scale(SSA).SSA scale has a minimum score of 18 and a maximum score of 46.The higher the score,the worse the swallowing function.5.3 Clinical efficacy evaluation:1)The patients with dysphagia were basically cured and the dysphagia disappeared,and the the drinking water test in the bottomland was assessed as grade 1.2)Obvious effect: the dysphagia was obviously improved,and the evaluation of drinking water test was improved by more than grade 2.3)Effective: improvement of dysphagia,improvement of grade 1 in drinking water test.4)Ineffective: swallowing disorder improvement is not obvious,drinking water test evaluation without progress.5.4 Adverse events: during the treatment,the patients were observed for serious adverse reactions.Such as secondary cerebral hemorrhage,seizures and so on.Statistical analysis method: SPSS18.0 statistical software was used for analysis,measurement data were expressed as mean standard deviation,univariate anova was used for inter-group comparison,and repeated measurement design anova was used for intra-group comparison.P < 0.05 was considered statistically significant.Results:1.The WST score:The levels of(4.49±1.29),(4.43±1.10)and(4.14±0.75)were respectively in the conventional treatment group,the control group and the experimental group before treatment.There was no statistical difference among the three groups.(P>0.05).The levels of the three groups after treatment were(4.15±0.24),(3.95±1.65)and(3.15±1.24),which were improved compared with those before treatment(P < 0.05).Both the experimental group and the control group were superior to the conventional treatment group(P < 0.05),and the improvement was more obvious between the experimental group and the control group(P < 0.05).2.SSA score:The scores of the conventional treatment group,the control group and the experimental group before treatment were(40.3±7.3),(38.2± 9.8)and(37.4± 9.9),respectively.There was no statistical difference among the three groups(P>0.05).The scores of the three groups after treatment were(29.9 ± 12.3),(22.4± 4.1)and(20.31± 3.9),which were improved compared with those before treatment(P < 0.05).Both the experimental group and the control group were superior to the conventional treatment group(P < 0.05),and the improvement was more obvious between the experimental group and the control group(P < 0.05).3.Clinical curative effect:Among the 20 patients in the experimental group,WST score of 18 patients was improved,among which 9 patients were basically cured,7 showed significant effect,3 were effective,and the total effective rate was 95.00%.Among the 20 patients in the control group,the score of 17 patients was improved,5 patients were basically cured,3 patients were significantly effective,9 patients were effective,and the total effective rate was 85.00%.Scores of 15 patients in the 20 patients in the conventional treatment group were improved,among which 4 patients were basically cured,3 were significantly effective,8 were effective,and the total effective rate was 75.00%.The efficacy of the control group was better than that of the conventional treatment group(P < 0.05).,while the efficacy of the experimental group was better than that of the conventional treatment group and the control group(P < 0.05).4.Adverse reactions:None of the patients in this study had severe adverse reactions such as seizures and secondary cerebral hemorrhage.Only 1 patient presented local slight pain caused by "8" coils hitting,without redness of the skin,and little change in the patient's heart rate and blood pressure.Conclusion:Randomized controlled studies have shown that TMS combined with targeted acupuncture on the basis of conventional rehabilitation therapy can significantly improve the swallowing function of stroke patients,and this therapy is safe with few side effects.Transcranial magnetic stimulation combined with targeted acupuncture may become one of the effective non-drug treatment methods for stroke swallowing disorder,which is worthy of promotion and application.Due to the small number of cases observed in this study,the treatment time is affected by the turnover of beds,and it is necessary to further study its long-term efficacy and treatment dose. |
PDF Full Text Request