段国平,王秋月,季英霞,等.经颅直流电刺激对大脑半球卒中患者吞咽障碍的影响[J].中华物理医学与康复杂志,2025,47(11):967-972
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| 经颅直流电刺激对大脑半球卒中患者吞咽障碍的影响 |
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| DOI：10.3760/cma.j.cn421666-20250330-00278 |
| 中文关键词: 半球卒中 吞咽障碍 经颅直流电刺激 |
| 英文关键词: Hemispheric stroke Dysphagia Transcranial direct current stimulation |
| 基金项目:中国中医科学院望京医院院级课题（WJYY-XZKT-2023-26，WJYY-ZZXT-2023-06，WJCXTD-2024-02）；中国中医科学院科技创新工程重大攻关项目（CI2021A01410）；首都临床特色应用研究（Z121107001012144，Z171100001017111）；龙岩市科技计划项目 （2022LYF17081） |
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| 中文摘要: |
| 目的 观察经颅直流电刺激（tDCS）对大脑半球卒中患者吞咽障碍的影响。 方法 选取大脑半球卒中后吞咽障碍患者62例，按照随机数字表法将其分为健侧组（21例）、患侧组（20例）、双侧组（21例）。研究过程中，健侧组和双侧组分别有1例患者退出，最终3组分别纳入20例患者。健侧组给予健侧半球tDCS治疗，患侧组给予患侧半球tDCS治疗，双侧组给予双侧半球tDCS治疗，电刺激结束后均进行常规吞咽功能训练。治疗前、治疗2周后（治疗后），采用改良曼恩吞咽能力评估（MMASA）和吞咽障碍严重程度量表（SSS）评定3组患者的吞咽功能。采用线性回归分析探讨影响大脑半球卒中后吞咽障碍恢复的相关因素。 结果 治疗后，3组患者的MMASA评分和SSS评分均较组内治疗前增加（P＜0.05）。健侧组与患侧组治疗后的MMASA评分和SSS评分比较，差异无统计学意义（P＞0.05）。与健侧组和患侧组比较，双侧组治疗后的MMASA评分［(54.35±10.39)分］和SSS评分［(4.05±1.47)分］较高（P＜0.05）。线性回归分析结果显示，tDCS治疗方案是影响大脑半球卒中后吞咽障碍恢复的重要因素（P＜0.05）。 结论 双侧半球tDCS能够有效促进大脑半球卒中患者的吞咽功能恢复，且疗效明显优于单侧tDCS。 |
| 英文摘要: |
| Objective To explore the effect of transcranial direct current stimulation (tDCS) on dysphagia in hemispheric stroke patients. Methods Sixty-two hemispheric stroke patients with dysphagia were randomized into an ipsilateral group, a contralateral group and a bilateral group with 20 in each group. The ipsilateral and contralateral groups received tDCS over their ipsilesional and contralesional hemispheres, respectively, while in the bilateral group it was over both hemispheres. That was followed by conventional swallowing therapy. Before and after 2 weeks of the treatment, swallowing function was assessed using the modified Mann Assessment of Swallowing Ability (MMASA) and a Swallow Severity scale (SSS). Linear regressions were evaluated to highlight the factors most influencing recovery from post-stroke hemispheric dysphagia. Results After the treatments, the average MMASA and SSS scores had increased significantly in all three groups. There was no significant difference in the average post-treatment MMASA and SSS scores between the ipsilateral and contralateral groups, but the bilateral group showed significantly better average post-treatment MMASA and SSS scores compared to the other two groups. Linear regression analysis confirmed that the tDCS protocol (group allocation) was a significant predictor of recovery. Conclusion Bilateral tDCS can effectively promote the recovery of swallowing function after a hemispheric stroke. It demonstrates greater therapeutic benefits than unilateral tDCS. |
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