张庆沙,谭芳,王蓓蓓,等.经颅交流电刺激与经颅直流电刺激对神经重症吞咽障碍患者的影响[J].中华物理医学与康复杂志,2025,47(12):1099-1104
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| 经颅交流电刺激与经颅直流电刺激对神经重症吞咽障碍患者的影响 |
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| DOI：10.3760/cma.j.cn421666-20250513-00406 |
| 中文关键词: 神经重症 吞咽障碍 经颅交流电刺激 经颅直流电刺激 |
| 英文关键词: Neurocritical care Dysphagia Transcranial alternating current stimulation Transcranial direct current stimulation |
| 基金项目:淄博市医药卫生科研项目（20231300091） |
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| 中文摘要: |
| 目的 探讨经颅交流电刺激（tACS）与经颅直流电刺激（tDCS）对神经重症吞咽障碍患者的影响。 方法 选取由神经重症康复病房收治的吞咽障碍患者120例，按照随机数字表法将其分为对照组、tACS组和tDCS组，每组40例。3组患者均接受常规吞咽康复训练，tACS组和tDCS组在此基础上分别接受tACS和tDCS。治疗前、治疗4周后（治疗后），采用标准吞咽功能评定量表（SSA）、功能性经口摄食量表（FOIS）评定吞咽功能，采用纤维内窥喉镜观察气道解剖结构，利用Marianjoy分泌物严重程度五分评分量表、渗漏-误吸量表（PAS）评估分泌物累积情况、渗漏及误吸程度。治疗后，比较3组患者的肺炎发生率和气切拔管成功率。 结果 治疗后，3组患者的SSA评分、FOIS分级、Marianjoy分泌物严重程度评分、PAS分级均较组内治疗前改善（P＜0.05）。与对照组比较，tACS组和tDCS组治疗后的上述指标改善较为优异（P＜0.05）。与tACS组治疗后比较，tDCS组治疗后的SSA评分［21.0（19.0，32.8）分］较低、FOIS分级［5.0（4.0，5.8）级］提升、Marianjoy分泌物严重程度评分［1（1，2）分］较低、PAS分级［2.0（2.0，4.0）级］下降（P＜0.05）。与对照组和tACS组比较，tDCS组治疗后的肺炎发生率（20.0%）较低、气切拔管成功率（77.5%）较高（P＜0.05）。 结论 tACS和tDCS均能有效改善神经重症吞咽障碍患者的吞咽功能，其中以tDCS的效果为佳，且能显著减少肺部感染率，提高气切拔管成功率。 |
| 英文摘要: |
| Objective To explore the effect of transcranial alternating current (tACS) and direct current (tDCS) stimulation on neurocritical care patients with dysphagia. Methods A total of 120 such patients were randomly allocated into a sham group, a tACS group, or a tDCS group, each of 40. All three groups received conventional swallowing training, while the tACS and tDCS groups additionally received the appropriate stimulation. Before the experiment and after 4 weeks, each patient′s swallowing was assessed using the standardized swallowing assessment (SSA) and the functional oral intake scale (FOIS). The anatomical structure of the airway was observed using fiberoptic endoscopy. The accumulation of secretions, leakage and aspiration were evaluated using the Marianjoy secretion scale and the penetration-aspiration scale (PAS). After the treatment, the incidence of pneumonia and the success rate of tracheostomy decannulation were compared among the three groups. Results All three groups showed significant improvement over the 4 weeks in terms of their average SSA scores, FOIS levels, Marianjoy Secretion Scale scores, and PAS levels, but improvement among the tACS and tDCS groups was significantly better, on average. The tDCS group exhibited significantly lower average SSA scores, higher FOIS levels, lower Marianjoy Secrection Scale scores, and reduced PAS levels compared to the tACS group. Later, both groups had an incidence of pneumonia significantly lower than among the controls and a significantly higher tracheostomy decannulation success rate. Conclusions Transcranial electrical stimulation can effectively improve the swallowing of neurocritical care patients with dysphagia. Direct current stimulation works better than alternating current. Such stimulation significantly reduces the subsequent incidence of pulmonary infections and increases the success rate of tracheostomy decannulation. |
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