Abstract:

Objective　To observe the rehabilitation effect of swallowing function training combined with bilateral alternating transcranial direct current stimulation (tDCS) in the treatment of patients with dysphagia after stroke. Methods　Sixty patients with dysphagia after stroke treated at Neurorehabilitation Ward, Shaanxi Rehabilitation Hospital from January 2023 to January 2024 were selected for the randomized controlled trial, and were divided into a control group and an observation group by the random number table method, with 30 cases in each group. There were 19 males and 11 females in the control group; they were (62.43±5.76) years old; their disease course was (1.46±0.34) months. There were 17 males and 13 females in the observation group; they were (61.37±6.58) years old; their disease course was (1.52±0.65) months. The control group took swallowing function training and received tDCS on their healthy sides. The observation group took swallowing function training and received bilateral alternating tDCS on their healthy and affected sides. The grades of Wada drinking water test (WST), scores of Television Fluoroscopy Swallowing Function Examination (VFSS), Oral Ingestion Function Score (FOIS), and Swallowing Disorder Specific Quality of Life Score (SWAL-QOL), amplitudes of hyoid muscle group checked by surface electromyography, and swallowing times before and 4 weeks after the treatment, clinical efficacies, and incidence rates of complications were compared between the two groups. Independent sample t test, paired t test, and χ² test were used for the statistical analysis. Results　Before the treatment, there were no statistical differences in the scores of WST, VFSS, FOIS, and SWAL-QOL, amplitude of hyoid muscle group, and swallowing time between the two groups (all P>0.05). Four weeks after the treatment, the score of WST in the observation group was lower than that in the control group (2.21±0.31 vs. 3.25±0.16); the scores of VFSS, FOIS, and SWAL-QOL and the amplitude of hyoid muscle group in the observation group were higher than those in the control group [8.79±1.37 vs. 6.34±1.24, 6.56±0.37 vs. 5.38±0.61, 146.89±14.43 vs. 124.87±13.85, and (591.25±23.27) µV vs. (510.81±19.30) µV]; the swallowing time in the observation group was shorter than that in the control group [(1.01±0.21) s vs. (1.25±0.44) s]; there were statistical differences (t=16.326, 7.262, 9.059, 6.030, 14.573, and 2.696; all P<0.05). The total clinical effective rate in the observation group was higher than that in the control group [93.3% (28/30) vs. 70.0% (21/30)], with a statistical difference (χ²=5.455; P=0.020). The incidence rate of complications in the observation group was lower than that in the control group [10.0% (3/30) vs. 33.3% (10/30)], with a statistical difference (χ²=4.812; P=0.028). Conclusion　Bilateral alternating tDCS combined with swallowing function training in the treatment of patients with dysphagia after stroke is effective, and can improve their swallowing function and life quality, and reduce the incidence rate of complications.

Key words:

Stroke, Dysphagia transcranial direct current stimulation, Swallowing function training

摘要：

目的　观察双侧交替经颅直流电刺激（tDCS）联合吞咽功能训练对脑卒中后吞咽障碍患者的康复效果。方法　选取2023年1月至2024年1月陕西省康复医院神经康复病区收住的60例脑卒中后吞咽障碍患者进行随机对照试验，以随机数字表法分为对照组（30例）和观察组（30例）。对照组男19例、女11例，年龄（62.43±5.76）岁，病程（1.46±0.34）个月；观察组男17例、女13例，年龄（61.37±6.58）岁，病程（1.52±0.65）个月。在常规吞咽功能训练基础上，对照组给予tDCS（健侧）治疗，观察组给予双侧交替tDCS（健侧+患侧）治疗。对比两组治疗前及治疗4周后洼田饮水试验（WST）分级、电视透视吞咽功能检查（VFSS）、经口摄食功能评估量表（FOIS）、吞咽障碍特异性生活质量量表（SWAL-QOL）、表面肌电图检查舌骨肌群的波幅、吞咽时间，治疗后临床疗效及不良反应发生情况。统计学方法采用独立样本t检验、配对t检验和χ²检验。结果　治疗前，两组患者WST、VFSS、FOIS、SWAL-QOL评分及舌骨肌群波幅、吞咽时间比较，差异均无统计学意义（均P>0.05）。治疗4周后，观察组WST评分低于对照组［（2.21±0.31）分比（3.25±0.16）分］，VFSS、FOIS、SWAL-QOL评分及舌骨肌群波幅均高于对照组［（8.79±1.37）分比（6.34±1.24）分、（6.56±0.37）分比（5.38±0.61）分、（146.89±14.43）分比（124.87±13.85）分、（591.25±23.27）µV比（510.81±19.30）µV］，吞咽时间短于对照组［（1.01±0.21）s比（1.25±0.44）s］，差异均有统计学意义（t=16.326、7.262、9.059、6.030、14.573、2.696，均P<0.05）。观察组治疗总有效率为93.3%（28/30），高于对照组的70.0%（21/30），差异有统计学意义（χ²=5.455，P=0.020）。观察组不良反应发生率为10.0%（3/30），低于对照组的33.3%（10/30），差异有统计学意义（χ²=4.812，P=0.028）。结论　双侧交替tDCS联合吞咽功能训练对脑卒中后吞咽障碍患者效果较好，可有效改善患者吞咽功能，提高生活质量，并降低不良反应发生率。

关键词:

脑卒中, 吞咽障碍, 经颅直流电刺激, 吞咽功能训练