双侧重复经颅磁刺激联合球囊扩张术对脑卒中后环咽肌失弛缓患者进食能力及渗漏-误吸情况的影响

The impact of bilateral repetitive transcranial magnetic stimulation combined with balloon dilation technique on the eating ability and penetration-aspiration in patients with post-stroke cricopharyngeal achalasia

摘要:

目的 探讨双侧重复经颅磁刺激联合球囊扩张术对脑卒中后环咽肌失弛缓患者进食能力及渗漏-误吸情况的影响。方法 选取2021年2月—2024年2月六安市中医院96例脑卒中后环咽肌失弛缓患者作为研究对象。按照随机数字表法分为对照组与联合组，每组48例。对照组接受球囊扩张术治疗，联合组在对照组基础上给予双侧重复经颅磁刺激治疗。对比两组患者治疗前后的进食功能、Rosenbek渗透误吸量表（PAS）、营养指标、生活质量及不良反应发生率。结果 进食功能方面，联合组治疗前后功能性经口摄食分级评分差值大于对照组（P <0.05）；吞咽功能方面，联合组治疗前后PAS、吞咽软管喉镜检查评分差值大于对照组（P <0.05）；营养指标方面，联合组治疗前后白蛋白水平差值大于对照组（P <0.05）；生活质量方面，联合组治疗前后生命质量-吞咽评分差值大于对照组（P <0.05）。两组不良反应总发生率比较，差异无统计学意义（P >0.05）。结论 双侧重复经颅磁刺激联合球囊扩张术可显著改善脑卒中后环咽肌失弛缓患者的临床症状，降低渗漏-误吸风险，治疗安全，值得临床推广。

Abstract:

Objective To investigate the effects of bilateral repetitive transcranial magnetic stimulation combined with balloon dilation technique on the swallowing ability and penetration-aspiration in patients with post-stroke cricopharyngeal achalasia.Methods From February 2021 to February 2024, 96 patients with post-stroke cricopharyngeal achalasia treated in Lu'an Hospital of Traditional Chinese Medicine were selected. According to the random number table method, the patients were divided into a control group (n = 48) and a combined group (n = 48). The control group received balloon dilation treatment, and the combined group was given bilateral repetitive transcranial magnetic stimulation on the basis of the control group. Comparisons were made between the two groups before and after treatment in terms of eating function, Rosenbek Penetration-Aspiration Scale (PAS), nutritional indicators, quality of life, and the incidence of adverse reactions.Results Significant between-group differences were observed in the changes from baseline to post-treatment. Eating function: The difference in Functional Oral Intake Scale (FOIS) scores before and after treatment in the combined group was higher than that in the control group (P < 0.05). Swallowing function: The differences in PAS scores and Flexible Endoscopic Evaluation of Swallowing (FEES) scores before and after treatment in the combined group were higher than those in the control group (P < 0.05). Nutritional indicators: The difference in albumin levels before and after treatment in the combined group was higher than that in the control group (P < 0.05). Quality of life: The difference in Swallowing Quality of Life (SWAL-QOL) scores before and after treatment in the combined group was higher than that in the control group (P < 0.05). No statistically significant difference in adverse event rates was found between groups (P > 0.05).Conclusion Bilateral repetitive transcranial magnetic stimulation combined with balloon dilation technique can significantly improve the clinical symptoms of patients with post-stroke cricopharyngeal achalasia and reduce the risk of penetration-aspiration.