经颅磁刺激定位头电针配合低频电治疗瓦伦贝格综合征患者吞咽困难
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摘要
目的观察经颅磁刺激定位头电针配合低频电治疗瓦伦贝格综合征患者吞咽困难的临床疗效。方法采用随机数字表法将2013年5月—2014年5月沧州市中心医院神经内科、康复科就诊的30例瓦伦贝格综合征合并吞咽困难患者分为治疗组和对照组,治疗组16例,对照组14例。在吞咽康复训练的基础上,治疗组给予头电针配合低频电治疗仪治疗。电针选用断续波,频率为50 Hz,电流强度2 m A;低频采用三角形波脉冲,刺激波宽750 ms,波幅0~25 m A,频率为2 Hz,电流强度为7.0~10.0 m A,每次刺激时间为2~3 s,间歇时间为5~6 s。治疗2次/d,每次20 min,4周为1个疗程;对照组给予低频电治疗仪治疗,2次/d,每次20 min,4周为1个疗程。将治疗组与对照组患者分别在治疗前、治疗后4周进行洼田饮水试验评分与电视透视吞咽评估(VFSS)评分。所有数据采用SPSS 16.0统计学软件进行数据分析,计量资料中,组间比较采用独立t检验,组内比较采用配对t检验,P<0.05为差异有统计学意义。结果治疗4周后,经颅磁刺激定位头电针配合低频电治疗瓦伦贝格综合征患者吞咽困难的洼田饮水试验与VFSS评分明显优于低频电治疗组(P<0.05)。结论经颅磁刺激定位头电针配合低频电治疗瓦伦贝格综合征能进一步改善吞咽功能,避免误吸,继而提高患者的生存质量。
Objective To observe the curative effect of transcranial magnetic stimulation including positioning head together with the low frequency treatment on medulla oblongata dorsolateral syndrome in patients with dysphagia.Methods Thirty cases of medulla oblongata dorsolateral syndrome with dysphagia patients from May,2013 to May,2014 Cangzhou of neurology and rehabilitation center hospital were divided into treatment group and control group by using random numbers,16 cases of treatment group and control group in 14 cases. In swallowing rehabilitation training,the treatment group was given head cupping treatment together with the low frequency therapeutic apparatus. Electric acupuncture selects the discontinuous wave,frequency 50 Hz,current strength 2 m A;Low frequency using triangle wave pulse to stimulate wave width 750 ms,amplitude 0 to 25 m A,frequency of 2 Hz,the current strength of 7. 0- 10. 0 m A,each time for2- 3 s,intermittent time is 5- 6 s. Treatment 2 times / d,20 min,at a time,4 weeks for 1 course of treatment; The control group given low frequency electric therapeutic treatment,2 times / d,20 min at a time,4 weeks for 1 course of treatment.Treatment group and control group respectively in both groups before treatment,4 weeks after treatment respectively for kubota drinking water test score and VFSS score. All the data with SPSS 16. 0 statistical software for data analysis,the measurement data by chi-square test,measurement data,the comparison between groups using independent t test,group in comparison with paired t test,take a 95% confidence interval. Results After 4 weeks treatment,the patients with transcranial magnetic stimulation including positioning head together with the low frequency treatment of medulla oblongata dorsolateral syndrome in patients with dysphagia Kubota drinking water test and VFSS score is better than low frequency electric therapy group( P ﹤ 0. 05). Conclusion Transcranial magnetic stimulation including positioning head together with the low frequency treatment of medulla oblongata dorsolateral syndrome can further improve swallowing function,avoid aspiration,and then improve the quality of life of patients.
Objective To observe the curative effect of transcranial magnetic stimulation including positioning head together with the low frequency treatment on medulla oblongata dorsolateral syndrome in patients with dysphagia.Methods Thirty cases of medulla oblongata dorsolateral syndrome with dysphagia patients from May,2013 to May,2014 Cangzhou of neurology and rehabilitation center hospital were divided into treatment group and control group by using random numbers,16 cases of treatment group and control group in 14 cases. In swallowing rehabilitation training,the treatment group was given head cupping treatment together with the low frequency therapeutic apparatus. Electric acupuncture selects the discontinuous wave,frequency 50 Hz,current strength 2 m A;Low frequency using triangle wave pulse to stimulate wave width 750 ms,amplitude 0 to 25 m A,frequency of 2 Hz,the current strength of 7. 0- 10. 0 m A,each time for2- 3 s,intermittent time is 5- 6 s. Treatment 2 times / d,20 min,at a time,4 weeks for 1 course of treatment; The control group given low frequency electric therapeutic treatment,2 times / d,20 min at a time,4 weeks for 1 course of treatment.Treatment group and control group respectively in both groups before treatment,4 weeks after treatment respectively for kubota drinking water test score and VFSS score. All the data with SPSS 16. 0 statistical software for data analysis,the measurement data by chi-square test,measurement data,the comparison between groups using independent t test,group in comparison with paired t test,take a 95% confidence interval. Results After 4 weeks treatment,the patients with transcranial magnetic stimulation including positioning head together with the low frequency treatment of medulla oblongata dorsolateral syndrome in patients with dysphagia Kubota drinking water test and VFSS score is better than low frequency electric therapy group( P ﹤ 0. 05). Conclusion Transcranial magnetic stimulation including positioning head together with the low frequency treatment of medulla oblongata dorsolateral syndrome can further improve swallowing function,avoid aspiration,and then improve the quality of life of patients.
引文
[1]江玉娟,杨玉霞,常娥,等.体表定位电头针结合Rosenbek八步训练法治疗脑卒中患者言语失用症的疗效观察[J].中国康复医学杂志,2015,30(4):366-368.
[2]袁英,汪洁,孙妍,等.经颅直流电刺激对吞咽失用症及皮质兴奋性的作用[J].中国康复医学杂志,2012,27(6):500.
[3]袁英,汪洁,吴东宇.非侵入性脑刺激技术在吞咽障碍治疗中的应用[J].中国康复医学杂志,2012,27(10):979-982.
[4]朱镛连.神经康复学[M].北京:人民军医出版社,2006:551.
[5]大西幸子,孙启良.摄食吞咽障碍实用技术[M].北京:中国医药科技出版社,2000:7-18.
[6]陈烈冉,张子尧,梁新明,等.Wallenberg综合征临床特征研究[J].中国临床研究,2012,4(18):115-117.
[7]高金立.延髓麻痹吞咽障碍的神经机理与临床诊断[J].哈尔滨医药,2014,34(2):120-122.
[8]窦祖林,兰月,于帆.吞咽造影数字化分析在脑干卒中后吞咽障碍患者疗效评估中的应用[J].中国康复医学杂志,2013,28(9):799-805.
[9]袁英,汪洁,孙妍,等.经颅直流电刺激对吞咽使用症及皮质兴奋性的作用[J].中国康复医学杂志,2012,27(6):497-502.
[10]卫小梅,窦祖林,兰月,等.吞咽障碍干预的中枢神经通路调控机制[J].中华物理医学与康复杂志,2013,35(12):934.
[11]肖艮,赵杨,范刚启.头针治疗急性脑卒中针刺方法研究[J].中国中医急症,2014,23(9):1685-1687.
[12]孙友霞,刘志红,桂亚雄.Vocastim-Master吞咽言语诊断治疗仪联合吞咽训练治疗脑梗死合并吞咽障碍的疗效[J].实用临床医学,2013,14(7):9-17.
[13]孙秀珍,陈永华,蒋剑文.吞咽言语治疗仪在脑卒中吞咽障碍康复治疗中的应用效果[J].按摩与康复医学,2015,6(20):75-76.
[14]古菁,黄怀,沈丹彤.吞咽功能训练对颅脑损伤后器官切开患者肺部感染的影响[J].山东医药,2014,54(45):67-68.
[15]罗凤萍,许梦雅,刘合玉.针刺配合综合康复训练治疗脑卒中后吞咽功能障碍的疗效[J].中国老年学杂志,2012,32(22):4984-4985.
[2]袁英,汪洁,孙妍,等.经颅直流电刺激对吞咽失用症及皮质兴奋性的作用[J].中国康复医学杂志,2012,27(6):500.
[3]袁英,汪洁,吴东宇.非侵入性脑刺激技术在吞咽障碍治疗中的应用[J].中国康复医学杂志,2012,27(10):979-982.
[4]朱镛连.神经康复学[M].北京:人民军医出版社,2006:551.
[5]大西幸子,孙启良.摄食吞咽障碍实用技术[M].北京:中国医药科技出版社,2000:7-18.
[6]陈烈冉,张子尧,梁新明,等.Wallenberg综合征临床特征研究[J].中国临床研究,2012,4(18):115-117.
[7]高金立.延髓麻痹吞咽障碍的神经机理与临床诊断[J].哈尔滨医药,2014,34(2):120-122.
[8]窦祖林,兰月,于帆.吞咽造影数字化分析在脑干卒中后吞咽障碍患者疗效评估中的应用[J].中国康复医学杂志,2013,28(9):799-805.
[9]袁英,汪洁,孙妍,等.经颅直流电刺激对吞咽使用症及皮质兴奋性的作用[J].中国康复医学杂志,2012,27(6):497-502.
[10]卫小梅,窦祖林,兰月,等.吞咽障碍干预的中枢神经通路调控机制[J].中华物理医学与康复杂志,2013,35(12):934.
[11]肖艮,赵杨,范刚启.头针治疗急性脑卒中针刺方法研究[J].中国中医急症,2014,23(9):1685-1687.
[12]孙友霞,刘志红,桂亚雄.Vocastim-Master吞咽言语诊断治疗仪联合吞咽训练治疗脑梗死合并吞咽障碍的疗效[J].实用临床医学,2013,14(7):9-17.
[13]孙秀珍,陈永华,蒋剑文.吞咽言语治疗仪在脑卒中吞咽障碍康复治疗中的应用效果[J].按摩与康复医学,2015,6(20):75-76.
[14]古菁,黄怀,沈丹彤.吞咽功能训练对颅脑损伤后器官切开患者肺部感染的影响[J].山东医药,2014,54(45):67-68.
[15]罗凤萍,许梦雅,刘合玉.针刺配合综合康复训练治疗脑卒中后吞咽功能障碍的疗效[J].中国老年学杂志,2012,32(22):4984-4985.