低频重复经颅磁刺激联合感觉唤醒护理治疗卒中后吞咽障碍

文献信息

中文摘要

背景： 卒中后吞咽障碍可损害气道保护、营养和功能恢复。本文描述了一种临床方案，将低频重复经颅磁刺激（rTMS）与结构化感觉唤醒护理包相结合，用于急性缺血性卒中伴吞咽障碍且存在进食相关上肢功能障碍的患者。方法：吞咽障碍是主要治疗焦点；上肢活动针对自我进食的相关限制。该方案整合了筛查、刺激安全性审查、运动阈值测定、对侧吞咽运动靶向、1 Hz rTMS、序列化感觉输入、进食相关任务练习和结局评估。结果：代表性结果来自一项单中心、随机、评估者盲法研究，纳入160例患者（每组80例），比较联合干预与常规护理对吞咽康复的效果，持续2周。标准化吞咽评估变化值的组间差异为-3.9分（95%置信区间[CI]，-5.8至-2.0；p < 0.001）。功能经口摄食量表变化值的组间差异为0.8个等级（95% CI，0.4至1.2；p < 0.001），穿透-误吸量表变化值的组间差异为-0.9分（95% CI，-1.5至-0.3；p = 0.004），后者仅限于有配对仪器评估的参与者（48例对46例）。吸入性肺炎发生在5/80例对11/80例参与者中（p = 0.118）；未报告与rTMS相关的严重不良事件。结论：这些发现表明量表评分存在短期差异，但并未确立吞咽方面具有临床重要性的获益或肺炎风险降低。该方案协调了已确立的康复组成部分。需要进一步研究以确定其各自效应，并识别可能从对侧抑制中获益的患者。

英文摘要

Post-stroke dysphagia can compromise airway protection, nutrition, and functional recovery. This article describes a clinical protocol combining low-frequency repetitive transcranial magnetic stimulation (rTMS) with a structured sensory arousal nursing package for patients with acute ischemic stroke and dysphagia accompanied by feeding-related upper-limb dysfunction. Dysphagia is the primary treatment focus; upper-limb activities address associated limitations in self-feeding. The protocol integrates screening, stimulation safety review, motor-threshold determination, contralesional swallowing-motor targeting, 1 Hz rTMS, sequenced sensory input, feeding-related task practice, and outcome assessment. Representative results come from a single-center, randomized, assessor-blinded study of 160 patients (80 per group) comparing the combined intervention with routine nursing for swallowing rehabilitation over 2 weeks. The between-group difference in Standardized Swallowing Assessment change was -3.9 points (95% confidence interval [CI], -5.8 to -2.0; p < 0.001). The between-group change-score differences were 0.8 levels for the Functional Oral Intake Scale (95% CI, 0.4 to 1.2; p < 0.001) and -0.9 points for the Penetration-Aspiration Scale (95% CI, -1.5 to -0.3; p = 0.004), the latter restricted to participants with paired instrumental assessments (48 versus 46). Aspiration pneumonia occurred in 5/80 versus 11/80 participants (p = 0.118); no serious rTMS-related adverse events were reported. These findings indicate short-term differences in scale scores but do not establish a clinically important benefit in swallowing or a reduced risk of pneumonia. The protocol coordinates established rehabilitation components. Further studies are needed to determine their individual effects and identify patients who may benefit from contralesional inhibition.