二腹肌电针联合重复经颅磁刺激对脑卒中后吞咽障碍患者的影响OA

Objective To observe the effect of ultrasound-guided digastric muscle electroacupuncture combined with repeti-tive transcranial magnetic stimulation(rTMS)on patients with post-stroke dysphagia.Methods A total of 66 patients with post-stroke dysphagia who were hospitalized in the Rehabilitation Department of Dalian Municipal Central Hospital from October 2020 to December 2021 were recruited and randomly divided into three groups:an electroacupuncture group with 20 cases,a magnetic stimulation group with 22 cases,and a combination group with 24 cases.During the treatment process,2 cases in the magnetic stimu-lation group and 4 cases in the combination group were unable to tolerate the treatment.Additionally,1 case in the magnetic stimula-tion group withdrew from the study due to family relocation.Finally,a total of 59 cases were included in the study,with 20 cases in the electroacupuncture group,19 cases in the magnetic stimulation group,and 20 cases in the combination group.All three groups underwent rehabilitation training,and in addition,the electroacupuncture group only received electroacupuncture threatment on the digastric muscles;the magnetic stimulation group only received rTMS treatment;the combination group received treatment first,and within 45 minutes after the end of rTMS treatment,received electroacupuncture treatment on the digastric muscles.Each group re-ceived treatment once a day,five times a week,for four consecutive weeks.The Functional Oral Intake Scale(FOIS)was used to as-sess the oral feeding ability of patients;the standardized swallowing assessment(SSA)scale was used to evaluate swallowing func-tion;the Rosenbek Penetration-Aspiration Scale(PAS)was used with the standardized videofluoroscopic swallowing study(VFSS)process to evaluate the aspiration risk;the VitalStim® Plus Swallowing Disorder Assessment and Treatment System was used to col-lect surface electromyographic signals of the patient's bilateral suprahyoid muscle groups,and analyze the swallowing duration and maximum wave amplitude;the VFSS combined with the Swallowing Signal Analysis System(SSAS)v2.0 developed by the China Rehabilitation Research Center,was used to evaluate the motion parameters of the hyoid bone(upward amplitude,forward ampli-tude,upward velocity,and forward velocity);the motor evoked potential(MEP)wave amplitude was used to evaluate cortical excit-ability and nerve conduction function of the suprahyoid muscle group on the affected side;the enzyme-linked immunosorbent assay was used to detect the relative expression levels of hemoglobin(Hb),serum prealbumin(PAB),serum albumin(ALB)and transfer-rin(TRF)to evaluate nutritional status.Results Compared with before treatment,FOIS scores increased in all three groups(P<0.05),while SSA scores and PAS grades decreased after treatment(P<0.05).Compared with those the electroacupuncture group,the magnetic stimulation group had a lower PAS grade after treatment(P<0.05),the combination group had a higher FOIS score(P<0.05),as well as lower SSA score and PAS grade(P<0.05).Compared with those the magnetic stimulation group,the combination group demonst rated a higher FOIS score(P<0.05),and lower SSA score and PAS grade after treatment(P<0.05).Compared with be-fore treatment,the swallowing duration was shortened and the maximum wave amplitudes were higher in the three groups(P<0.05).Compared with the electroacupuncture group and the magnetic stimulation group,the combination group had a shorter swallowing duration and a higher maximum wave amplitude after treatment(P<0.05).Compared with before treatment,the three groups showed greater amplitudes and faster velocities of upward and forward movement(P<0.05).Compared with the those electroacupuncture group and the magnetic stimulation group,the combination group had a greater amplitude and a faster speed of upward and forward movement after treatment(P<0.05).Compared with those before treatment,the MEP wave amplitudes on the affected side increased in all three groups(P<0.05).Compared with the electroacupuncture group and the magnetic stimulation group,the combination group had a higher MEP wave amplitude on the affected side after treatment(P<0.05).Compared with before treatment,the relative levels of Hb,PAB,ALB and TRF increased in all three groups(P<0.05).Compared with the electroacupuncture group and the mag-netic stimulation group,the combination group exhibited higher relative levels of Hb,PAB,ALB and TRF after treatment(P<0.05).Conclusion The combination of digastric muscle electroacupuncture and rTMS can synergistically enhance swallowing function,cortical excitability,and nutritional status in patients with post-stroke dysphagia,outperforming either monotherapy.