神经调控技术在吞咽障碍康复中的应用进展

doi:10.3969/j.issn.1006-9771.2020.11.007

摘要/Abstract

摘要：

神经调控技术基于皮质修复机制,通过电或化学方法直接或间接作用于大脑皮质,影响神经元兴奋性,辅助神经网络重建,促进功能恢复。经颅直流电刺激和经颅磁刺激技术近年来在吞咽障碍康复中被广泛应用,且疗效显著。吞咽障碍患者可根据大脑皮质受损情况,选择适宜的恢复模型,通过电极部位、频率的选择,实施不同的神经调控干预策略,兴奋、抑制或调控大脑目标皮质,从而改善吞咽功能。

关键词: 吞咽障碍, 康复, 神经调控技术, 经颅直流电刺激, 经颅磁刺激, 综述

Abstract:

Neuromodulation is a kind of technique based on neurocortical repair mechanism, which affects the cerebral cortex by electrical or chemical means directly or indirectly, impacts the activity of neurons, to help the reconstruction of neural network and promote functional recovery. Transcranial direct current stimulation and transcranial magnetic stimulation are the neuromodulation techniques used widely in the rehabilitation of dysphagia in recent years. Neuromodulation intervention strategies for dysphagia can be selected in term of models, electrode placement, frequency, etc., based on the cerebral damage, to excite, inhibit or regulate target cerebral cortex, to improve swallowing function.

Key words: dysphagia, rehabilitation, neuromodulation, transcranial direct current stimulation, transcranial magnetic stimulation, review

中图分类号:

R742

陈柱,陆瑶,陈宜懿. 神经调控技术在吞咽障碍康复中的应用进展[J]. 《中国康复理论与实践》, 2020, 26(11): 1287-1291.

CHEN Zhu,LU Yao,CHEN Yi-yi. Application of Neuromodulation in Rehabilitation for Dysphagia (review)[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2020, 26(11): 1287-1291.

图/表 1

参考文献 51

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研究者	刺激方式	效果	参考策略
Verin等^[39]	刺激吞咽皮质	吞咽功能改善	rTMS真刺激
Verin等^[39]	刺激吞咽皮质	进食时吞咽反应更快	rTMS真刺激
Khedr等^[40]	刺激受损皮质	真刺激有效	rTMS真刺激
Khedr等^[40]	刺激受损皮质	伪刺激组治疗2个月也未见吞咽功能显著改善	rTMS真刺激
郑秀琴等^[41]	以1 Hz、5 Hz和10 Hz刺激健康成人	5 Hz的刺激对吞咽皮质既有兴奋作用,也有后续效应	高频rTMS (5 Hz)
郑秀琴等^[41]	以1 Hz、5 Hz和10 Hz刺激健康成人	1 Hz和10 Hz rTMS均无兴奋效应	高频rTMS (5 Hz)
Khedr等^[42]	3 Hz刺激受损侧皮质	吞咽功能较前改善	高频rTMS (3 Hz)
Khedr等^[42]	3 Hz刺激受损侧皮质	吞咽肌肉运动诱发电位振幅较前增大	高频rTMS (3 Hz)
Park等^[43]	5 Hz刺激健侧咽部皮质区	健侧皮质兴奋性增加	高频rTMS (5 Hz)
		延髓运动神经元兴奋性增加
		投射到咽部的刺激增加
Verin等^[39]	1 Hz刺激吞咽障碍患者健侧皮质	患者吞咽协调性提高	低频rTMS (1 Hz)
Du等^[44]、Kim等^[45]	以1 Hz和3 Hz刺激吞咽障碍患者皮质	1 Hz降低健侧皮质兴奋性,增加患侧皮质兴奋性	低频rTMS (1 Hz)
	以1 Hz和3 Hz刺激吞咽障碍患者皮质	3 Hz增强患侧皮质兴奋性	低频rTMS (1 Hz)
焦勇钢等^[46]	3 Hz刺激急性期患者双侧相应区域	双侧高频刺激效果优于单侧刺激	双侧高频rTMS (3 Hz)
Khedr等^[42]	3 Hz刺激双侧吞咽运动区大脑皮质	治疗延髓损伤吞咽困难有效	双侧高频rTMS (3 Hz)
Khedr等^[42]	3 Hz刺激双侧吞咽运动区大脑皮质	可提高皮质延髓的兴奋性	双侧高频rTMS (3 Hz)

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