探讨针刺联合重复经颅磁刺激（rTMS）治疗脑卒中后吞咽障碍的临床疗效。

选取苏州瑞盛康复医院神经康复科自2018年5月至2019年10月收治的75例脑卒中后吞咽障碍患者，按照随机数字表法分为针刺组、rTMS组和联合组，每组25例。3组患者均进行常规吞咽训练与药物治疗，针刺组在常规治疗上加用电针治疗，rTMS组在常规治疗上加用rTMS治疗，联合组在常规治疗上联合电针+rTMS治疗。对比3组患者治疗前后洼田饮水试验、标准吞咽功能评价量表和表面肌电图的检测结果，分析各组患者对应的治疗效果。

（1）总有效率：联合组（88%）明显高于针刺组（72%）与rTMS组（76%），差异有统计学意义（P<0.05），针刺组与rTMS组比较差异无统计学意义（P>0.05）。（2）标准吞咽功能评分：治疗前，3组比较差异无统计学意义（P>0.05），治疗后联合组优于针刺组与rTMS组，差异均具有统计学意义（P<0.05），针刺组和rTMS组比较差异无统计学意义（P>0.05）。（3）表面肌电图结果：治疗前，3组比较差异无统计学意义（P>0.05），治疗后联合组优于针刺组与rTMS组，差异均有统计学意义（P<0.05），针刺组和rTMS组比较差异无统计学意义（P>0.05）。

脑卒中后吞咽障碍患者采用针刺加rTMS联合吞咽康复训练疗法实施治疗，效果显著，能够有效地改善患者吞咽功能。

To evaluate the clinical effect of acupuncture combined with repeated transcranial magnetic stimulation (rTMS) on dysphagia after stroke.

Seventy-five patients with dysphagia after stroke admitted to Department of Neurological Rehabilitation, Suzhou Ruisheng Rehabilitation Hospital from May 2018 to October 2019 were selected as the study subjects, and were randomly divided into acupuncture group, rTMS group and combined group according to the random number table method. All cases in 3 groups, each one of 25 cases, that received conventional swallowing training and drug therapy. The acupuncture group received conventional treatment with electro-acupuncture, the rTMS group received routine treatment with rTMS, and the combined group received conventional treatment with electro-acupuncture and rTMS. The results of water swallow test, standard swallowing function evaluation scale and surface electromyography (sEMG) were compared before and after treatment in 3 groups of patients, and the corresponding treatment effects were analyzed.

The total effective rate of the combined group (88%) was significantly higher than that of the acupuncture group (72%) and the rTMS group (76%), and there was no statistically significant difference between the acupuncture group and the rTMS group. Standard swallowing function score showed no statistical difference among 3 groups before treatment (P>0.05), and the combined group was superior to the acupuncture group and the rTMS group after treatment (P<0.05), and there was no statistical difference between the acupuncture group and the rTMS group (P>0.05). sEMG results showed that there was no statistical difference among 3 groups before treatment (P>0.05), and the combined group was superior to the acupuncture group and the rTMS group after treatment (P<0.05), and there was no statistical difference between the acupuncture group and the rTMS group (P>0.05).

Acupuncture combined with rTMS combined with rehabilitation training for swallowing in patients with dysphagia after stroke has a significant effect and can effectively improve the patients’ swallowing function, which is worthy of popularization and application.