Swallowing dysfunction is a common complication after stroke, and the recovery of swallowing function is important regarding patients' intake of nutrients, improved quality of life, reduced risk of complications, and improved quality of life. Although intermittent θ burst stimulation (iTBS) and chin tuck against resistance (CTAR) have been shown to have significant effects in improving dysphagia, fewer studies have been performed on combining iTBS with CTAR in the treatment of patients with dysphagia in stroke, and its rehabilitative effects need to be further investigated.

To observe the clinical effects of iTBS combined with CTAR training on swallowing function in stroke patients.

From March 2023 to July 2024, 90 patients with post-stroke dysphagia attending the Department of Rehabilitation Medicine of the First Affiliated Hospital of Bengbu Medical University were selected. The patients were randomly divided into the routine group (n=30), the CTAR group (n=30), and the combined group (n=30) according to the method of random number table. The routine group received conventional swallowing training, the CTAR group received CTAR training based on the routine group, and the combined group received iTBS based on the CTAR group. Both groups received treatment five times per week for four weeks. The Standard Swallowing Assessment (SSA) and Functional Oral Intake Scale (FOIS) were used before and after the treatment. Surface electromyography (sEMG) was used to measure the duration of swallowing and the maximum amplitude value of the supraglottic muscle group and to compare the clinical effects of the three groups of patients.

Thirty cases in the routine group, 30 cases in the CTAR group, and 30 cases in the combined group were finally included. After 4 weeks of treatment, the SSA score of the patients in the three groups was lower than those before treatment in the group, the FOIS score and the maximum amplitude value of sEMG were higher than those before treatment in the group, and the duration of swallowing was shorter than those before treatment in the group (P<0.05). After 4 weeks of treatment, the SSA score of the patients in the CTAR group and the combined group was lower than those in the routine group, the FOIS score and the maximum amplitude value of sEMG in the CTAR group and the combined group were higher than those in the routine group, and the duration of swallowing in the CTAR group and the combined group was shorter than those in the routine group (P<0.05) ; the SSA score of the patients in the combined group was lower than those in the CTAR group, the FOIS score and the maximum amplitude value of sEMG in the combined group were higher than those in the CTAR group, and the duration of swallowing in the combined group was shorter than those in the CTAR group (P<0.05). And the overall effective rate of the CTAR group and the combined group was higher than that of the routine group (P<0.017), and the overall effective rate of the combined group was higher than that of the CTAR group (P<0.017) .

CTAR combined with iTBS can improve the swallowing function of stroke patients with dysphagia, reinforce the strength of swallowing muscle groups, and enhance their quality of life.

吞咽障碍是脑卒中后常见的并发症，而吞咽功能的恢复在患者摄取营养、减少并发症和提高生活质量等方面具有重要意义。尽管间歇性θ短阵脉冲刺激（iTBS）和下颌抗阻力训练（CTAR）已被证明在改善吞咽障碍方面有显著疗效，但目前将iTBS联合CTAR治疗脑卒中后吞咽障碍患者的研究较少，其康复疗效有待进一步取证。

观察iTBS联合CTAR对脑卒中患者吞咽功能的临床疗效。

2023年3月—2024年7月，选取蚌埠医科大学第一附属医院康复医学科就诊的脑卒中后吞咽障碍患者90例，按照随机数字表法将患者分为常规组（n=30）、CTAR组（n=30）和联合组（n=30）。常规组进行常规吞咽训练，CTAR组在常规组的基础上进行CTAR，联合组在CTAR组的基础上接受大脑皮质iTBS刺激，5次/周，共4周。治疗前后选用标准吞咽功能评定量表（SSA）和功能性经口摄食表分级量表（FOIS）进行评估，表面肌电（sEMG）测量患者舌骨上肌群的吞咽时程及最大波峰值，并且比较三组患者的临床疗效。

最终纳入常规组30例、CTAR组30例和联合组30例。治疗4周后，三组患者SSA评分较组内治疗前降低，FOIS评分、sEMG的最大波峰值较组内治疗前升高，吞咽时程均较组内治疗前缩短（P<0.05）。治疗4周后，CTAR组、联合组患者的SSA评分低于常规组，FOIS评分、sEMG的最大波峰值高于常规组，吞咽时程短于常规组（P<0.05）；联合组患者SSA评分低于CTAR组，FOIS评分、sEMG的最大波峰值高于CTAR组，吞咽时程短于CTAR组（P<0.05）；且CTAR组、联合组的总有效率高于常规组（P<0.017），联合组的总有效率高于CTAR组（P<0.017）。

iTBS联合CTAR可以有效改善脑卒中后吞咽障碍患者的吞咽功能，强化吞咽肌群肌力，提高其生活质量。