重复经颅磁刺激联合乳果糖改善卒中后便秘的临床研究

Clinical Study of Repetitive Transcranial Magnetic Stimulation Combined with Lactulose for Post-Stroke Constipation

摘要: 目的：探讨重复经颅磁刺激联合乳果糖对卒中后便秘患者排便功能、生活质量改善情况及其对肠道菌群及其代谢物的影响。方法：将60例卒中后便秘患者随机分为rTMS组与假rTMS组，每组30例。两组均予以乳果糖口服溶液。在此基础上，rTMS组接受真性rTMS治疗；假rTMS组则采用圆形线圈背面施以假刺激治疗，共治疗14日。比较两组患者治疗前、后CSBMs、SBMs、CCS以及PAC-QOL评分变化，检测肠道菌群和粪便SCFAs含量，并在治疗结束４周后对两组治疗有效者进行随访并记录复发情况。结果：与治疗前相比，两组患者治疗后CSBMs、SBMs及SCFAs含量均明显升高(P < 0.05)；CCS与PAC-QOL评分均明显降低(P < 0.05)；且rTMS组上述各指标改善均优于假rTMS组(P < 0.05)。rTMS组肠道中双歧杆菌、乳酸杆菌数量增加，大肠杆菌、肠球菌数量减少，优于假rTMS组(P < 0.05)。rTMS组总有效率(89.66%)高于假rTMS组(71.43%)，复发率26.92%低于假rTMS组(60.00%) (P < 0.05)。结论：重复经颅磁刺激联合乳果糖可有效改善卒中后便秘患者排便功能和生活质量，调节肠道菌群平衡，提高短链脂肪酸含量，并有助于降低复发风险。

Abstract: Objective: To investigate the effects of repetitive transcranial magnetic stimulation (rTMS) combined with lactulose on bowel function, quality of life, and their impact on gut microbiota and its metabolites in patients with post-stroke constipation. Methods: Sixty patients with post-stroke constipation were randomly assigned to either the rTMS group or the sham rTMS group, with 30 patients in each group. Both groups received oral lactulose solution. Additionally, the rTMS group underwent active rTMS treatment, while the sham rTMS group received sham stimulation using the reverse side of a circular coil for a total treatment duration of 14 days. Complete spontaneous bowel movements (CSBMs), spontaneous bowel movements (SBMs), Cleveland Clinic Score (CCS), and Patient Assessment of Constipation Quality of Life (PAC-QOL) questionnaire scores were compared before and after treatment. Gut microbiota and fecal short-chain fatty acids (SCFAs) content were measured. A follow-up was conducted 4 weeks after the end of treatment to record recurrence rates in effectively treated patients. Results: After treatment, both groups showed significant increases in CSBMs, SBMs, and SCFAs content, and significant decreases in CCS and PAC-QOL scores compared to pre-treatment levels (P < 0.05). The improvements in all these indicators were significantly greater in the rTMS group than in the sham rTMS group (P < 0.05). The rTMS group demonstrated a more significant increase in beneficial bacteria (Bifidobacterium, Lactobacillus) and a more significant reduction in harmful bacteria (Escherichia coli, Enterococcus) compared to the sham rTMS group (P < 0.05). The total effective rate was significantly higher in the rTMS group (89.66%) than in the sham rTMS group (71.43%), while the recurrence rate was significantly lower in the rTMS group (26.92%) than in the sham rTMS group (60.00%) (P < 0.05). Conclusion: The combination of repetitive transcranial magnetic stimulation and lactulose effectively improves bowel function and quality of life in patients with post-stroke constipation, and helps reduce the risk of recurrence.