目的：探讨经颅磁刺激联合通关利窍针刺法对脑梗死后吞咽困难患者吸入性肺炎风险的影响，并基 于双重差分模型（Difference-in-differences model，DID）分析患者吞咽功能的变化。方法：根据随机数字表 法将2022年10月至2024年4月确诊为脑梗死后吞咽困难且于我院就诊的120例患者分为针刺组和联合组 各60例。2组均采用通关利窍针刺法治疗，联合组加用经颅磁刺激治疗。对比两组患者的临床疗效和吸入 性肺炎发生情况，采用DID模型对比两组患者治疗前后的吞咽功能变化，并根据吸入性肺炎发生情况将患 者亚分组为肺炎组和非肺炎组，采用多因素COX回归分析脑梗死后吞咽困难患者发生吸入性肺炎风险的 影响。结果：治疗1个月后联合组的总有效率高于针刺组（P＜0.05）；接受治疗2周后、4周后联合组的SSA 评分低于针刺组，FOIS评分高于针刺组（P＜0.05）；DID回归模型显示，联合组较针刺组的SSA、FOIS评分 改变更明显，治疗方式在时间上与总体治疗效应相同，时间越长，SSA 评分下降 76.38%，FOIS 评分上升 30.92%（P＜0.05）；两组患者的吸入性肺炎发生率比较差异具有统计学意义，联合组的吸入性肺炎发生率曲 线低于针刺组（P＜0.05）。结论：经颅磁刺激联合通关利窍针刺法可以提高脑梗死后吞咽困难患者的总体 治疗效果，加速吞咽功能的改善情况，同时还可预防患者吸入性肺炎的发生。

To explore the effect of transcranial magnetic stimulation combined with Tongdu Liqiao acupuncture on the risk of aspiration pneumonia in patients with dysphagia after cerebral infarction, and to analyze the changes in swallowing function based on the Difference-in-Differences (DID) model. Methods: A total of 120 patients diagnosed with dysphagia after cerebral infarction admitted to our hospital from October 2022 to April 2024 were divided into an acupuncture group and a combined group via the random number table method, with 60 patients in each group. Both groups received Tongdu Liqiao acupuncture, and the combined group was additionally treated with transcranial magnetic stimulation. The clinical efficacy and incidence of aspiration pneumonia were compared between the two groups. The DID model was used to compare the changes in swallowing function before and after treatment. Patients were further subdivided into a pneumonia subgroup and a non-pneumonia subgroup according to whether aspiration pneumonia occurred. Multivariate Cox regression analysis was conducted to analyze the influencing factors for aspiration pneumonia in patients with post-cerebral infarction dysphagia. Results: After 1 month of treatment, the total effective rate in the combined group was higher than that in the acupuncture group (P<0.05). At 2 weeks and 4 weeks after treatment, the SSA scores of the combined group were lower, while the FOIS scores were higher compared with the acupuncture group (P<0.05). DID regression results revealed more prominent changes in SSA and FOIS scores in the combined group relative to the acupuncture group. The treatment effect interacted with time; with prolonged treatment duration, the SSA score decreased by 76.38% and the FOIS score increased by 30.92% (P<0.05). There was a statistically significant difference in the incidence of aspiration pneumonia between the two groups, and the incidence curve of aspiration pneumonia in the combined group was lower than that in the acupuncture group (P<0.05). Conclusion: Transcranial magnetic stimulation combined with Tongdu Liqiao acupuncture can improve the overall therapeutic efficacy, accelerate the recovery of swallowing function, and prevent the occurrence of aspiration pneumonia in patients with dysphagia after cerebral infarction.