针灸治疗运动性构音障碍的系统评价
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摘要
目的:系统评价针灸治疗运动性构音障碍的临床疗效,并探讨针灸治疗运动性构音障碍的选穴规律。方法:检索建库至2018年1月中国期刊全文数据库(CNKI)、万方数据资源系统(WF)、维普数据库(VIP)、中国生物医学文献数据库(CBM)、PubMed、Ebsco、Science Direct、Cochrane Library数据库中针灸治疗运动性构音障碍临床随机对照试验文献,对纳入文献进行资料提取和质量评价,使用RevMan 5.3软件进行Meta分析,使用Excel软件进行腧穴频数统计,分析选穴特点。结果:共纳入21篇文献,病例数1651例。临床疗效资料合并:异质性检验P=0.74,I ~2=0%,OR=6.39,95%可信区间:[4.55,8.88],Z=10.84(P<0.01),治疗组疗效明显优于对照组,两组疗效差异有统计学意义。Frenchay构音障碍量表症状评分资料合并:异质性检验,P=0.56,I ~2=0%,WMD=3.20,95%可信区间:[1.38,5.02],Z=3.45(P<0.01),治疗组疗效明显优于对照组。腧穴频数统计5次以上的穴位:风池、玉液、金津、廉泉、百会、舌三针、哑门。归经频数统计前5位:经外奇穴、督脉、足少阳胆经、任脉、足阳明胃经。结论:针灸配合言语训练/常规治疗的临床疗效明显优于对照组(言语训练、药物、常规),针灸治疗运动性构音障碍疗效确切且安全性高,选穴多以舌、咽喉、颈项局部穴位为主,经外奇穴及经验效穴居多,进一步证据仍有待高质量大样本多中心随机对照试验提供。
Objective To systematically evaluate the clinical efficacy of acupuncture for dysarthria, and to explore the rules of acupoints selection for dysarthria. Methods The clinical randomized control trial literature regarding acupuncture for dysarthria published before January of 2018 were searched in databases, including CNKI, Wanfang, VIP, CBM, PubMed,Ebsco, Science Direct and Cochrane Library. The information of included studies was extract and the quality was assessed.The Meta analysis was performed by using RevMan 5.3 software. The frequency of acupoints was calculated by using Excel software to analyzed the rules of acupoints selection. Results Totally 21 papers were included, involving 1651 patients. The pooled effects of clinical efficacy: heterogeneity test P =0.74, I 2=0%, OR =6.36, 95% CI: 4.55, 8.88, Z =10.84(P<0.01),indicating the efficacy in the treatment group was significantly higher than that in the control group. The pooled effects of the symptom score in Frenchay scale: heterogeneity test P =0.56, I 2=0%, WMD =3.20, 95% CI: 1.38, 5.02, Z =3.45(P<0.01),indicating the efficacy in the treatment group was significantly higher than that in the control group. The acupoints with frequency of more than 5 times were Fengchi(GB 20), Yuye(EX-HN 13), Jinjin(EX-HN 12), Lianquan(CV 23), Baihui(GV20), tongue-three needles and Yamen(GV15). The meridians with frequency of more than 5 times were the extra channels,governor vessel, gallbladder channel, conception vessel and stomach channel. Conclusion The clinical efficacy of acupuncture combined with speech training/regular treatment is significantly superior to that of control group(speech training,medication, regular treatment); acupuncture is safe and effective for dysarthria; the majority of selected acupoint is local acupoints around tongue, throat and neck, as well as extra points and empirical points. However, high-quality randomized controlled trials with large sample sizes are still needed to provide further evidence.
Objective To systematically evaluate the clinical efficacy of acupuncture for dysarthria, and to explore the rules of acupoints selection for dysarthria. Methods The clinical randomized control trial literature regarding acupuncture for dysarthria published before January of 2018 were searched in databases, including CNKI, Wanfang, VIP, CBM, PubMed,Ebsco, Science Direct and Cochrane Library. The information of included studies was extract and the quality was assessed.The Meta analysis was performed by using RevMan 5.3 software. The frequency of acupoints was calculated by using Excel software to analyzed the rules of acupoints selection. Results Totally 21 papers were included, involving 1651 patients. The pooled effects of clinical efficacy: heterogeneity test P =0.74, I 2=0%, OR =6.36, 95% CI: 4.55, 8.88, Z =10.84(P<0.01),indicating the efficacy in the treatment group was significantly higher than that in the control group. The pooled effects of the symptom score in Frenchay scale: heterogeneity test P =0.56, I 2=0%, WMD =3.20, 95% CI: 1.38, 5.02, Z =3.45(P<0.01),indicating the efficacy in the treatment group was significantly higher than that in the control group. The acupoints with frequency of more than 5 times were Fengchi(GB 20), Yuye(EX-HN 13), Jinjin(EX-HN 12), Lianquan(CV 23), Baihui(GV20), tongue-three needles and Yamen(GV15). The meridians with frequency of more than 5 times were the extra channels,governor vessel, gallbladder channel, conception vessel and stomach channel. Conclusion The clinical efficacy of acupuncture combined with speech training/regular treatment is significantly superior to that of control group(speech training,medication, regular treatment); acupuncture is safe and effective for dysarthria; the majority of selected acupoint is local acupoints around tongue, throat and neck, as well as extra points and empirical points. However, high-quality randomized controlled trials with large sample sizes are still needed to provide further evidence.
引文
[1]李胜利.构音障碍的评价与治疗[J].中国临床康复, 2001, 5(23):24-26.
[2]Higgins J, Green S. Cochrane Collaboration:Cochrane Handbook forSystematicReviewsofInterventionsVersion5.1.0.[DB/OL].[2018-01-01].www. cochrane.org.
[3]胡纪可,胡卡明,胡婷.针刺结合语言训练治疗脑卒中痉挛型构音障碍的临床研究[J].四川中医, 2011, 29(2):117-119.
[4]史术峰,吴桂华,张亚娟.头项针结合舌针对脑卒中患者构音障碍的影响[J].针灸临床杂志, 2012, 28(6):17-19.
[5]徐基民,李惠兰,卢虎英,等.针刺对构音障碍患者言语和声学水平的影响[J].中国针灸, 2010, 30(7):537-541.
[6]杨玲,郭耀光,李德华,等.言语训练配合“颞三针”治疗中风后构音障碍疗效观察[J].世界中医药, 2017, 12(6):1425-1428.
[7]赵妍妍,白俊敏.项针配合言语训练治疗脑卒中后失调型构音障碍的疗效[J].中国康复, 2013, 28(1):38-40.
[8]罗开涛,钱立锋,颜玉琴,等.针刺配合言语康复训练治疗中风后构音障碍疗效分析[J].中国中医药科技, 2012, 19(4):361-362.
[9]贾力,白洁,刘东,等.舌体分区多针点刺配合言语训练治疗脑卒中后运动性构音障碍30例[J].中国中医药现代远程教育,2016, 14(2):44-46.
[10]康康.针刺结合言语康复训练治疗脑卒中后构音障碍的临床效果观察[J].中国基层医药, 2017, 24(4):559-562.
[11]韩建,吴妍.项针、舌针联合言语康复训练治疗脑卒中后构音障碍随机平行对照研究[J].实用中医内科杂志, 2014, 28(5):135-137.
[12]管志敏,屈璐,侯胜开,等.针刺颈项部腧穴治疗痉挛性构音障碍60例[J].河南中医, 2016, 36(11):1929-1930.
[13]董赟,郝盼富,刘梦婷,等.通督开喑针刺治疗脑卒中构音障碍的临床研究[J].中医药临床杂志, 2015, 27(2):172-174.
[14]董宝杰.醒脑通络法治疗脑卒中后痉挛型构音障碍60例的疗效观察[J].北京中医药, 2011, 30(1):48-49.
[15]吴海科,谭峰,万赛英,等.电针联合功能性电刺激早期干预对脑梗死后痉挛型构音障碍的疗效研究[J].中国康复医学杂志, 2012, 27(12):1116-1119.
[16] WuZJ,HuKM,GuoYG,etal.Acupuncturecombinedwith speech rehabilitation training for post-stroke spasmodic dysphonia:a multicenter randomized controlled trial[J]. World J Acup-Moxi,2014, 24(4):12-16.
[17]徐颖,罗子芮,金蓉,等.针刺“咽四穴”联合构音训练治疗脑卒中后痉挛型构音障碍的临床观察[J].按摩与康复医学,2017,8(8):27-29.
[18]梁娇.针刺联合言语训练治疗脑卒中后构音障碍[J].长春中医药大学学报, 2014, 30(4):669-671.
[19]陈立早,王丽菊.针刺结合语言训练治疗脑卒中患者痉挛型构音障碍[J].针灸临床杂志, 2011, 27(8):24-26.
[20]张素钊,张晓琪,薛维华,等.化浊通督针法治疗中风后假性球麻痹的临床疗效及其对患者吞咽功能、构音功能的影响研究[J].河北中医, 2016, 38(10):1531-1534.
[21]李钦潘,王伟,韩永升,等.针刺联合言语训练、心理干预治疗肝豆状核变性构音障碍疗效观察[J].上海针灸杂志,2015,34(10):966-969.
[22]刘诗丹.言语训练结合针刺治疗脑卒中构音障碍的临床研究[J].内科, 2012, 7(4):336-338.
[23]曾学清,滕东时,杨涛,等.针刺配合康复训练治疗脑梗塞后构音障碍30例[J].针灸临床杂志, 2005, 21(10):9-10.
[24]汪洁.构音障碍综合性评价量表的编制[J].中国康复医学杂志, 1998, 13(6):3-5.
[25]缪鸿石.康复医学理论与实践[M].上海:科学技术出版社,2000:421-425.
[26]高维滨.神经病针灸新疗法[M].北京:人民卫生出版社, 2002:422, 436.
[27]李胜利.构音障碍的评定与康复治疗[J].中国听力语言康复科学杂志, 2009, 32(1):8-12.
[28]李胜利,张庆苏.构音障碍的发音、言语表现与治疗[J].中国康复理论与实践, 2003, 9(1):62-64.
[29]何维佳,李胜利.运动性构音障碍言语声学水平客观评价的研究进展[J].中国康复理论与实践, 2010, 16(2):118-120.
[30]段林茹,郑洁皎,陈秀恩,等.构音障碍治疗的研究进展[J].中国康复, 2015, 30(3):229-232.
[31]王红,陈卓铭.脑卒中后遗构音障碍的诊断与治疗[J].新医学,2006, 37(11):717-719.
[32]于国华,吴芬,李俊.综合语言康复治疗对运动性构音障碍的疗效[J].实用临床医学, 2015, 16(5):61-64.
[33]夏娣文,佘江健,邹碧花,等.脑卒中患者痉挛性构音障碍的言语评定和治疗[J].中国民康医学, 2007, 19(8):615-616.
[34]陈虹静,胡卡明.脑卒中后构音障碍各评定方法浅析[J].湖南中医杂志, 2012, 28(6):126-129.
[35]丘卫红.构音障碍的评价及语言治疗[J].中国临床康复,2004,8(28):6155-6157.
[36]李欢.构音障碍评估研究述评[J].中国特殊教育,2010,15(6):59-64.
[37]汪洁.构音障碍的功能性评价[J].中国康复,1999,14(2):111-113.
[38]朱守娟,屈云,刘珂.运动性构音障碍的评估进展[J].中国康复医学杂志, 2012, 27(1):92-95.
[39]董恺,张倩,黄晓钦,等.培养神经内科医师NIHSS评分量表使用能力的探讨[J].医学教育管理, 2017, 3(S1):82-83.
[40]丛文杰,杜忠衡,胡欢,等.不同针刺方法治疗缺血性脑卒中后构音障碍的疗效对比研究[J].上海针灸杂志,2016,35(11):1269-1272.
[41]金泽,曹晓婷.颈部电针治疗中风后痉挛型构音障碍30例[J].针灸临床杂志, 2015, 31(5):26-28.
[42]郭丽娜.电针配合语言训练治疗脑卒中患者痉挛型构音障碍[J].中国临床康复, 2003, 7(11):3861.
[43]陈立早,汤守珍.针刺并高压氧治疗脑卒中后痉挛型构音障碍28例[J].上海针灸杂志, 2010, 29(1):50-51.
[2]Higgins J, Green S. Cochrane Collaboration:Cochrane Handbook forSystematicReviewsofInterventionsVersion5.1.0.[DB/OL].[2018-01-01].www. cochrane.org.
[3]胡纪可,胡卡明,胡婷.针刺结合语言训练治疗脑卒中痉挛型构音障碍的临床研究[J].四川中医, 2011, 29(2):117-119.
[4]史术峰,吴桂华,张亚娟.头项针结合舌针对脑卒中患者构音障碍的影响[J].针灸临床杂志, 2012, 28(6):17-19.
[5]徐基民,李惠兰,卢虎英,等.针刺对构音障碍患者言语和声学水平的影响[J].中国针灸, 2010, 30(7):537-541.
[6]杨玲,郭耀光,李德华,等.言语训练配合“颞三针”治疗中风后构音障碍疗效观察[J].世界中医药, 2017, 12(6):1425-1428.
[7]赵妍妍,白俊敏.项针配合言语训练治疗脑卒中后失调型构音障碍的疗效[J].中国康复, 2013, 28(1):38-40.
[8]罗开涛,钱立锋,颜玉琴,等.针刺配合言语康复训练治疗中风后构音障碍疗效分析[J].中国中医药科技, 2012, 19(4):361-362.
[9]贾力,白洁,刘东,等.舌体分区多针点刺配合言语训练治疗脑卒中后运动性构音障碍30例[J].中国中医药现代远程教育,2016, 14(2):44-46.
[10]康康.针刺结合言语康复训练治疗脑卒中后构音障碍的临床效果观察[J].中国基层医药, 2017, 24(4):559-562.
[11]韩建,吴妍.项针、舌针联合言语康复训练治疗脑卒中后构音障碍随机平行对照研究[J].实用中医内科杂志, 2014, 28(5):135-137.
[12]管志敏,屈璐,侯胜开,等.针刺颈项部腧穴治疗痉挛性构音障碍60例[J].河南中医, 2016, 36(11):1929-1930.
[13]董赟,郝盼富,刘梦婷,等.通督开喑针刺治疗脑卒中构音障碍的临床研究[J].中医药临床杂志, 2015, 27(2):172-174.
[14]董宝杰.醒脑通络法治疗脑卒中后痉挛型构音障碍60例的疗效观察[J].北京中医药, 2011, 30(1):48-49.
[15]吴海科,谭峰,万赛英,等.电针联合功能性电刺激早期干预对脑梗死后痉挛型构音障碍的疗效研究[J].中国康复医学杂志, 2012, 27(12):1116-1119.
[16] WuZJ,HuKM,GuoYG,etal.Acupuncturecombinedwith speech rehabilitation training for post-stroke spasmodic dysphonia:a multicenter randomized controlled trial[J]. World J Acup-Moxi,2014, 24(4):12-16.
[17]徐颖,罗子芮,金蓉,等.针刺“咽四穴”联合构音训练治疗脑卒中后痉挛型构音障碍的临床观察[J].按摩与康复医学,2017,8(8):27-29.
[18]梁娇.针刺联合言语训练治疗脑卒中后构音障碍[J].长春中医药大学学报, 2014, 30(4):669-671.
[19]陈立早,王丽菊.针刺结合语言训练治疗脑卒中患者痉挛型构音障碍[J].针灸临床杂志, 2011, 27(8):24-26.
[20]张素钊,张晓琪,薛维华,等.化浊通督针法治疗中风后假性球麻痹的临床疗效及其对患者吞咽功能、构音功能的影响研究[J].河北中医, 2016, 38(10):1531-1534.
[21]李钦潘,王伟,韩永升,等.针刺联合言语训练、心理干预治疗肝豆状核变性构音障碍疗效观察[J].上海针灸杂志,2015,34(10):966-969.
[22]刘诗丹.言语训练结合针刺治疗脑卒中构音障碍的临床研究[J].内科, 2012, 7(4):336-338.
[23]曾学清,滕东时,杨涛,等.针刺配合康复训练治疗脑梗塞后构音障碍30例[J].针灸临床杂志, 2005, 21(10):9-10.
[24]汪洁.构音障碍综合性评价量表的编制[J].中国康复医学杂志, 1998, 13(6):3-5.
[25]缪鸿石.康复医学理论与实践[M].上海:科学技术出版社,2000:421-425.
[26]高维滨.神经病针灸新疗法[M].北京:人民卫生出版社, 2002:422, 436.
[27]李胜利.构音障碍的评定与康复治疗[J].中国听力语言康复科学杂志, 2009, 32(1):8-12.
[28]李胜利,张庆苏.构音障碍的发音、言语表现与治疗[J].中国康复理论与实践, 2003, 9(1):62-64.
[29]何维佳,李胜利.运动性构音障碍言语声学水平客观评价的研究进展[J].中国康复理论与实践, 2010, 16(2):118-120.
[30]段林茹,郑洁皎,陈秀恩,等.构音障碍治疗的研究进展[J].中国康复, 2015, 30(3):229-232.
[31]王红,陈卓铭.脑卒中后遗构音障碍的诊断与治疗[J].新医学,2006, 37(11):717-719.
[32]于国华,吴芬,李俊.综合语言康复治疗对运动性构音障碍的疗效[J].实用临床医学, 2015, 16(5):61-64.
[33]夏娣文,佘江健,邹碧花,等.脑卒中患者痉挛性构音障碍的言语评定和治疗[J].中国民康医学, 2007, 19(8):615-616.
[34]陈虹静,胡卡明.脑卒中后构音障碍各评定方法浅析[J].湖南中医杂志, 2012, 28(6):126-129.
[35]丘卫红.构音障碍的评价及语言治疗[J].中国临床康复,2004,8(28):6155-6157.
[36]李欢.构音障碍评估研究述评[J].中国特殊教育,2010,15(6):59-64.
[37]汪洁.构音障碍的功能性评价[J].中国康复,1999,14(2):111-113.
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