深刺廉泉与翳风穴对脑卒中后吞咽障碍的影响
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摘要
目的:观察针刺对脑卒中后吞咽障碍的影响。方法:将104例脑卒中后吞咽障碍患者随机分为试验组与对照组,每组52例。对照组患者给予常规吞咽康复训练,每日1次,每周6d,连续治疗4周。试验组患者在对照组基础上配合深刺廉泉穴与翳风穴结合常规针刺治疗,每日1次,每周6d,连续治疗4周。治疗前后对两组患者进行标准吞咽功能评定法(SSA)、洼田饮水试验检测,并进行临床疗效及不良反应情况综合评价。结果:与治疗前比较,两组治疗后SSA评分均降低(P<0.05);试验组治疗后SSA评分明显低于对照组(P<0.05)。治疗后,两组患者洼田饮水试验吞咽能力较治疗前均有提高(P<0.05);试验组治疗后洼田饮水试验吞咽能力提高程度优于对照组(P<0.05)。治疗后试验组(46/52,88.46%)综合疗效的总有效率高于对照组(32/52,61.54%,P<0.05)。试验组不良反应总发生率为9.62%(5/52),对照组不良反应总发生率为11.54%(6/52),两组差异无统计学意义(P>0.05)。结论:深刺廉泉穴与翳风穴基础上结合常规针刺治疗可以改善脑卒中后吞咽障碍患者的舌咽功能,协调吞咽肌肉,重建吞咽功能,不良反应发生较少。
Objective To observe the therapeutic effect of acupuncture therapy in the treatment of dysphagia in apoplexy patients.Methods A total of 104 patients with post-stroke dysphagia were randomized into a control(conventional swallowing rehabilitation training)group and an acupuncture group(n=52 cases in each one).In the control group,the conventional swallowing rehabilitation training was conducted,twice daily,6 times a week for 4 weeks.In the acupuncture group,deep needling of main acupoints Lianquan(CV23)and Yifeng(TE17),and conventional acupuncture of adjuvant acupoints as Fengchi(GB20)and Fengfu(GV16),Wangu(GB12),Lieque(LU7),Jinjin(EX-HN12),Yuye(EX-HN13),etc.as well as electroacupuncture stimulation(15-20 Hz,5 mA,and duration of 30 min)of ipsilateral CV23-GV16,TE17-GB20,and bilateral Neidaying acupoints were conducted.The acupuncture treatment was given once daily,6 times a week for consecutive 4 weeks.In addition,patients of the two groups also received routine symptomatic treatment with drugs for anti-platelet aggregation,nourishing cranial nerve,lowering blood pressure,controlling blood glucose,improving cerebral circulation,etc.Before and after the treatment,the standard swallowing assessment(SSA,18-46 points)and Kubota water swallowing test(WST,1-5 grades)were conducted to evaluate the patient's swallowing function.The comprehensive therapeutic effect was assessed in accordance with the SSA and Kubota WST,and adverse reactions were recorded.Results After the treatment,the SSA score was considerably reduced in the two groups relevant to their own pre-treatment(both P<0.05),and was significantly lower in the acupuncture group than in the control group(P<0.05).The Kubota WST grade was evidently increased in the number of patients with gradeⅠ(P<0.05)and reduced in the numbers of patients with gradeⅢ-Ⅴin both groups relevant to their own pre-treatment,and was more patients with gradeⅠin the acupuncture group than in the control group(P<0.05).Outcomes of the comprehensive therapeutic effect indicated that of the two 52 cases in the control and acupuncture groups,8(15.38%)and 19(36.53%)were cured,7(13.46%)and 15(28.45%)had marked improvement,17(32.69%)and 12(23.08%)were effective,and 20(38.46%)and6(11.54%)failed in the treatment,with the effective rate being 61.54% and 88.46%,respectively.The total effective rate of the acupuncture group was significantly higher than that of the control group(P<0.05).The adverse reactions such as regional hematoma(in 3 cases)and pain(in 2 cases)in the acupuncture group,and choking-coughing in the control group were seen,being 9.62% and 11.54%in the incidence rate,respectively.Conclusion Deep needling of main acupoints Lianquan(CV23)and Yifeng(TE 17)in combination with conventional acupuncture of other acupoints is effective in improving local glossopharyngeal function in apoplexy patients with dysphagia,which is obviously superior to conventional swallowing rehabilitation training in the therapeutic effect and is applicable in clinical practice.
Objective To observe the therapeutic effect of acupuncture therapy in the treatment of dysphagia in apoplexy patients.Methods A total of 104 patients with post-stroke dysphagia were randomized into a control(conventional swallowing rehabilitation training)group and an acupuncture group(n=52 cases in each one).In the control group,the conventional swallowing rehabilitation training was conducted,twice daily,6 times a week for 4 weeks.In the acupuncture group,deep needling of main acupoints Lianquan(CV23)and Yifeng(TE17),and conventional acupuncture of adjuvant acupoints as Fengchi(GB20)and Fengfu(GV16),Wangu(GB12),Lieque(LU7),Jinjin(EX-HN12),Yuye(EX-HN13),etc.as well as electroacupuncture stimulation(15-20 Hz,5 mA,and duration of 30 min)of ipsilateral CV23-GV16,TE17-GB20,and bilateral Neidaying acupoints were conducted.The acupuncture treatment was given once daily,6 times a week for consecutive 4 weeks.In addition,patients of the two groups also received routine symptomatic treatment with drugs for anti-platelet aggregation,nourishing cranial nerve,lowering blood pressure,controlling blood glucose,improving cerebral circulation,etc.Before and after the treatment,the standard swallowing assessment(SSA,18-46 points)and Kubota water swallowing test(WST,1-5 grades)were conducted to evaluate the patient's swallowing function.The comprehensive therapeutic effect was assessed in accordance with the SSA and Kubota WST,and adverse reactions were recorded.Results After the treatment,the SSA score was considerably reduced in the two groups relevant to their own pre-treatment(both P<0.05),and was significantly lower in the acupuncture group than in the control group(P<0.05).The Kubota WST grade was evidently increased in the number of patients with gradeⅠ(P<0.05)and reduced in the numbers of patients with gradeⅢ-Ⅴin both groups relevant to their own pre-treatment,and was more patients with gradeⅠin the acupuncture group than in the control group(P<0.05).Outcomes of the comprehensive therapeutic effect indicated that of the two 52 cases in the control and acupuncture groups,8(15.38%)and 19(36.53%)were cured,7(13.46%)and 15(28.45%)had marked improvement,17(32.69%)and 12(23.08%)were effective,and 20(38.46%)and6(11.54%)failed in the treatment,with the effective rate being 61.54% and 88.46%,respectively.The total effective rate of the acupuncture group was significantly higher than that of the control group(P<0.05).The adverse reactions such as regional hematoma(in 3 cases)and pain(in 2 cases)in the acupuncture group,and choking-coughing in the control group were seen,being 9.62% and 11.54%in the incidence rate,respectively.Conclusion Deep needling of main acupoints Lianquan(CV23)and Yifeng(TE 17)in combination with conventional acupuncture of other acupoints is effective in improving local glossopharyngeal function in apoplexy patients with dysphagia,which is obviously superior to conventional swallowing rehabilitation training in the therapeutic effect and is applicable in clinical practice.
引文
[1]王桂碧.针刺结合现代康复医学治疗脑卒中后吞咽障碍的研究进展[J].中西医结合心脑血管病杂志,2016,14(7):733-736.
[2]刘玉梅,陈佳伟,王思连,等.针刺结合功能性电刺激对急性脑卒中后吞咽困难患者吞咽功能的影响[J].现代生物医学进展,2016,16(14):2676-2678.
[3]王伯清,韩桂玲,张咏梅.脑卒中后呃逆中医治疗进展[J].山东中医杂志,2012,31(9):688-690.
[4]中华医学会神经病学分会脑血管病学组急性缺血性脑卒中诊治指南撰写组.中国急性缺血性脑卒中诊治指南2010[J].中国全科医学,2011,14(35):4013-4017.
[5]张生玉,刘哨兵,吴伟,等.Vitalstim穴位电针法联合康复训练治疗脑卒中后吞咽障碍的疗效观察[J].针刺研究,2017,42(2):168-172.
[6]安晓蕾,郭亮军,李彦梅,等.针灸电刺激康复训练结合因时护理模式在脑卒中吞咽障碍患者中的应用效果观察[J].山西医药杂志,2015,44(18):2190-2193.
[7] XIA W,ZHENG C,ZHU S,et al.Does the addition of specific acupuncture to standard swallowing training improve outcomes in patients with dysphagia after stroke?a randomized controlled trial[J].Clinic Rehabilit,2015,30(3):237-246.
[8]张彦明,郭丽荣,石晓娟.针刺治疗吞咽障碍与综合治疗吞咽障碍疗效的对比[J].中国伤残医学,2013,21(11):27-28.
[9]冯声旺,曹淑华,杜淑佳,等.针刺配合吞咽训练治疗脑卒中后吞咽障碍:随机对照研究[J].中国针灸,2016,36(4):347-350.
[10]段雪芳,王海荣.针刺天容穴为主治疗脑卒中后吞咽障碍的疗效观察[J].针灸临床杂志,2016,32(1):29-31.
[11]夏隽晖,许翠娥,夏文广,等.针刺联合康复训练对脑卒中后吞咽障碍的影响[J].湖北中医药大学学报,2015,17(4):88-90.
[12]王娟,李志伟,余雨.电刺激及针灸治疗急性脑卒中后吞咽障碍的疗效分析[J].重庆医科大学学报,2014,39(8):1131-1134.
[13]魏海棠,彭涛,杨丹,等.针灸结合康复训练治疗脑卒中后吞咽困难的临床观察[J].中国中医急症,2015,24(10):1808-1810.
[14] LI C M,WANG T G,LEE H Y,et al.Swallowing training combined with game-based biofeedback in post-stroke dysphagia[J].PM R,2016,8(8):773-779.
[15]张茜,付海燕,刘欢,等.针刺结合神经肌肉电刺激对脑卒中后咽期吞咽障碍的影响[J].中国康复,2016,31(1):39-41.
[16]尹正录,孟兆祥,薛永骥,等.吞咽训练联合针刺和电刺激治疗脑卒中恢复期中重度吞咽障碍的疗效观察[J].中华物理医学与康复杂志,2011,33(12):916-919.
[2]刘玉梅,陈佳伟,王思连,等.针刺结合功能性电刺激对急性脑卒中后吞咽困难患者吞咽功能的影响[J].现代生物医学进展,2016,16(14):2676-2678.
[3]王伯清,韩桂玲,张咏梅.脑卒中后呃逆中医治疗进展[J].山东中医杂志,2012,31(9):688-690.
[4]中华医学会神经病学分会脑血管病学组急性缺血性脑卒中诊治指南撰写组.中国急性缺血性脑卒中诊治指南2010[J].中国全科医学,2011,14(35):4013-4017.
[5]张生玉,刘哨兵,吴伟,等.Vitalstim穴位电针法联合康复训练治疗脑卒中后吞咽障碍的疗效观察[J].针刺研究,2017,42(2):168-172.
[6]安晓蕾,郭亮军,李彦梅,等.针灸电刺激康复训练结合因时护理模式在脑卒中吞咽障碍患者中的应用效果观察[J].山西医药杂志,2015,44(18):2190-2193.
[7] XIA W,ZHENG C,ZHU S,et al.Does the addition of specific acupuncture to standard swallowing training improve outcomes in patients with dysphagia after stroke?a randomized controlled trial[J].Clinic Rehabilit,2015,30(3):237-246.
[8]张彦明,郭丽荣,石晓娟.针刺治疗吞咽障碍与综合治疗吞咽障碍疗效的对比[J].中国伤残医学,2013,21(11):27-28.
[9]冯声旺,曹淑华,杜淑佳,等.针刺配合吞咽训练治疗脑卒中后吞咽障碍:随机对照研究[J].中国针灸,2016,36(4):347-350.
[10]段雪芳,王海荣.针刺天容穴为主治疗脑卒中后吞咽障碍的疗效观察[J].针灸临床杂志,2016,32(1):29-31.
[11]夏隽晖,许翠娥,夏文广,等.针刺联合康复训练对脑卒中后吞咽障碍的影响[J].湖北中医药大学学报,2015,17(4):88-90.
[12]王娟,李志伟,余雨.电刺激及针灸治疗急性脑卒中后吞咽障碍的疗效分析[J].重庆医科大学学报,2014,39(8):1131-1134.
[13]魏海棠,彭涛,杨丹,等.针灸结合康复训练治疗脑卒中后吞咽困难的临床观察[J].中国中医急症,2015,24(10):1808-1810.
[14] LI C M,WANG T G,LEE H Y,et al.Swallowing training combined with game-based biofeedback in post-stroke dysphagia[J].PM R,2016,8(8):773-779.
[15]张茜,付海燕,刘欢,等.针刺结合神经肌肉电刺激对脑卒中后咽期吞咽障碍的影响[J].中国康复,2016,31(1):39-41.
[16]尹正录,孟兆祥,薛永骥,等.吞咽训练联合针刺和电刺激治疗脑卒中恢复期中重度吞咽障碍的疗效观察[J].中华物理医学与康复杂志,2011,33(12):916-919.