通窍活血汤合星香散化裁联合“通督开窍”针法治疗痰瘀互结证脑梗死后吞咽障碍患者的临床疗效
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摘要
目的观察通窍活血汤合星香散化裁联合"通督开窍"针法治疗痰瘀互结证脑梗死后吞咽障碍患者的临床疗效。方法选取2015年4月—2018年10月苏州市第七人民医院和苏州高新区人民医院收治的痰瘀互结证脑梗死后吞咽障碍患者106例,采用随机数字表法分为对照组和观察组,每组53例。对照组患者在常规治疗基础上进行吞咽功能训练,观察组患者在对照组基础上给予通窍活血汤合星香散化裁联合"通督开窍"针法治疗;两组患者均连续干预4周。比较两组患者临床疗效,干预前后吞咽造影检查(VFSS)评分、洼田饮水试验分级、标准吞咽功能评价量表(SSA)评分、美国国立卫生研究院卒中量表(NIHSS)评分及吞咽障碍特异性生活质量量表(SWAL-QOL)评分;观察两组患者干预期间并发症/不良反应发生情况。结果 (1)观察组患者临床疗效优于对照组(P<0.05)。(2)两组患者干预前VFSS评分、洼田饮水试验分级及SSA评分比较,差异无统计学意义(P>0.05);观察组患者干预后VFSS评分高于对照组,洼田饮水试验分级优于对照组,SSA评分低于对照组(P<0.05)。(3)两组患者干预前NIHSS评分、SWAL-QOL评分比较,差异无统计学意义(P>0.05);观察组患者干预后NIHSS评分低于对照组,SWAL-QOL评分高于对照组(P<0.05)。(4)观察组患者干预期间并发症发生率低于对照组(P<0.05)。两组患者干预期间均未发生明显不良反应。结论通窍活血汤合星香散化裁联合"通督开窍"针法治疗痰瘀互结证脑梗死后吞咽障碍的临床疗效确切,能有效改善患者吞咽功能、神经功能,提高患者生活质量,降低并发症发生风险,且安全性较高。
Objective To observe the clinical effect of modified Tongqiao-Huoxue decoction and Xingxiang powder combined with "Tongdu-Kaiqiao" acupuncture therapy on dysphagia after cerebral infarction differed as phlegm and blood stasis syndrome. Methods A total of 106 patients with dysphagia after cerebral infarction differed as phlegm and blood stasis syndrome were selected in the Seventh People's Hospital of Suzhou and the People's Hospital of Suzhou High-tech Zone from April 2015 to October 2018,and they were divided into control group and observation group according to random number table method,each with 53 cases. Patients in control group were given swallowing function training based on conventional treatment,while patients in the observation group were treated with modified Tongqiao-Huoxue decoction and Xingxiang powder combined with "Tongdu-Kaiqiao" acupuncture therapy based on that of control group;both groups continuously intervened for 4 weeks. Clinical effect,Video Floroscopic Swallowing Study(VFSS)score,Water swallow test grading,Standard Swallowing Assessment(SSA)score,National Institutes of Health Stroke Scale(NIHSS)score and Swallowing Quality of Life(SWAL-QOL)score before and after intervention were compared between two groups,and incidence of complications/adverse reactions was observed during intervention. Results(1)Clinical effect in observation group was statistically significantly better than that in control group(P<0.05).(2)There was no statistically significant difference of VFSS score,Water swallow test grading or SSA score was found between the two groups before intervention(P>0.05);after intervention,VFSS score in observation group was statistically significantly higher than that in control group,Water swallow test grading in observation group was statistically significantly better than that in control group,while SSA score in observation group was statistically significantly lower than that in control group(P<0.05).(3)There was no statistically significant difference of NIHSS score or SWAL-QOL score between the two groups before intervention(P>0.05);after intervention,NIHSS score in observation group was statistically significantly lower than that in control group,while SWAL-QOL score in observation group was statistically significantly higher than that in control group(P<0.05).(4)Incidence of complications in observation group was statistically significantly lower than that in control group(P<0.05).No one in the two groups occurred any obvious adverse reactions during intervention. Conclusion Modified Tongqiao-Huoxue decoction and Xingxiang powder combined with "Tongdu-Kaiqiao" acupuncture therapy has certain clinical effect in treating dysphagia after cerebral infarction differed as phlegm and blood stasis syndrome,which can effectively improve the swallowing function,neurological function and quality of life,reduce the risk of complications,with relatively high safety.
Objective To observe the clinical effect of modified Tongqiao-Huoxue decoction and Xingxiang powder combined with "Tongdu-Kaiqiao" acupuncture therapy on dysphagia after cerebral infarction differed as phlegm and blood stasis syndrome. Methods A total of 106 patients with dysphagia after cerebral infarction differed as phlegm and blood stasis syndrome were selected in the Seventh People's Hospital of Suzhou and the People's Hospital of Suzhou High-tech Zone from April 2015 to October 2018,and they were divided into control group and observation group according to random number table method,each with 53 cases. Patients in control group were given swallowing function training based on conventional treatment,while patients in the observation group were treated with modified Tongqiao-Huoxue decoction and Xingxiang powder combined with "Tongdu-Kaiqiao" acupuncture therapy based on that of control group;both groups continuously intervened for 4 weeks. Clinical effect,Video Floroscopic Swallowing Study(VFSS)score,Water swallow test grading,Standard Swallowing Assessment(SSA)score,National Institutes of Health Stroke Scale(NIHSS)score and Swallowing Quality of Life(SWAL-QOL)score before and after intervention were compared between two groups,and incidence of complications/adverse reactions was observed during intervention. Results(1)Clinical effect in observation group was statistically significantly better than that in control group(P<0.05).(2)There was no statistically significant difference of VFSS score,Water swallow test grading or SSA score was found between the two groups before intervention(P>0.05);after intervention,VFSS score in observation group was statistically significantly higher than that in control group,Water swallow test grading in observation group was statistically significantly better than that in control group,while SSA score in observation group was statistically significantly lower than that in control group(P<0.05).(3)There was no statistically significant difference of NIHSS score or SWAL-QOL score between the two groups before intervention(P>0.05);after intervention,NIHSS score in observation group was statistically significantly lower than that in control group,while SWAL-QOL score in observation group was statistically significantly higher than that in control group(P<0.05).(4)Incidence of complications in observation group was statistically significantly lower than that in control group(P<0.05).No one in the two groups occurred any obvious adverse reactions during intervention. Conclusion Modified Tongqiao-Huoxue decoction and Xingxiang powder combined with "Tongdu-Kaiqiao" acupuncture therapy has certain clinical effect in treating dysphagia after cerebral infarction differed as phlegm and blood stasis syndrome,which can effectively improve the swallowing function,neurological function and quality of life,reduce the risk of complications,with relatively high safety.
引文
[1]包芳,陈可.针刺结合吞咽功能训练对脑卒中后吞咽功能障碍的干预作用研究[J].湖北中医药大学学报,2018,20(6):87-90.
[2]CHANG M C,KWAK S G,CHUN M H.Dysphagia in patients with isolated pontine infarction[J].Neural Regen Res,2018,13(12):2156-2159.DOI:10.4103/1673-5374.241466.
[3]HELLDéN J,BERGSTR?M L,KARLSSON S.Experiences of living with persisting post-stroke dysphagia and of dysphagia management-a qualitative study[J].Int J Qual Stud Health Well-being,2018,13(sup1):1522194.DOI:10.1080/17482631.2018.1522194.
[4]KOYAMA Y,SUGIMOTO A,HAMANO T,et al.Proposal for a modified jaw opening exercise for dysphagia:A randomized,controlled trial[J].Tokai J Exp Clin Med,2017,42(2):71-78.
[5]胡建芳,余志辉,毕小丽,等.局部针刺合药棒冰刺激治疗对卒中后吞咽障碍患者脑血流量的影响[J].针灸临床杂志,2018,34(12):10-13.
[6]中华神经科学会.各类脑血管疾病诊断要点[J].中华神经科杂志,1996,29(6):379-380.
[7]郑筱萸.中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社,2002:236.
[8]尚克中,程英升.吞咽障碍诊疗学[M].北京:人民卫生出版社,2005:5-28.
[9]中华神经科学会,中华神经外科学会.脑卒中患者临床神经功能缺损程度评分标准[J].中华神经科杂志,1996,29(6):381-383.
[10]MCHORNEY C A,ROBBINS J,LOMAX K,et al. The SWALQOL and SWAL-CARE outcomes tool for oropharyngeal dysphagia in adults:Ⅲ.Documentation of reliability and validity[J].Dysphagia,2002,17(2):97-114. DOI:10.1007/s00455-001-0109-1.
[11]李军,李毓新,吉智.综合康复训练对老年吞咽障碍患者并发症及康复效果的影响[J].中国老年学杂志,2018,38(22):5498-5499.DOI:10.3969/j.issn.1005-9202.2018.22.049.
[12]袁英,汪洁,黄小波,等.吞咽功能的中枢及周围神经调控机制[J].中国康复医学杂志,2018,33(12):1479-1482.DOI:10.3969/j.issn.1001-1242.2018.12.023.
[13]薛利圆,郭英平,韦玲,等.针刺治疗中风后吞咽障碍研究进展[J].中医药临床杂志,2018,30(12):2178-2181.DOI:10.16448/j.cjtcm.2018.0668.
[14]M A R I A NT, S C H R?D E RJB, M U H L EP, e ta l.Pharyngolaryngeal sensory deficits in patients with middle cerebral artery infarction:lateralization and relation to overall dysphagia severity[J].Cerebrovasc Dis Extra,2017,7(3):130-139.DOI:10.1159/000479483.
[15]MO S J,JEONG H J,HAN Y H,et al.association of brain lesions and videofluoroscopic dysphagia scale parameters on patients with acute cerebral infarctions[J].Ann Rehabil Med,2018,42(4):560-568.DOI:10.5535/arm.2018.42.4.560.
[16]王志杰,杨敏,海妮,等.舌三针结合头颈部控制训练治疗脑卒中后吞咽障碍的疗效观察[J].中国中医急症,2019,28(1):116-119.DOI:10.3969/j.issn.1004-745X.2019.01.034.
[17]郭英平,薛利圆,韦玲,等.针刺配合现代康复医学治疗中风后吞咽障碍研究概况[J].中医药临床杂志,2019,31(1):30-33.DOI:10.16448/j.cjtcm.2019.0010.
[18]梁碧莹,唐强,朱路文,等.脑卒中后吞咽障碍临床治疗进展[J].山东中医杂志,2018,37(11):968-970.
[19]刘军兵,陈蓉,任胜洪.针灸配合中医定向透药疗法对缺血性脑卒中患者肢体功能恢复及高凝状态的影响[J].现代中西医结合杂志,2018,27(19):2129-2133.
[20]常红恩,郑娜,安红伟,等.通窍活血汤对大鼠脑缺血再灌注损伤后血清中TNF-α及IL-6水平的影响[J].成都中医药大学学报,2018,41(3):18-20,103.
[21]舒内华,李冬松.通窍活血汤对颅脑损伤模型大鼠海马CA1区超微结构及神经元修复与突触重塑影响[J].四川中医,2018,36(11):32-35.
[22]周峻,谭明生.哑门穴古今研究进展[J].中华中医药杂志,2018,33(12):5532-5534.
[23]廖柏丹,柳元娥,彭宣军,等.廉泉穴不同针刺深度治疗中风后吞咽障碍疗效观察[J].上海针灸杂志,2018,37(8):856-859.DOI:10.13460/j.issn.1005-0957.2018.08.0856.
[24]杨圣洁,高瑞骏,卢岩.针灸治疗脑卒中后吞咽障碍用穴规律研究[J].中国中医急症,2018,27(6):979-981,999.
[2]CHANG M C,KWAK S G,CHUN M H.Dysphagia in patients with isolated pontine infarction[J].Neural Regen Res,2018,13(12):2156-2159.DOI:10.4103/1673-5374.241466.
[3]HELLDéN J,BERGSTR?M L,KARLSSON S.Experiences of living with persisting post-stroke dysphagia and of dysphagia management-a qualitative study[J].Int J Qual Stud Health Well-being,2018,13(sup1):1522194.DOI:10.1080/17482631.2018.1522194.
[4]KOYAMA Y,SUGIMOTO A,HAMANO T,et al.Proposal for a modified jaw opening exercise for dysphagia:A randomized,controlled trial[J].Tokai J Exp Clin Med,2017,42(2):71-78.
[5]胡建芳,余志辉,毕小丽,等.局部针刺合药棒冰刺激治疗对卒中后吞咽障碍患者脑血流量的影响[J].针灸临床杂志,2018,34(12):10-13.
[6]中华神经科学会.各类脑血管疾病诊断要点[J].中华神经科杂志,1996,29(6):379-380.
[7]郑筱萸.中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社,2002:236.
[8]尚克中,程英升.吞咽障碍诊疗学[M].北京:人民卫生出版社,2005:5-28.
[9]中华神经科学会,中华神经外科学会.脑卒中患者临床神经功能缺损程度评分标准[J].中华神经科杂志,1996,29(6):381-383.
[10]MCHORNEY C A,ROBBINS J,LOMAX K,et al. The SWALQOL and SWAL-CARE outcomes tool for oropharyngeal dysphagia in adults:Ⅲ.Documentation of reliability and validity[J].Dysphagia,2002,17(2):97-114. DOI:10.1007/s00455-001-0109-1.
[11]李军,李毓新,吉智.综合康复训练对老年吞咽障碍患者并发症及康复效果的影响[J].中国老年学杂志,2018,38(22):5498-5499.DOI:10.3969/j.issn.1005-9202.2018.22.049.
[12]袁英,汪洁,黄小波,等.吞咽功能的中枢及周围神经调控机制[J].中国康复医学杂志,2018,33(12):1479-1482.DOI:10.3969/j.issn.1001-1242.2018.12.023.
[13]薛利圆,郭英平,韦玲,等.针刺治疗中风后吞咽障碍研究进展[J].中医药临床杂志,2018,30(12):2178-2181.DOI:10.16448/j.cjtcm.2018.0668.
[14]M A R I A NT, S C H R?D E RJB, M U H L EP, e ta l.Pharyngolaryngeal sensory deficits in patients with middle cerebral artery infarction:lateralization and relation to overall dysphagia severity[J].Cerebrovasc Dis Extra,2017,7(3):130-139.DOI:10.1159/000479483.
[15]MO S J,JEONG H J,HAN Y H,et al.association of brain lesions and videofluoroscopic dysphagia scale parameters on patients with acute cerebral infarctions[J].Ann Rehabil Med,2018,42(4):560-568.DOI:10.5535/arm.2018.42.4.560.
[16]王志杰,杨敏,海妮,等.舌三针结合头颈部控制训练治疗脑卒中后吞咽障碍的疗效观察[J].中国中医急症,2019,28(1):116-119.DOI:10.3969/j.issn.1004-745X.2019.01.034.
[17]郭英平,薛利圆,韦玲,等.针刺配合现代康复医学治疗中风后吞咽障碍研究概况[J].中医药临床杂志,2019,31(1):30-33.DOI:10.16448/j.cjtcm.2019.0010.
[18]梁碧莹,唐强,朱路文,等.脑卒中后吞咽障碍临床治疗进展[J].山东中医杂志,2018,37(11):968-970.
[19]刘军兵,陈蓉,任胜洪.针灸配合中医定向透药疗法对缺血性脑卒中患者肢体功能恢复及高凝状态的影响[J].现代中西医结合杂志,2018,27(19):2129-2133.
[20]常红恩,郑娜,安红伟,等.通窍活血汤对大鼠脑缺血再灌注损伤后血清中TNF-α及IL-6水平的影响[J].成都中医药大学学报,2018,41(3):18-20,103.
[21]舒内华,李冬松.通窍活血汤对颅脑损伤模型大鼠海马CA1区超微结构及神经元修复与突触重塑影响[J].四川中医,2018,36(11):32-35.
[22]周峻,谭明生.哑门穴古今研究进展[J].中华中医药杂志,2018,33(12):5532-5534.
[23]廖柏丹,柳元娥,彭宣军,等.廉泉穴不同针刺深度治疗中风后吞咽障碍疗效观察[J].上海针灸杂志,2018,37(8):856-859.DOI:10.13460/j.issn.1005-0957.2018.08.0856.
[24]杨圣洁,高瑞骏,卢岩.针灸治疗脑卒中后吞咽障碍用穴规律研究[J].中国中医急症,2018,27(6):979-981,999.