针灸联合会厌通络汤治疗缺血性脑卒中后假性延髓麻痹吞咽困难的疗效观察
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摘要
目的:探讨针灸联合会厌通络汤治疗缺血性脑卒中后假性延髓麻痹吞咽困难的临床疗效及对患者误吸发生风险的影响。方法:选取2015年7月至2017年6月中国人民解放军联勤保障部队第九八二医院收治的缺血性脑卒中后假性延髓麻痹吞咽困难患者100例,采用随机数字表法分为对照组50例和观察组50例。对照组患者给予常规治疗(包括抗血小板、降血脂及营养脑神经等),观察组患者在对照组的基础上加用针灸及会厌通络汤,两组患者均治疗4周。观察两组患者的临床疗效、洼田饮水试验评分;动态评价皇家布里斯班医院吞咽功能评定表(the royal brisbane hospital outcome measure for swallowing,RBHOMS)评分变化情况;于治疗后随访6个月,比较两组患者误吸发生风险的差异。结果:治疗4周后,观察组患者的总有效率为92.0%(46/50),明显高于对照组的70.0%(35/50),差异有统计学意义(P<0.05)。治疗后,观察组患者洼田饮水试验评分为(1.52±1.28)分,明显低于对照组的(2.61±1.43)分,差异有统计学意义(P<0.05)。随着治疗时间的延长,观察组患者RBHOMS评分逐渐升高;治疗4周后,观察组患者RBHOMS评分明显高于治疗前,差异有统计学意义(P<0.05)。治疗4周后随访6个月,观察组患者误吸发生率为12.0%(6/50),明显低于对照组的34.0%(17/50),差异有统计学意义(P<0.05)。结论:针灸联合会厌通络汤治疗缺血性脑卒中后假性延髓麻痹吞咽困难的疗效确切,可提高患者吞咽功能,降低误吸发生风险。
OBJECTIVE: To investigate the efficacy of acupuncture and moxibustion combined with epiglottis and tongluo decoction in treatment of dysphagia caused by pseudobulbar paralysis after ischemic stroke. METHODS: 100 patients with dysphagia caused by pseudobulbar paralysis after ischemic stroke admitted into 982 Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army from Jul. 2015 to Jun. 2017 were extracted to be divided into the control group and the observation group via the random number table, with 50 cases in each group. Patients in the control group were given routine treatment after stroke, including anti-platelet, blood lipid-lowering and nourishing cerebral nerve, while the observation group received acupuncture and moxibustion combined with epiglottis and tongluo decoction on the basis of the control group. Both groups were treated for 4 weeks. The clinical efficacy and the Watian drinking water test score of two groups were observed. Changes in the royal brisbane hospital outcome measure for swallowing(RBHOMS) scores were dynamically evaluated. The follow-up was last for 6 months, differences in the risk of aspiration were compared between two groups. RESULTS: After treatment of 4 weeks, the total effective rate in the observation group was 92.0%(46/50), significantly higher than that in the control group 70.0%(35/50), with statistically significant difference(P<0.05). After treatment, the Watian drinking water test score of the observation group was(1.52±1.28) points, which was significantly lower than that of the control group(2.61±1.43) points, and the difference was statistically significant(P<0.05). With the prolonged treatment time, the RBHOMS score of the observation group increased. After 4 weeks of treatment, the RBHOMS score of the observation group was significantly higher than that before treatment,with statistically significant difference(P<0.05). After 6 months of follow-up, and the risk of aspiration rate was 12.0%(6/50), significantly lower than that of the control group 34.0%(17/50), the difference was statistically significant(P<0.05). CONCLUSIONS: The efficacy of acupuncture and moxibustion combined with epiglottis and tongluo decoction in treatment of dysphagia caused by pseudobulbar paralysis after ischemic stroke is remarkable, which can improve the swallowing function of patients and reduce the risk of aspiration.
OBJECTIVE: To investigate the efficacy of acupuncture and moxibustion combined with epiglottis and tongluo decoction in treatment of dysphagia caused by pseudobulbar paralysis after ischemic stroke. METHODS: 100 patients with dysphagia caused by pseudobulbar paralysis after ischemic stroke admitted into 982 Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army from Jul. 2015 to Jun. 2017 were extracted to be divided into the control group and the observation group via the random number table, with 50 cases in each group. Patients in the control group were given routine treatment after stroke, including anti-platelet, blood lipid-lowering and nourishing cerebral nerve, while the observation group received acupuncture and moxibustion combined with epiglottis and tongluo decoction on the basis of the control group. Both groups were treated for 4 weeks. The clinical efficacy and the Watian drinking water test score of two groups were observed. Changes in the royal brisbane hospital outcome measure for swallowing(RBHOMS) scores were dynamically evaluated. The follow-up was last for 6 months, differences in the risk of aspiration were compared between two groups. RESULTS: After treatment of 4 weeks, the total effective rate in the observation group was 92.0%(46/50), significantly higher than that in the control group 70.0%(35/50), with statistically significant difference(P<0.05). After treatment, the Watian drinking water test score of the observation group was(1.52±1.28) points, which was significantly lower than that of the control group(2.61±1.43) points, and the difference was statistically significant(P<0.05). With the prolonged treatment time, the RBHOMS score of the observation group increased. After 4 weeks of treatment, the RBHOMS score of the observation group was significantly higher than that before treatment,with statistically significant difference(P<0.05). After 6 months of follow-up, and the risk of aspiration rate was 12.0%(6/50), significantly lower than that of the control group 34.0%(17/50), the difference was statistically significant(P<0.05). CONCLUSIONS: The efficacy of acupuncture and moxibustion combined with epiglottis and tongluo decoction in treatment of dysphagia caused by pseudobulbar paralysis after ischemic stroke is remarkable, which can improve the swallowing function of patients and reduce the risk of aspiration.
引文
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[12] 常兴,张恬,孟庆岩,等.从《灵枢》探析五脏“司外揣内”思维[J].辽宁中医杂志,2018,45(6):1193-1195.
[13] 李成文,潘思安,卢享君,等.《铜人腧穴针灸图经》针灸学术思想探析[J].中医药学报,2015,43(1):84-86.
[14] 任玉兰,李戎.《铜人腧穴针灸图经》腧穴归经探析[J].江苏中医药,2006,27(5):45-47.
[15] 李鞍英.针刺五泉穴联合穴位按摩治疗卒中后吞咽困难并发肺感染疗效观察[J].中国中医急症,2016,25(9):1783-1785.
[16] 于川,申斌,许世闻.针灸治疗脑卒中后吞咽困难的系统评价[J].上海针灸杂志,2016,35(9):1126-1129.
[17] 董进友,韩淑凯,张宝昌,等.补气化痰通络法配合口针治疗脑血管意外假性球麻痹临床观察[J].中国中医急症,2010,19(3):405-406.
[2] 田翻花,田荷花,李静文,等.脑卒中伴吞咽困难患者应用鼻胃管与鼻肠管营养支持的对比研究[J].内蒙古医学杂志,2013,(12):1506-1508.
[3] 王军华.改良留置胃管在急性脑卒中伴吞咽困难患者中的应用[J].齐鲁护理杂志,2013,19(6):103-104.
[4] Oz Tuncer G,Teber S,Kutluk MG,et al.Hashimoto's encep-halopathy presenting as pseudobulbar palsy[J].Childs Nerv Syst,2018,34(6):1251-1254.
[5] Chan YT,Zhang HW,Guo YQ,et al.Effectiveness and Safety of Acupuncture for Poststroke Dysphagia:Study Protocol for a Prag-matic Multicenter Nonrandomized Controlled Trial[J].Evid Based Complement Alternat Med,2017,2017:2349794.
[6] Li X,Wu L,Guo F,et al.Quick needle insertion at pharyngeal acupoints for poststroke dysphagia:A case report[J].Medicine (Baltimore),2017,96(50):e9299.
[7] 鲁跃英.早期针刺治疗卒中后假性球麻痹41例[J].中国中医急症,2012,21(3):462-463.
[8] Zalyalova ZA.Salivation after stroke[J].Zh Nevrol Psikhiatr Im S S Korsakova,2017,117(1):85-89.
[9] Arena JE,Weigand SD,Whitwell JL,et al.Progressive supranuclear palsy:progression and survival[J].J Neurol,2016,263(2):380-389.
[10] Wang G,Teng F,Chen Y,et al.Clinical Features and Related Factors of Poststroke Pathological Laughing and Crying:A Case-Control Study[J].J Stroke Cerebrovasc Dis,2016,25(3):556-564.
[11] 张惠利,朱立春,王文刚,等.针刺治疗中风后假性球麻痹的现代文献回顾性研究[J].中国中医急症,2013,22(3):369-372.
[12] 常兴,张恬,孟庆岩,等.从《灵枢》探析五脏“司外揣内”思维[J].辽宁中医杂志,2018,45(6):1193-1195.
[13] 李成文,潘思安,卢享君,等.《铜人腧穴针灸图经》针灸学术思想探析[J].中医药学报,2015,43(1):84-86.
[14] 任玉兰,李戎.《铜人腧穴针灸图经》腧穴归经探析[J].江苏中医药,2006,27(5):45-47.
[15] 李鞍英.针刺五泉穴联合穴位按摩治疗卒中后吞咽困难并发肺感染疗效观察[J].中国中医急症,2016,25(9):1783-1785.
[16] 于川,申斌,许世闻.针灸治疗脑卒中后吞咽困难的系统评价[J].上海针灸杂志,2016,35(9):1126-1129.
[17] 董进友,韩淑凯,张宝昌,等.补气化痰通络法配合口针治疗脑血管意外假性球麻痹临床观察[J].中国中医急症,2010,19(3):405-406.