醒脑开窍针结合神经肌肉电刺激对脑卒中后吞咽障碍患者的疗效
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摘要
目的:探讨醒脑开窍针结合神经肌肉电刺激对脑卒中后吞咽障碍患者的疗效。方法:选择2015年6月至2017年1月我院收治的96例脑卒中后吞咽障碍患者为研究对象。患者被随机均分为电刺激组(在常规治疗基础上接受神经肌肉电刺激治疗)和联合治疗组(在电刺激组基础上加用醒脑开窍针治疗),两组均连续治疗6周。观察比较两组治疗前后吞咽障碍特异性生活质量量表(SWAL-QOL)评分、表面肌电信号(sEMG)最大波幅和洼田饮水试验分级。结果:与治疗前比较,治疗后两组SWAL-QOL评分和sEMG最大波幅均显著升高,洼田饮水试验分级均显著降低,P均=0.001。与电刺激组比较,联合治疗组治疗后SWAL-QOL评分[(154.67±26.82)分比(198.73±32.55)分]和sEMG最大波幅[(718.56±86.71)μV比(979.82±85.42)μV]升高更显著,洼田饮水试验分级[(2.82±0.71)级比(1.62±0.45)级]降低更显著,P均=0.001。结论:醒脑开窍针治疗结合神经肌肉电刺激治疗脑卒中后吞咽障碍患者,治疗效果显著优于单纯神经肌肉电刺激治疗,值得临床推广。
Objective:To explore therapeutic effect of Xingnaokaiqiao acupuncture combined neuromuscular electrical stimulation on patients with dysphagia after stroke.Methods:A total of 96 patients with dysphagia after stroke,who were treated in our hospital from Jun 2015 to Jan 2017,were selected.Patients were randomly and equally divided into electrical stimulation group(ES group,received neuromuscular electrical stimulation based on routine treatment)and combined treatment group(received additional Xingnaokaiqiao acupuncture based on ES group),both groups were continuously treated for six weeks.Score of swallow quality of life questionnaire(SWAL-QOL),maximal amplitude of surface electromyography(sEMG)and grade of Kubota's drinking test were observed and compared between two groups before and after treatment.Results:Compared with before treatment,there were significant rise in SWAL-QOL score and sEMG maximal amplitude,and significant reduction in Kubota's drinking test grade in two groups after treatment,P=0.001 all.Compared with ES group after treatment,there were significant rise in SWAL-QOL score[(154.67±26.82)scores vs.(198.73±32.55)scores]and sEMG maximal amplitude[(718.56±86.71)μV vs.(979.82±85.42)μV],and significant reduction in Kubota's drinking test grade[(2.82±0.71)grades vs.(1.62±0.45)grades]in combined treatment group,P=0.001 all.Conclusion:Compared with pure neuromuscular electrical stimulation,Xingnaokaiqiao acupuncture combined neuromuscular electrical stimulation possesses significant better therapeutic effect on patients with dysphagia after stroke,which is worth extending.
Objective:To explore therapeutic effect of Xingnaokaiqiao acupuncture combined neuromuscular electrical stimulation on patients with dysphagia after stroke.Methods:A total of 96 patients with dysphagia after stroke,who were treated in our hospital from Jun 2015 to Jan 2017,were selected.Patients were randomly and equally divided into electrical stimulation group(ES group,received neuromuscular electrical stimulation based on routine treatment)and combined treatment group(received additional Xingnaokaiqiao acupuncture based on ES group),both groups were continuously treated for six weeks.Score of swallow quality of life questionnaire(SWAL-QOL),maximal amplitude of surface electromyography(sEMG)and grade of Kubota's drinking test were observed and compared between two groups before and after treatment.Results:Compared with before treatment,there were significant rise in SWAL-QOL score and sEMG maximal amplitude,and significant reduction in Kubota's drinking test grade in two groups after treatment,P=0.001 all.Compared with ES group after treatment,there were significant rise in SWAL-QOL score[(154.67±26.82)scores vs.(198.73±32.55)scores]and sEMG maximal amplitude[(718.56±86.71)μV vs.(979.82±85.42)μV],and significant reduction in Kubota's drinking test grade[(2.82±0.71)grades vs.(1.62±0.45)grades]in combined treatment group,P=0.001 all.Conclusion:Compared with pure neuromuscular electrical stimulation,Xingnaokaiqiao acupuncture combined neuromuscular electrical stimulation possesses significant better therapeutic effect on patients with dysphagia after stroke,which is worth extending.
引文
[1]Marchina S,Schlaug G,Kumar S,et al.Study Design for the Fostering Eating after Stroke with Transcranial Direct Current Stimulation Trial:A Randomized Controlled Intervention for Improving Dysphagia after Acute Ischemic Stroke[J].JStroke Cerebrovasc Dis,2015,24(3):511-520.
[2]中华医学会神经科学分会.各类脑血管疾病诊断要点[J].中华神经科杂志,1996,29(6):379-380.
[3]Hgg MK,Tibbling LI.Effects on facial dysfunction and swallowing capacity of intraoral stimulation early and late after stroke[J].Neuro Rehabilitation,2015,36(1):101-106.
[4]邓行行,吴灿.醒脑开窍针刺法联合Vitalstim吞咽治疗仪治疗脑卒中吞咽障碍临床研究[J].中医学报,2017,32(3):466-469.
[5]李莎.脑卒中后吞咽障碍患者生活质量的相关因素[J].中国康复理论与实践,2016,22(5):563-568.
[6]武文娟,毕霞.表面肌电技术在脑卒中后吞咽障碍评估中的应用进展[J].中国康复医学杂志,2016,31(8):932-934.
[7]武文娟,毕霞,宋磊等.洼田饮水试验在急性脑卒中后吞咽障碍患者中的应用价值[J].上海交通大学学报(医学版),2016,36(7):1049-1053.
[8]Yang SN,Pyun SB,Kim HJ,et al.Effectiveness of Non-invasive Brain Stimulation in Dysphagia Subsequent to Stroke:ASystemic Review and Meta-analysis[J].Dysphagia,2015,30(4):383-391.
[9]Cowey ES,Smith LN,Stott DJ,et al.Impact of a Clin pathway on end-of-life care following stroke:A mixed methods study[J].Palliat Med,2015,29(3):249-259.
[10]Beom J,Oh BM,Choi KH,et al.Effect of Electrical Stimulation of the Suprahyoid Muscles in Brain-Injured Patients with Dysphagia[J].Dysphagia,2015,30(4):423-429.
[11]田野,熊高华,胡可慧,等.肌电生物反馈疗法联合神经肌肉电刺激对脑卒中后吞咽障碍患者吞咽功能及营养状况的影响[J].中国康复,2016,31(6):430-433.
[12]徐晓明,段隽丹,杨麟,等.神经肌肉电刺激与酸性刺激治疗急性脑卒中吞咽障碍口腔期的效果[J].中国康复理论与实践,2017,23(2):194-198.
[13]杨涓,冯珍.不同频次神经肌肉电刺激治疗脑卒中后咽期吞咽障碍的疗效观察[J].中华物理医学与康复杂志,2017,39(2):122-126.
[14]吴霜,陈彦,俞育秀,等.肌电生物反馈治疗对脑卒中患者吞咽功能及远期并发症的影响[J].贵州医药,2016,40(10):1040-1043.
[15]周惠婷,邵宇祺,江仁荣,等.DPNS冰刺激疗法联合针灸治疗脑卒中后吞咽障碍患者的疗效观察[J].浙江临床医学,2016,18(6):1075-1076.
[16]储瑾,唐军,姚红霞,等.中风复元方联合针灸治疗脑卒中吞咽障碍的临床观察[J].湖北中医药大学学报,2016,18(5):85-87.
[17]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.
[18]刘喜悦.针灸与吞咽训练治疗脑卒中后吞咽障碍的临床观察[J].中国中医急症,2017,26(1):170-172.
[19]赵亚伟.醒脑开窍针刺法治疗中风病研究进展[J].现代中西医结合杂志,2016,25(8):907-910.
[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]萧言菘,杜健茹,章娟娟.传统针刺法与深刺法对老年中风后吞咽障碍的临床疗效评价[J].中国医药导报,2016,13(10):76-79.
[2]中华医学会神经科学分会.各类脑血管疾病诊断要点[J].中华神经科杂志,1996,29(6):379-380.
[3]Hgg MK,Tibbling LI.Effects on facial dysfunction and swallowing capacity of intraoral stimulation early and late after stroke[J].Neuro Rehabilitation,2015,36(1):101-106.
[4]邓行行,吴灿.醒脑开窍针刺法联合Vitalstim吞咽治疗仪治疗脑卒中吞咽障碍临床研究[J].中医学报,2017,32(3):466-469.
[5]李莎.脑卒中后吞咽障碍患者生活质量的相关因素[J].中国康复理论与实践,2016,22(5):563-568.
[6]武文娟,毕霞.表面肌电技术在脑卒中后吞咽障碍评估中的应用进展[J].中国康复医学杂志,2016,31(8):932-934.
[7]武文娟,毕霞,宋磊等.洼田饮水试验在急性脑卒中后吞咽障碍患者中的应用价值[J].上海交通大学学报(医学版),2016,36(7):1049-1053.
[8]Yang SN,Pyun SB,Kim HJ,et al.Effectiveness of Non-invasive Brain Stimulation in Dysphagia Subsequent to Stroke:ASystemic Review and Meta-analysis[J].Dysphagia,2015,30(4):383-391.
[9]Cowey ES,Smith LN,Stott DJ,et al.Impact of a Clin pathway on end-of-life care following stroke:A mixed methods study[J].Palliat Med,2015,29(3):249-259.
[10]Beom J,Oh BM,Choi KH,et al.Effect of Electrical Stimulation of the Suprahyoid Muscles in Brain-Injured Patients with Dysphagia[J].Dysphagia,2015,30(4):423-429.
[11]田野,熊高华,胡可慧,等.肌电生物反馈疗法联合神经肌肉电刺激对脑卒中后吞咽障碍患者吞咽功能及营养状况的影响[J].中国康复,2016,31(6):430-433.
[12]徐晓明,段隽丹,杨麟,等.神经肌肉电刺激与酸性刺激治疗急性脑卒中吞咽障碍口腔期的效果[J].中国康复理论与实践,2017,23(2):194-198.
[13]杨涓,冯珍.不同频次神经肌肉电刺激治疗脑卒中后咽期吞咽障碍的疗效观察[J].中华物理医学与康复杂志,2017,39(2):122-126.
[14]吴霜,陈彦,俞育秀,等.肌电生物反馈治疗对脑卒中患者吞咽功能及远期并发症的影响[J].贵州医药,2016,40(10):1040-1043.
[15]周惠婷,邵宇祺,江仁荣,等.DPNS冰刺激疗法联合针灸治疗脑卒中后吞咽障碍患者的疗效观察[J].浙江临床医学,2016,18(6):1075-1076.
[16]储瑾,唐军,姚红霞,等.中风复元方联合针灸治疗脑卒中吞咽障碍的临床观察[J].湖北中医药大学学报,2016,18(5):85-87.
[17]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.
[18]刘喜悦.针灸与吞咽训练治疗脑卒中后吞咽障碍的临床观察[J].中国中医急症,2017,26(1):170-172.
[19]赵亚伟.醒脑开窍针刺法治疗中风病研究进展[J].现代中西医结合杂志,2016,25(8):907-910.
[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]萧言菘,杜健茹,章娟娟.传统针刺法与深刺法对老年中风后吞咽障碍的临床疗效评价[J].中国医药导报,2016,13(10):76-79.