通督调神针法联合吞咽训练对缺血性脑卒中吞咽障碍患者的疗效及对脑血流和血清神经营养因子的影响
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摘要
目的:观察通督调神针法联合吞咽训练治疗缺血性脑卒中吞咽障碍的疗效,探讨其作用机制。方法:选择缺血性脑卒中吞咽功能障碍患者100例,按随机数字表法分为对照组和治疗组,每组50例。两组患者均给予缺血性脑卒中常规治疗,在此基础上,对照组进行吞咽训练。治疗组在对照组基础上予通督调神针法,针刺大椎、风府、神庭、神道等穴,1次/d,每周治疗5次,共治疗4周。比较两组患者的洼田饮水试验评分、电视透视吞咽功能检查(VFSS)评分、标准吞咽功能评价量表(SSA)评分、吞咽障碍特异性生活质量量表(SWAL-QOL)评分、临床疗效,及双侧大脑动脉血流最大峰值流速(Vs)、平均流速(Vm)、血管阻力指数(RI)。酶联免疫吸附法检测两组患者治疗前后血清神经营养因子(BDNF、NGF)的含量。结果:和治疗前比较,治疗后两组患者的洼田饮水试验、SSA、SWAL-QOL评分及RI降低,VFSS评分、Vs、Vm以及血清BDNF、NGF含量升高(P<0.01)。治疗组患者的洼田饮水试验、SSA、SWAL-QOL评分及RI低于对照组(P<0.01),VFSS评分、Vs、Vm以及血清BDNF、NGF水平高于对照组(P<0.01)。治疗组总有效率(41/49,83.68%)高于对照组(30/48,62.50%),差异有统计学意义(P<0.05)。结论:通督调神针法联合吞咽训练治疗缺血性脑卒中吞咽障碍的疗效明显,可能与其改善患者的脑血流动力学和神经营养因子水平有关。
Objective To observe the efficacy of Tongdu Tiaoshen(dredging Governor Vessel and regulating mind needling combined with swallowing training in the treatment of ischemic stroke(IS)with dysphagia,and to investigate its effect on cerebral blood flow and serum levels of brain-derived neurotrophic factor(BDNF)and nerve growth factor(NGF).Methods A total of 100 IS inpatients with dysphagia were enrolled in the present study,and randomly and equally divided into control group and treatment group by using a random number table.The patients of the control group received routine swallowing training including tongue extending and retracting,cheek-muscle training,breathing exercise,and laryngopharyngeal exercise,beginning from the 2 nd day after hospitalization.The patients of the treatment group received manual acupuncture stimulation of Dazhui(GV14),Fengfu(GV16),Shenting(GV24),Shendao(GV11),Baihui(GV20),Shuigou(GV26),etc.,on the basic treatment as those mentioned in the control group.The treatment was conducted once daily,5 times per week and for 4 successive weeks.The swallowing ability was tested by using video fluoroscopic swallowing study(VFSS),Kubota water swallowing test,and the standard swallowing function assessment(SSA)scale,separately,and patients' daily life quality was assessed by using swallowing related quality of life questionnaire(SWAL-QOL).The cerebral hemodynamics including mean blood flow velocity(Vm),maximum peak flow speed(Vs),and vascular resistance index(RI)of the bilateral cerebral arteries was detected by transcranial color Doppler ultrasound tests,and serum BDNF and NGF contents were assayed by enzyme linked immunosorbent assay.The therapeutic effect of swallowing ability was evaluated after the treatment.Results After 4 weeks' treatment,the scores of Kubata water swallowing test,SSA,and SWAL-QOL and RI were considerably decreased(P<0.01),and the VFSS scores,Vs and Vm levels as well as serum BDNF and NGF contents were significantly increased(P<0.01)in both groups compared with their own pre-treatment.Of the 48 and 49 cases in the control and treatment groups,4(8.33%)and 8(16.33%)were cured,26(54.17%)and 33(67.35%)effective,18(37.50%)and 8(16.33%)failed,with the effective rate being62.50% and 83.67%,respectively.The therapeutic effect of the treatment group was significantly superior to that of the control group in the effective rate(P<0.05),and in lowering the scores of Kubota water swallowing test,SWAL-QOL,SSA,RI,and in up-regulating the scores of VFSS,Vs and Vm,and serum BDNF and NGF levels(P<0.01).Conclusion Tongdu Tiaoshen needling combined with swallowing training is effective in improving swallowing ability,promoting cerebral blood flow and in up-regulating serum neurotrophic factor levels in patients with dysphagia after ischemic stroke.
Objective To observe the efficacy of Tongdu Tiaoshen(dredging Governor Vessel and regulating mind needling combined with swallowing training in the treatment of ischemic stroke(IS)with dysphagia,and to investigate its effect on cerebral blood flow and serum levels of brain-derived neurotrophic factor(BDNF)and nerve growth factor(NGF).Methods A total of 100 IS inpatients with dysphagia were enrolled in the present study,and randomly and equally divided into control group and treatment group by using a random number table.The patients of the control group received routine swallowing training including tongue extending and retracting,cheek-muscle training,breathing exercise,and laryngopharyngeal exercise,beginning from the 2 nd day after hospitalization.The patients of the treatment group received manual acupuncture stimulation of Dazhui(GV14),Fengfu(GV16),Shenting(GV24),Shendao(GV11),Baihui(GV20),Shuigou(GV26),etc.,on the basic treatment as those mentioned in the control group.The treatment was conducted once daily,5 times per week and for 4 successive weeks.The swallowing ability was tested by using video fluoroscopic swallowing study(VFSS),Kubota water swallowing test,and the standard swallowing function assessment(SSA)scale,separately,and patients' daily life quality was assessed by using swallowing related quality of life questionnaire(SWAL-QOL).The cerebral hemodynamics including mean blood flow velocity(Vm),maximum peak flow speed(Vs),and vascular resistance index(RI)of the bilateral cerebral arteries was detected by transcranial color Doppler ultrasound tests,and serum BDNF and NGF contents were assayed by enzyme linked immunosorbent assay.The therapeutic effect of swallowing ability was evaluated after the treatment.Results After 4 weeks' treatment,the scores of Kubata water swallowing test,SSA,and SWAL-QOL and RI were considerably decreased(P<0.01),and the VFSS scores,Vs and Vm levels as well as serum BDNF and NGF contents were significantly increased(P<0.01)in both groups compared with their own pre-treatment.Of the 48 and 49 cases in the control and treatment groups,4(8.33%)and 8(16.33%)were cured,26(54.17%)and 33(67.35%)effective,18(37.50%)and 8(16.33%)failed,with the effective rate being62.50% and 83.67%,respectively.The therapeutic effect of the treatment group was significantly superior to that of the control group in the effective rate(P<0.05),and in lowering the scores of Kubota water swallowing test,SWAL-QOL,SSA,RI,and in up-regulating the scores of VFSS,Vs and Vm,and serum BDNF and NGF levels(P<0.01).Conclusion Tongdu Tiaoshen needling combined with swallowing training is effective in improving swallowing ability,promoting cerebral blood flow and in up-regulating serum neurotrophic factor levels in patients with dysphagia after ischemic stroke.
引文
[1]吕洪艳,韩淑艳,康晋.脑卒中合并吞咽障碍的管理策略[J].中国地方病防治杂志,2017,32(11):10002-10003.
[2]孙丹,徐纬,陈娜,等.皮内针埋针对脑卒中后吞咽障碍患者的吞咽功能和表面肌电图的影响[J].针刺研究,2018,43(2):118-122.
[3]吴英,陈香凤,董军,等.吞咽功能训练操应用于老年脑卒中吞咽障碍患者中对吞咽功能及依从性的影响[J].实用医学杂志,2018,34(5):851-853.
[4]毛立亚,毛忠南,张晓凌,等.电针夹廉泉穴为主治疗脑卒中后吞咽障碍的疗效观察[J].中国中西医结合杂志,2016,36(5):632-634.
[5]于涛,徐振华,许能贵,等.通督调神针法治疗中风后假性球麻痹临床观察[J].新中医,2010,42(7):86-88.
[6]中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2014[J].中华神经科杂志,2015,48(4):246-257.
[7]大西幸子,孙启良.摄食-吞咽障碍康复实用技术[M].赵峻译.北京:中国医药科技出版社,2000:7-18.
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[9]朱镛连.神经康复学[M].北京:人民军医出版社,2006:551.
[10]马月利,张黎明,祝勤雅,等.标准吞咽功能评定量表应用于高龄患者吞咽功能评估的信效度研究[J].护理学报,2012,19(5):65-67.
[11]MCHORNEY C A,BRICKER D E,KRAMER A E,et al.The SWAL-QOL outcomes tool for oropharyngeal dysphagia in adults:I.conceptual foundation and item development[J].Dysphagia,2000,15(3):115-121.
[12]李庆彬,黄丽贤,王亮,等.功能训练联合舌针治疗多脑卒中吞咽障碍疗效研究[J].中华中医药学刊,2018,36(7):1686-1689.
[13]李江霞.早期吞咽功能训练对脑卒中后吞咽障碍患者吞咽功能的影响[J].中国当代医药,2017,24(29):191-193.
[14]梁盛华,刘强,李婷妤,等.吞咽功能训练联合舌肌训练治疗脑卒中后吞咽障碍患者的效果观察[J].安徽医药,2018,22(2):283-285.
[15]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.
[16]常静玲,黄幸,吕天丽,等.论“益髓醒神”针刺方案治疗中风后失语的理论内涵[J].世界中医药,2017,12(7):1487-1490.
[17]许贝贝,章显宝.肖伟治疗卒中后吞咽障碍经验[J].山东中医药大学学报,2018,42(4):332-334.
[18]孙培养,储浩然,李佩芳,等.通督调神针刺干预对药物治疗脑卒中后抑郁的影响[J].中国针灸,2015,35(8):753-757.
[19]GUAN J,ZHANG B,ZHANG J,et al.Nerve regeneration and functional recovery by collagen-binding brain-derived neurotrophic factor in an intracerebral hemorrhage model[J].Tissue Eng Part A,2015,21(1-2):62-74.
[20]成静,马绍骏,曹爽,等.神经生长因子在老年吞咽功能障碍治疗中的应用[J].中国临床保健杂志,2016,19(6):586-588.
[2]孙丹,徐纬,陈娜,等.皮内针埋针对脑卒中后吞咽障碍患者的吞咽功能和表面肌电图的影响[J].针刺研究,2018,43(2):118-122.
[3]吴英,陈香凤,董军,等.吞咽功能训练操应用于老年脑卒中吞咽障碍患者中对吞咽功能及依从性的影响[J].实用医学杂志,2018,34(5):851-853.
[4]毛立亚,毛忠南,张晓凌,等.电针夹廉泉穴为主治疗脑卒中后吞咽障碍的疗效观察[J].中国中西医结合杂志,2016,36(5):632-634.
[5]于涛,徐振华,许能贵,等.通督调神针法治疗中风后假性球麻痹临床观察[J].新中医,2010,42(7):86-88.
[6]中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2014[J].中华神经科杂志,2015,48(4):246-257.
[7]大西幸子,孙启良.摄食-吞咽障碍康复实用技术[M].赵峻译.北京:中国医药科技出版社,2000:7-18.
[8]中华医学会神经病学分会.中国脑卒中康复治疗指南[J].中国康复理论与实践,2012,18(4):301-318.
[9]朱镛连.神经康复学[M].北京:人民军医出版社,2006:551.
[10]马月利,张黎明,祝勤雅,等.标准吞咽功能评定量表应用于高龄患者吞咽功能评估的信效度研究[J].护理学报,2012,19(5):65-67.
[11]MCHORNEY C A,BRICKER D E,KRAMER A E,et al.The SWAL-QOL outcomes tool for oropharyngeal dysphagia in adults:I.conceptual foundation and item development[J].Dysphagia,2000,15(3):115-121.
[12]李庆彬,黄丽贤,王亮,等.功能训练联合舌针治疗多脑卒中吞咽障碍疗效研究[J].中华中医药学刊,2018,36(7):1686-1689.
[13]李江霞.早期吞咽功能训练对脑卒中后吞咽障碍患者吞咽功能的影响[J].中国当代医药,2017,24(29):191-193.
[14]梁盛华,刘强,李婷妤,等.吞咽功能训练联合舌肌训练治疗脑卒中后吞咽障碍患者的效果观察[J].安徽医药,2018,22(2):283-285.
[15]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.
[16]常静玲,黄幸,吕天丽,等.论“益髓醒神”针刺方案治疗中风后失语的理论内涵[J].世界中医药,2017,12(7):1487-1490.
[17]许贝贝,章显宝.肖伟治疗卒中后吞咽障碍经验[J].山东中医药大学学报,2018,42(4):332-334.
[18]孙培养,储浩然,李佩芳,等.通督调神针刺干预对药物治疗脑卒中后抑郁的影响[J].中国针灸,2015,35(8):753-757.
[19]GUAN J,ZHANG B,ZHANG J,et al.Nerve regeneration and functional recovery by collagen-binding brain-derived neurotrophic factor in an intracerebral hemorrhage model[J].Tissue Eng Part A,2015,21(1-2):62-74.
[20]成静,马绍骏,曹爽,等.神经生长因子在老年吞咽功能障碍治疗中的应用[J].中国临床保健杂志,2016,19(6):586-588.