针刺兴奋法治疗假性延髓麻痹构音障碍疗效观察
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摘要
目的观察朱琏针刺兴奋法治疗脑卒中后假性延髓麻痹痉挛性构音障碍的临床疗效。方法将60例假性延髓麻痹构音障碍患者随机分为观察组和对照组,每组30例。两组均给予神经内科基础治疗。对照组给予常规针刺,观察组采用朱琏针刺兴奋法刺激。观察治疗前后GRBAS分级评分和Frenchay构音障碍等级变化,并比较两组临床疗效,并观察观察组痉挛性构音障碍发病次数对疗效的影响。结果两组治疗后Frenchay构音障碍等级与同组治疗前比较,差异有统计学意义(P<0.01),且观察组优于对照组(P<0.01)。两组治疗后GRBAS分级评分较治疗前明显降低(P<0.01),观察组低于对照组(P<0.01)。观察组临床痊愈所需时间明显少于对照组(P<0.01)。观察组总有效率为90.0%,优于对照组的83.3%(P<0.01)。观察组发病次数为1次的患者临床疗效与发病次数≥2次患者比较,差异有统计学意义(P<0.05)。结论两种针刺方法均能改善患者痉挛性构音障碍的临床症状,且在选取相同腧穴的基础上,针刺兴奋法治疗改善痉挛性构音障碍疗效肯定,较常规针刺效果更加明显,且发病次数与针刺兴奋法的疗效呈反比。
Objective To observe the clinical efficacy of ZHU Lian's excitatory acupuncture method in the treatment of spastic dysarthria in post-stroke pseudobulbar palsy. Method Sixty patients with dysarthria due to pseudobulbar palsy were randomized into an observation group and a control group, with 30 cases in each group. The two groups were both given basic neurological intervention. In addition, the control group was given ordinary acupuncture, while the observation group was intervened by ZHU Lian's excitatory acupuncture method. The scores of Grade, Roughness, Breathiness, Asthenia, Strain Scale (GRBAS) and Frenchay Dysarthria Assessment of the two groups were observed before and after the treatment. The clinical efficacies were compared. For the observation group, the effect of the onset frequency of spastic dysarthria on the therapeutic efficacy was also observed. Result The Frenchay Dysarthria Assessment scores changed significantly after the treatment in both groups (P<0.01), and the observation group was superior to the control group (P<0.01). The GRBAS scores declined significantly after the intervention in the two groups (P<0.01), and the observation group was lower than the control group (P<0.01). It took less time for the observation group to obtain clinical recovery than for the control group (P<0.01). The total effective rate was 90.0% in the observation group, better than 83.3% in the control group (P<0.01). In the observation group, patients who only had one onset showed significantly different efficacy compared with those who had more than one onset (P<0.05). Conclusion The two acupuncture methods both can improve the symptoms of spastic dysarthria. Given the same acupoint selection, excitatory acupuncture can produce valid efficacy in improving spastic dysarthria, which is better than that of ordinary acupuncture. The time of onset is inversely related to the efficacy of excitatory acupuncture.
Objective To observe the clinical efficacy of ZHU Lian's excitatory acupuncture method in the treatment of spastic dysarthria in post-stroke pseudobulbar palsy. Method Sixty patients with dysarthria due to pseudobulbar palsy were randomized into an observation group and a control group, with 30 cases in each group. The two groups were both given basic neurological intervention. In addition, the control group was given ordinary acupuncture, while the observation group was intervened by ZHU Lian's excitatory acupuncture method. The scores of Grade, Roughness, Breathiness, Asthenia, Strain Scale (GRBAS) and Frenchay Dysarthria Assessment of the two groups were observed before and after the treatment. The clinical efficacies were compared. For the observation group, the effect of the onset frequency of spastic dysarthria on the therapeutic efficacy was also observed. Result The Frenchay Dysarthria Assessment scores changed significantly after the treatment in both groups (P<0.01), and the observation group was superior to the control group (P<0.01). The GRBAS scores declined significantly after the intervention in the two groups (P<0.01), and the observation group was lower than the control group (P<0.01). It took less time for the observation group to obtain clinical recovery than for the control group (P<0.01). The total effective rate was 90.0% in the observation group, better than 83.3% in the control group (P<0.01). In the observation group, patients who only had one onset showed significantly different efficacy compared with those who had more than one onset (P<0.05). Conclusion The two acupuncture methods both can improve the symptoms of spastic dysarthria. Given the same acupoint selection, excitatory acupuncture can produce valid efficacy in improving spastic dysarthria, which is better than that of ordinary acupuncture. The time of onset is inversely related to the efficacy of excitatory acupuncture.
引文
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[10]李欢.构音障碍评估研究述评[J].中国特殊教育,2010,15(6):59-64.
[11]张明星,温武.嗓音主观评估研究进展[J].听力学及言语疾病杂志,2007,15(6):508-511.
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[13]余静,卢爱兰,朱伟新,等.针刺联合电刺激对假性延髓麻痹吞咽功能及脑血流的影响[J].上海针灸杂志,2016,35(10):1174-1177.
[14]魏爱翔,安玉兰.针刺配合吞咽功能训练治疗中风后吞咽障碍50例临床观察[J].世界中西医结合杂志,2012,7(5):415-416,434.
[15]夏娣文.脑卒中患者痉挛性构音障碍的言语评定和治疗[C].中国康复医学会,中国康复医学会第五届全国康复治疗学术会议论文集,2006:4.
[16]周静,方灿,张晓晓.口部运动训练对脑卒中后痉挛性构音障碍患者声学/电声门图评价参数的作用[J].现代实用医学,2017,29(4):426-428.
[17]徐颖,罗子芮,金蓉.针刺“咽四穴”联合构音训练治疗脑卒中后痉挛型构音障碍的临床观察[J].按摩与康复医学,2017,8(8):27-29.
[18]Wu ZL,Hu KM,Guo YG,et al.Acupuncture combined with speech rehabilitation training for post-stroke spasmodic dysphonia:a multicenter randomized controlled trial[J].World Journal of AcupunctureMoxibustion,2014,24(4):12-16.
[19]赵援非,王学远.解痉正音针刺法治疗脑卒中后痉挛型构音障碍的临床疗效观察[J].黑龙江中医药,2015,44(1):41-42.
[20]南登昆.康复医学[M].第5版.北京:人民卫生出版社,2013:69.
[21]高维滨,陈东,李晓艳,等.针刺七绝:神经病针刺新疗法[M].哈尔滨:黑龙江科学技术出版社,2014:77.
[22]杜建,陈立典.中西医结合康复学[M].北京:人民卫生出版社,2006:417.
[23]盛国滨,时境镁,蔡玉梅,等.针刺治疗假性延髓麻痹舌音障碍的临床疗效观察[J].中医药信息,2015,32(2):109-110.
[24]朱琏.新针灸学[M].南宁:广西人民出版社,1980:11,14-15.
[25]韦立富,岳进,潘小霞.现代针灸学家朱琏学术思想简介[J].中国针灸,2008,28(9):667-671.
[26]陈丽容,潘小霞,陈明明,等.朱琏针刺兴奋法对缺血缺氧性脑损伤幼鼠脑组织氧化应激的影响[J].国际中医中药杂志,2016,38(3):238-241.
[27]莫智珍,岳进,陈明明,等.朱琏兴奋针法联合耳尖放血辅助治疗小儿风热型外感发热40例临床观察[J].江苏中医药,2018,50(2):57-59.
[2]Veis SL,Logemann JA.Swallowing disorders in persons with cerebrovascular accident[J].Arch Phys Med Rehabil,1985,66(6):372-375.
[3]郑诚东,蒋建章,刘梅仕.临床神经病学[M].哈尔滨:黑龙江科学技术出版社,2002:159.
[4]史玉泉,周孝达.实用神经病学[M].第3版.上海:上海科学技术出版社,1994:108.
[5]中华神经科学会,中华神经外科学会.各类脑血管疾病诊断要点[J].中华神经科杂志,1996,29(6):379-380.
[6]王笑中,焦守恕.神经系统疾病症候学[M].北京:人民卫生出版社,1978:240-242.
[7]李胜利.言语治疗学[M].北京:华夏出版社,2004:84.
[8]饶明俐.中国脑血管病防治指南摘要(一)[J].中风与神经疾病杂志,2005,22(5):388-393.
[9]高维滨.针灸六绝-神经病针灸现代疗法[M].第2版.北京:中国医药科出版社,2007:421-438.
[10]李欢.构音障碍评估研究述评[J].中国特殊教育,2010,15(6):59-64.
[11]张明星,温武.嗓音主观评估研究进展[J].听力学及言语疾病杂志,2007,15(6):508-511.
[12]刘莉,邵伟波.脑卒中所致痉挛型构音障碍的康复训练方法及疗效[J].中国康复理论与实践,2008,14(10):925-926.
[13]余静,卢爱兰,朱伟新,等.针刺联合电刺激对假性延髓麻痹吞咽功能及脑血流的影响[J].上海针灸杂志,2016,35(10):1174-1177.
[14]魏爱翔,安玉兰.针刺配合吞咽功能训练治疗中风后吞咽障碍50例临床观察[J].世界中西医结合杂志,2012,7(5):415-416,434.
[15]夏娣文.脑卒中患者痉挛性构音障碍的言语评定和治疗[C].中国康复医学会,中国康复医学会第五届全国康复治疗学术会议论文集,2006:4.
[16]周静,方灿,张晓晓.口部运动训练对脑卒中后痉挛性构音障碍患者声学/电声门图评价参数的作用[J].现代实用医学,2017,29(4):426-428.
[17]徐颖,罗子芮,金蓉.针刺“咽四穴”联合构音训练治疗脑卒中后痉挛型构音障碍的临床观察[J].按摩与康复医学,2017,8(8):27-29.
[18]Wu ZL,Hu KM,Guo YG,et al.Acupuncture combined with speech rehabilitation training for post-stroke spasmodic dysphonia:a multicenter randomized controlled trial[J].World Journal of AcupunctureMoxibustion,2014,24(4):12-16.
[19]赵援非,王学远.解痉正音针刺法治疗脑卒中后痉挛型构音障碍的临床疗效观察[J].黑龙江中医药,2015,44(1):41-42.
[20]南登昆.康复医学[M].第5版.北京:人民卫生出版社,2013:69.
[21]高维滨,陈东,李晓艳,等.针刺七绝:神经病针刺新疗法[M].哈尔滨:黑龙江科学技术出版社,2014:77.
[22]杜建,陈立典.中西医结合康复学[M].北京:人民卫生出版社,2006:417.
[23]盛国滨,时境镁,蔡玉梅,等.针刺治疗假性延髓麻痹舌音障碍的临床疗效观察[J].中医药信息,2015,32(2):109-110.
[24]朱琏.新针灸学[M].南宁:广西人民出版社,1980:11,14-15.
[25]韦立富,岳进,潘小霞.现代针灸学家朱琏学术思想简介[J].中国针灸,2008,28(9):667-671.
[26]陈丽容,潘小霞,陈明明,等.朱琏针刺兴奋法对缺血缺氧性脑损伤幼鼠脑组织氧化应激的影响[J].国际中医中药杂志,2016,38(3):238-241.
[27]莫智珍,岳进,陈明明,等.朱琏兴奋针法联合耳尖放血辅助治疗小儿风热型外感发热40例临床观察[J].江苏中医药,2018,50(2):57-59.