中风后吞咽障碍的中医证型分布特点初探
|
摘要
目的:实施前瞻性调查研究,初步探讨中风后吞咽障碍发病6个月内患者中医证型及其与年龄、性别、病程、吞咽障碍情况及营养状况的关系,初步探索中风后吞咽障碍发病6个月内患者的中医证型分布特点。方法:本研究通过对2013年1月至11月在广东省中医院针灸科、神经科住院部确诊为中风合并吞咽障碍且符合课题标准的70例患者进行前瞻性调查。采用问卷调查和中医辨证的方法充分采集患者中医证型、年龄、性别、病程,采用洼田饮水试验及标准吞咽功能评价法(SSA)评价患者的吞咽功能,微型营养评价法(MNA)评价其营养状况。比较主要中医证型间患者年龄、性别、病程、吞咽功能及营养状况的差异。结果:中风后吞咽障碍中医证型分布以风痰阻络证较为多见(38例,占54.29%),其次为气虚血瘀证(26例,占37.14%),而肝阳暴亢证(2例,占2.86%)、痰热腑实证(3例,占4.29%)、阴虚风动证(1例,占1.43%)则相对少见。各主要证型间患者年龄、性别、洼田饮水分级、SSA评分、MNA评分、MNA营养分级差异均无统计学意义。而各主要证型间病程,差异有统计学意义(P<0.05),其中肝阳暴亢证、阴虚风动证、痰热腑实证平均病程为(5.83±6.50)d,风痰阻络证及气虚血瘀证平均病程分别为(12.61±20.09)、(66.00±60.150)d。结论:中风后吞咽障碍发病6个月内患者中医证型分布特点以风痰阻络证、气虚血瘀证较为多见,而肝阳暴亢证、痰热腑实证、阴虚风动证则相对少见;各证型的分布在病程方面差异较大,急性期以肝阳暴亢证、阴虚风动证、痰热腑实证为主,恢复期则以风痰阻络证、气虚血瘀证为主。
Objective: To preliminarily explore the distribution characteristics of TCM syndrome types of dysphagia after stroke within six months course, to summarize the relationship of patients' age, gender, course, swallowing function and situation of nutrition within the TCM syndrome types by a prospective study. Methods: A prospective research was launched in Guangdong Province Traditional Chinese Medical Hospital during January to November in 2013, patients who suffered from dysphagia after stroke were selected according to eligible criteria. All these patients were from Acupuncture Department and Nerve Medical Department in Guangdong Province Traditional Chinese Medical Hospital. Combining methods of questionnaire investigation and TCM syndrome differentiation, patients' information about TCM syndrome types, age, gender, course were collected. Water swallow test and standardized swallowing assessment(SSA) were used to assess their swallowing function. Mini nutrition assessment(MNA) was used to assess their situation of nutrition. Then these data were processed to analyze the distribution of TCM syndrome types of dysphagia after stroke within six months course, compare the difference of age, gender, course, swallowing function and nutrition within major TCM syndrome types. Results: The TCM syndrome types could be categorized into five patterns, wind-phlegm obstructing collateral(38 cases, 54.29%) was more common, followed by syndrome of blood stasis due to qi deficiency(26 cases, 37.14%), while syndrome of upward disturbance of liver yang(2 cases, 2.86%), syndrome of excessive fu-viscera caused by phlegm-heat(3 cases, 4.29%) and syndrome of stirring wind due to yin deficiency(1 case, 1.43%) were relatively rare. Comparison of the difference of patients' age, gender, there was no significant difference in the level of water swallow test, the score of SSA and both of the scores and nutrition levels of MNA within major TCM syndrome types. Otherwise, Comparison of patients' course within major TCM syndrome types, there was significant difference(P<0.05). What was more, syndrome of upward disturbance of liver yang, syndrome of excessive fu-viscera caused by phlegm-heat, syndrome of stirring wind due to yin deficiency had short course(5.83±6.50)d, and wind-phlegm obstructing collateral and syndrome of blood stasis due to qi deficiency had longer course(12.61±20.09),(66.00±60.15)d. Conclusion: The distribution characteristics of TCM syndrome types of dysphagia after stroke within six months course is that the most common syndrome are wind-phlegm obstructing collateral and syndrome of blood stasis due to qi deficiency, and rare to have syndrome of upward disturbance of liver yang, syndrome of excessive fu-viscera caused by phlegm-heat and syndrome of stirring wind due to yin deficiency. The distribution of each syndrome type differed greatly in the course of disease. In the acute phase, the upward disturbance of liver yang, syndrome of excessive fu-viscera caused by phlegm-heat and syndrome of stirring wind due to yin deficiency are the main ones. In the recovery period, the windphlegm obstructing collateral and syndrome of blood stasis due to qi deficiency are the main ones.
Objective: To preliminarily explore the distribution characteristics of TCM syndrome types of dysphagia after stroke within six months course, to summarize the relationship of patients' age, gender, course, swallowing function and situation of nutrition within the TCM syndrome types by a prospective study. Methods: A prospective research was launched in Guangdong Province Traditional Chinese Medical Hospital during January to November in 2013, patients who suffered from dysphagia after stroke were selected according to eligible criteria. All these patients were from Acupuncture Department and Nerve Medical Department in Guangdong Province Traditional Chinese Medical Hospital. Combining methods of questionnaire investigation and TCM syndrome differentiation, patients' information about TCM syndrome types, age, gender, course were collected. Water swallow test and standardized swallowing assessment(SSA) were used to assess their swallowing function. Mini nutrition assessment(MNA) was used to assess their situation of nutrition. Then these data were processed to analyze the distribution of TCM syndrome types of dysphagia after stroke within six months course, compare the difference of age, gender, course, swallowing function and nutrition within major TCM syndrome types. Results: The TCM syndrome types could be categorized into five patterns, wind-phlegm obstructing collateral(38 cases, 54.29%) was more common, followed by syndrome of blood stasis due to qi deficiency(26 cases, 37.14%), while syndrome of upward disturbance of liver yang(2 cases, 2.86%), syndrome of excessive fu-viscera caused by phlegm-heat(3 cases, 4.29%) and syndrome of stirring wind due to yin deficiency(1 case, 1.43%) were relatively rare. Comparison of the difference of patients' age, gender, there was no significant difference in the level of water swallow test, the score of SSA and both of the scores and nutrition levels of MNA within major TCM syndrome types. Otherwise, Comparison of patients' course within major TCM syndrome types, there was significant difference(P<0.05). What was more, syndrome of upward disturbance of liver yang, syndrome of excessive fu-viscera caused by phlegm-heat, syndrome of stirring wind due to yin deficiency had short course(5.83±6.50)d, and wind-phlegm obstructing collateral and syndrome of blood stasis due to qi deficiency had longer course(12.61±20.09),(66.00±60.15)d. Conclusion: The distribution characteristics of TCM syndrome types of dysphagia after stroke within six months course is that the most common syndrome are wind-phlegm obstructing collateral and syndrome of blood stasis due to qi deficiency, and rare to have syndrome of upward disturbance of liver yang, syndrome of excessive fu-viscera caused by phlegm-heat and syndrome of stirring wind due to yin deficiency. The distribution of each syndrome type differed greatly in the course of disease. In the acute phase, the upward disturbance of liver yang, syndrome of excessive fu-viscera caused by phlegm-heat and syndrome of stirring wind due to yin deficiency are the main ones. In the recovery period, the windphlegm obstructing collateral and syndrome of blood stasis due to qi deficiency are the main ones.
引文
[1]Martino R,Foley N,Bhogal S,et al.Dysphagia after stroke:Incidence,diagnosis,and pulmonary complications.Stroke,2005,36(12):2756-2763
[2]Paciaroni M,Mazzotta G,Corea F,et al.Dysphagia following stroke.Eur Neurol,2004,51(3):162-167
[3]中华医学会神经病学分会神经康复学组,中华医学会神经病学分会脑血管病学组,卫生部脑卒中筛查与防治工程委员会办公室,等.中国脑卒中康复治疗指南.中国康复理论与实践,2012,18(4):301-318
[4]国家中医药管理局脑病急症协作组.中风病诊断与疗效评定标准(试行).北京中医药大学学报,1996,19:55-56
[5]中华全国中医学会内科分会.中风病中医诊断、疗效评定标准.中国医药学报,1986,1(2):56-57
[6]郑宏,朱士文,杨福,等.冲脉理论针刺治疗中风后吞咽障碍疗效观察.中国针灸,2011,31(12):1067-1070
[7]杨洁,石学敏.石学敏院士治疗中风后吞咽障碍学术经验介绍.针灸临床杂志,2018,34(1):67-69
[8]张丹,张春红,孟智宏.“通关利窍”针刺法配合康复训练治疗缺血性中风后吞咽障碍的疗效观察.中华中医药杂志,2018,33(4):1649-1652
[9]罗菁,古志林,徐振华.调神利咽针刺法治疗脑卒中后吞咽障碍的疗效观察.中华物理医学与康复杂志,2015,37(12):940-942
[10]施杨婉琳,杨孝芳,崔瑾,等.假性球麻痹致吞咽困难针灸辨证选穴规律微探.中华中医药杂志,2011,26(12):2962-2964
[11]Ellul J,Barer D.On behalf ESDBCOSTAR collaborative dysphagia study interobserver reliability of a standardized swallowing assessment(SSA).Cerebrovasc Dis,1996,6(2):152-158
[12]伍少玲,马超,黄粉燕,等.标准吞咽功能评定量表的临床应用研究.中华物理医学与康复杂志,2008,30(6):396-399
[13]侯莹,王相明,刘娟,等.脑卒中后吞咽困难两种床旁评估量表比较.中华物理医学与康复杂志,2009,31(9):607-609
[14]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.护理学报,2012,19(3):65-66
[15]Sieber C C.Nutritional screening tools:How does the MAN(R)compare proceedings of the session held in Cicago May2-3,2006(15 years of mini nutritional assessment).J Nutrition Health Aging,2006,10(6):88-94
[16]李艳玲,雷雯,张克明,等.微型营养评价法在脑卒中患者吞咽障碍中的应用.中国老年学杂志,2009,8(29):1952-1953
[17]霍建华.微型营养评价法对老年喉癌患者的营养评估及其意义.中国老年学杂志,2010,12(30):3812-3813
[18]郭丽娜,黄英,何盈犀,等.脑卒中住院康复治疗患者营养状态评估方法的比较.临床医学工程,2012,19(10):1746-1747
[19]王涛,高月平,张占英,等.通络饮治疗脑梗死吞咽障碍的临床观察.中华中医药杂志,2012,27(1):34-36
[2]Paciaroni M,Mazzotta G,Corea F,et al.Dysphagia following stroke.Eur Neurol,2004,51(3):162-167
[3]中华医学会神经病学分会神经康复学组,中华医学会神经病学分会脑血管病学组,卫生部脑卒中筛查与防治工程委员会办公室,等.中国脑卒中康复治疗指南.中国康复理论与实践,2012,18(4):301-318
[4]国家中医药管理局脑病急症协作组.中风病诊断与疗效评定标准(试行).北京中医药大学学报,1996,19:55-56
[5]中华全国中医学会内科分会.中风病中医诊断、疗效评定标准.中国医药学报,1986,1(2):56-57
[6]郑宏,朱士文,杨福,等.冲脉理论针刺治疗中风后吞咽障碍疗效观察.中国针灸,2011,31(12):1067-1070
[7]杨洁,石学敏.石学敏院士治疗中风后吞咽障碍学术经验介绍.针灸临床杂志,2018,34(1):67-69
[8]张丹,张春红,孟智宏.“通关利窍”针刺法配合康复训练治疗缺血性中风后吞咽障碍的疗效观察.中华中医药杂志,2018,33(4):1649-1652
[9]罗菁,古志林,徐振华.调神利咽针刺法治疗脑卒中后吞咽障碍的疗效观察.中华物理医学与康复杂志,2015,37(12):940-942
[10]施杨婉琳,杨孝芳,崔瑾,等.假性球麻痹致吞咽困难针灸辨证选穴规律微探.中华中医药杂志,2011,26(12):2962-2964
[11]Ellul J,Barer D.On behalf ESDBCOSTAR collaborative dysphagia study interobserver reliability of a standardized swallowing assessment(SSA).Cerebrovasc Dis,1996,6(2):152-158
[12]伍少玲,马超,黄粉燕,等.标准吞咽功能评定量表的临床应用研究.中华物理医学与康复杂志,2008,30(6):396-399
[13]侯莹,王相明,刘娟,等.脑卒中后吞咽困难两种床旁评估量表比较.中华物理医学与康复杂志,2009,31(9):607-609
[14]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.护理学报,2012,19(3):65-66
[15]Sieber C C.Nutritional screening tools:How does the MAN(R)compare proceedings of the session held in Cicago May2-3,2006(15 years of mini nutritional assessment).J Nutrition Health Aging,2006,10(6):88-94
[16]李艳玲,雷雯,张克明,等.微型营养评价法在脑卒中患者吞咽障碍中的应用.中国老年学杂志,2009,8(29):1952-1953
[17]霍建华.微型营养评价法对老年喉癌患者的营养评估及其意义.中国老年学杂志,2010,12(30):3812-3813
[18]郭丽娜,黄英,何盈犀,等.脑卒中住院康复治疗患者营养状态评估方法的比较.临床医学工程,2012,19(10):1746-1747
[19]王涛,高月平,张占英,等.通络饮治疗脑梗死吞咽障碍的临床观察.中华中医药杂志,2012,27(1):34-36