针刺治疗缺血性脑卒中所致吞咽障碍
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摘要
目的:观察针刺治疗缺血性脑卒中后吞咽障碍的疗效及对血液流变学的影响。方法:将120例缺血性脑卒中所致吞咽障碍患者随机分为对照组和治疗组,每组各60例。对照组进行常规吞咽康复训练干预,每天1次,每次30 min,每周5次。治疗组在对照组基础上予针刺治疗,每天1次,每周5次。两组连续观察8周。比较两组吞咽困难分级、洼田饮水试验吞咽功能、标准吞咽功能评价量表(standardized swallowing assessment,SSA)评分、巴塞尔指数(barthel index,BI)评分及临床疗效。检测两组血液流变学情况。结果:治疗后,治疗组吞咽困难分级、SSA及洼田饮水试验评分显著低于对照组(P <0. 01)。治疗后4周、8周,治疗组BI评分高于对照组同期(P <0. 01)。治疗组有效率为93. 33%,显著高于对照组78. 33%(P <0. 05)。治疗组治疗后血液流变学水平明显低于对照组(P <0. 01)。结论:在常规吞咽康复训练基础上,针刺疗法可促进脑卒中吞咽障碍好转,改善血液流变学水平可能是其作用机制之一。
Objective: To observe the therapeutic effect of acupuncture on dysphagia after ischemic stroke and its influence on hemorheology. Methods: 120 patients with dysphagia caused by ischemic stroke were randomly divided into control group and treatment group,60 cases in each group. The control group received routine swallowing rehabilitation training intervention once a day,30 minutes each time,5 times a week. The treatment group was given acupuncture treatment on the basis of the control group,once a day,five times a week. The two groups were observed for 8 weeks. The classification of dysphagia,swallowing function of Watian drinking water test,standardized swallowing assessment( SSA),Barthel index( BI) and clinical efficacy were compared between the two groups. The hemorheological levels of the two groups were measured. Results: After treatment,the scores of dysphagia classification,SSA and Watian drinking water test in the treatment group were significantly lower than those in the control group( P <0. 01). At 4 and 8 weeks after treatment,the BI score of the treatment group was higher than that of the control group( P < 0. 01).The effective rate was 93. 33% in the treatment group,which was significantly higher than 78. 33% in the control group( P <0. 05). The level of hemorheology in the treatment group was significantly lower than that in the control group( P < 0. 01). Conclusion: On the basis of routine swallowing rehabilitation training,this group of acupuncture therapy can promote the improvement of swallowing disorder in stroke,and improving the level of hemorheology may be one of its mechanisms.
Objective: To observe the therapeutic effect of acupuncture on dysphagia after ischemic stroke and its influence on hemorheology. Methods: 120 patients with dysphagia caused by ischemic stroke were randomly divided into control group and treatment group,60 cases in each group. The control group received routine swallowing rehabilitation training intervention once a day,30 minutes each time,5 times a week. The treatment group was given acupuncture treatment on the basis of the control group,once a day,five times a week. The two groups were observed for 8 weeks. The classification of dysphagia,swallowing function of Watian drinking water test,standardized swallowing assessment( SSA),Barthel index( BI) and clinical efficacy were compared between the two groups. The hemorheological levels of the two groups were measured. Results: After treatment,the scores of dysphagia classification,SSA and Watian drinking water test in the treatment group were significantly lower than those in the control group( P <0. 01). At 4 and 8 weeks after treatment,the BI score of the treatment group was higher than that of the control group( P < 0. 01).The effective rate was 93. 33% in the treatment group,which was significantly higher than 78. 33% in the control group( P <0. 05). The level of hemorheology in the treatment group was significantly lower than that in the control group( P < 0. 01). Conclusion: On the basis of routine swallowing rehabilitation training,this group of acupuncture therapy can promote the improvement of swallowing disorder in stroke,and improving the level of hemorheology may be one of its mechanisms.
引文
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[11]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.
[12]张菡,姜有君,魏清琳,等.体针加点刺金津、玉液治疗中风后吞咽困难疗效观察[J].中国针灸,2013,33(增刊):11-13.
[13]王珊珊,白田雨,刘敏,等.肌电生物反馈和针刺结合康复功能训练治疗脑卒中后吞咽障碍的临床疗效观察[J].中华物理医学与康复杂志,2014,36(2):129-131.
[14]陈雪,李振海.中医药治疗脑卒中后吞咽障碍研究进展[J].河南中医,2016,36(7):1290-1293.
[15]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.
[2]张宝霞.针药结合治疗脑梗死后吞咽障碍临床研究[J].中医学报,2014,29(8):1234-1235.
[3]杨辉.调神利咽针刺法治疗脑卒中后吞咽障碍的疗效观察[J].中国疗养医学,2016,25(11):1139-1141.
[4]闫磊,王智达,马金娜,等.针刺治疗脑卒中后吞咽困难方案优选分析[J].河南中医,2016,36(1):153-155.
[5]陈琴,陈邦国.脑卒中后吞咽困难的研究进展[J].中医学报,2012,27(3):384-386.
[6]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[J].中华物理医学与康复杂志,2015,37(12):940-942.
[7]大西幸子,孙启良.摄食-吞咽障碍康复实用技术[M].北京:中国医药科技出版社,2000:7-18.
[8]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(1996)[J].临床和实验医学杂志,2013,12(7):559-562.
[9]中华神经科学会.脑卒中患者临床神经功能缺损程度评分标准[J].中华神经科杂志,1996,29(6):381-383.
[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,2012,5(19):65-67.
[11]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.
[12]张菡,姜有君,魏清琳,等.体针加点刺金津、玉液治疗中风后吞咽困难疗效观察[J].中国针灸,2013,33(增刊):11-13.
[13]王珊珊,白田雨,刘敏,等.肌电生物反馈和针刺结合康复功能训练治疗脑卒中后吞咽障碍的临床疗效观察[J].中华物理医学与康复杂志,2014,36(2):129-131.
[14]陈雪,李振海.中医药治疗脑卒中后吞咽障碍研究进展[J].河南中医,2016,36(7):1290-1293.
[15]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.