针刺人迎穴治疗假性延髓麻痹吞咽困难的临床观察
摘要
目的：通过观察针刺人迎穴治疗假性延髓麻痹所致吞咽困难的临床疗效对比,以探讨针刺人迎穴治疗本病症的作用机理,为针刺治疗假性延髓麻痹所致吞咽困难提高有效的治疗方法。
方法：将60例假性延髓麻痹所致吞咽困难的患者随机分为2组,治疗组30例,对照组30例。治疗组予针刺人迎穴配合吞咽功能康复训练,对照组单纯予吞咽功能康复训练,两组治疗4周后观察疗效。对比两组疗效及治疗前后蛙田氏饮水试验评定,吞咽困难评分以及治疗后并发症的比较,对本疗法的临床疗效进行系统观察。
结果：两组疗效对比,治疗组总有效率83.3%,对照组总有效率73.3%,比较差异有统计学意义(P<0.05)；两组治疗前后蛙田氏饮水试验评定,吞咽困难评分以及治疗后并发症的比较均有所改善,其中治疗组明显优于对照组,比较差异有统计学意义(P<0.05)。
结论：针刺人迎穴治疗假性延髓麻痹所致吞咽困难疗效显著,明显改善了患者的蛙田氏饮水试验评定,吞咽困难评分。针刺人迎穴治疗假性延髓麻痹所致吞咽困难经济安全、操作简便、疗效确切,适合在各级医院推广使用,为针刺治疗本病开辟了新的途径。
Objective:Through observing the comparation of clinical efficacy of the acupuncture treatment Renying point to dysphagia which due to pseudobulbar palsy, to explore the mechanism about the treatment of this disease by acupuncturing point Renying, and to provide effective treatments for the acupuncture treatment of dysphagia which due to pseudobulbar palsy
Method:60 patients with dysphagia due to pseudobulbar palsy were randomly divided into 2 groups, the treatment group,30 cases and the control group of 30 patients. We gqve the treatment group acupuncture treatment and swallowing rehabilitation, and the control group were treated for swallowing rehabilitation training only. After 4 weeks we observed the treatment effections between the two groups. Compared the two groups before and after treatment of test and evaluation of drinking water, dysphagia score, and the comparation of complications after treatment, and systematicly to observe the clinical efficacy of this therapy.
Results:Compared the two groups, the treatment group was 83.3%, and the control group was 73.3%, and there were significant differences (P<0.05); Compared the two groups before and after treatment of test and evaluation of drinking water, dysphagia score, and the comparation of complications after treatment, they were improved, and the treatment group was better than the control group clearly. There were significant differences (P<0.05).
Conclusion:The effection of acupuncture treatment of dysphagia due to pseudobulbar palsy by acupuncturing point Renying is significant, significantly improved the patients' drinking water test evaluation and dysphagia score. This method is economic security, simple, effective, suitable for promoting the use of hospitals at all levels, and it has opened up new avenues for the acupuncture treatment of this disease.
方法：将60例假性延髓麻痹所致吞咽困难的患者随机分为2组,治疗组30例,对照组30例。治疗组予针刺人迎穴配合吞咽功能康复训练,对照组单纯予吞咽功能康复训练,两组治疗4周后观察疗效。对比两组疗效及治疗前后蛙田氏饮水试验评定,吞咽困难评分以及治疗后并发症的比较,对本疗法的临床疗效进行系统观察。
结果：两组疗效对比,治疗组总有效率83.3%,对照组总有效率73.3%,比较差异有统计学意义(P<0.05)；两组治疗前后蛙田氏饮水试验评定,吞咽困难评分以及治疗后并发症的比较均有所改善,其中治疗组明显优于对照组,比较差异有统计学意义(P<0.05)。
结论：针刺人迎穴治疗假性延髓麻痹所致吞咽困难疗效显著,明显改善了患者的蛙田氏饮水试验评定,吞咽困难评分。针刺人迎穴治疗假性延髓麻痹所致吞咽困难经济安全、操作简便、疗效确切,适合在各级医院推广使用,为针刺治疗本病开辟了新的途径。
Objective:Through observing the comparation of clinical efficacy of the acupuncture treatment Renying point to dysphagia which due to pseudobulbar palsy, to explore the mechanism about the treatment of this disease by acupuncturing point Renying, and to provide effective treatments for the acupuncture treatment of dysphagia which due to pseudobulbar palsy
Method:60 patients with dysphagia due to pseudobulbar palsy were randomly divided into 2 groups, the treatment group,30 cases and the control group of 30 patients. We gqve the treatment group acupuncture treatment and swallowing rehabilitation, and the control group were treated for swallowing rehabilitation training only. After 4 weeks we observed the treatment effections between the two groups. Compared the two groups before and after treatment of test and evaluation of drinking water, dysphagia score, and the comparation of complications after treatment, and systematicly to observe the clinical efficacy of this therapy.
Results:Compared the two groups, the treatment group was 83.3%, and the control group was 73.3%, and there were significant differences (P<0.05); Compared the two groups before and after treatment of test and evaluation of drinking water, dysphagia score, and the comparation of complications after treatment, they were improved, and the treatment group was better than the control group clearly. There were significant differences (P<0.05).
Conclusion:The effection of acupuncture treatment of dysphagia due to pseudobulbar palsy by acupuncturing point Renying is significant, significantly improved the patients' drinking water test evaluation and dysphagia score. This method is economic security, simple, effective, suitable for promoting the use of hospitals at all levels, and it has opened up new avenues for the acupuncture treatment of this disease.
引文
[1]刘东霞.试论中风假性球麻痹综合征的病机特点[J]中国中医基础医学杂志,2004,8(10)：567-568.
[2]王永炎.中医内科学[M].上海：上海科学技术出版社,1997：125
[3]张宏伟.醒脑汤治疗中风假性球麻痹[J].中国中医急症,1997,6(2)：92
[4]蒋戈利.针刺治疗假性延髓麻痹临床研究概况[J].中医药信息,1989}6(26)：3
[5]石学敏.通关利窍针法治疗脑中风性假性延髓麻痹300例[[J].上海针灸杂志,1997,(2)：17-18
[6]杨俊生.针刺治疗脑血管病所致假性球麻痹96例观察[[J].针灸临床杂志,1999,15(5)：9-11
[7]张青云.补肾法针刺治疗假性延髓麻痹的临床研究[J].天津医药,2000,9(9)：571
[8]夏永潮,李妍怡,韩滟,等.中风病合并假性球麻痹50例的临床观察[J].中医杂志,1993,(4)：227
[9]王辉.针刺治疗假性延髓麻痹61例［J].中国针灸,1998,(7)：423-424
[10]刘军,刘志顺,黄石玺,等.针刺治疗假性球麻痹吞咽障碍临床观察[J].中国针灸,1996,16(10)：18
[11]崔立俊,干文生.辩证论治球麻痹综合征20例[J].山东中医杂志,1995,14(5)：304-305
[12]陈英华,李岩,陈伊.项针疗法为主治疗延髓麻痹[J].中医药信息,1999,(5)：41-42
[13]赵晓峰.针刺治疗中风性假性延髓麻痹56例[J].江苏中医,2000,(1)：30-31
[14]赵晓峰.针刺治疗中风性假性延髓麻痹56例[J].江苏中医,2000,(1)：30-31
[15]任家训.多发性脑梗塞并假性球麻痹治验[J].湖北中医杂志,1992 14(2)：41
[16]刘香华.针刺治疗中风舌本病-假性球麻痹的临床观察[J].中国针2000,20(6)：326
[17]张金茹.针刺治疗脑卒中假性球麻痹30例[J].北京中医,2004,23(1)：41-2
[18]秦黎红,王艳昕.颈项九针疗法治疗中风后吞咽困难临床研究[J].中国中医药信息杂志,2003,10(8)：64
[19]周佛养,李中林,李飞,等.针刺廉泉、风池透风池穴对假性球麻痹患者TCD的影响[J].安徽中医学院学报,2007}26(4)：26
[20]杨永梅,罗守滨,岳卫东,等.脑卒中后假性球麻痹致吞咽困难的针刺治疗[J].天津中医药,2005,22(6)：475-476
[21]许晶,何淑艳,庞妹弘.针刺疗法治疗脑卒中假性球麻痹吞咽困难[J].针灸临床杂志,2001(17)8：14
[22]王秀杰,陈伊.针药并用治疗中风吞咽困难48例疗效观察[J].针刺临床杂志,1999,15(9)：12
[23]张若燕,冉茂东,郭蕴屏.针刺治疗假性球麻痹84例.[J]辽宁中医杂志,2002 29(6)：360
[24]赵长泉,张月峰.开窍降逆针刺治疗吞咽障碍13例[J].中国针刺,2001,21(10)：586
[25]农泽宁.预三针为主治疗假性球麻痹40例[J].中国针灸,2001 21(2)：126
[26]陆青,黄柳妮.脑卒中后吞咽障碍的康复治疗.[J]广西中医药,2002,25(3)：43
[27]张毅明,颜纷,张敏.针刺治疗脑血管意外假性球麻痹疗效观察[J].中华现代中医学杂志,2006,2(4)：357
[28]苏永立,李沛,赵高峰.电针治疗中风后吞咽困难45例[J].山东中医杂志,2003,22(3)：164
[29]包烨华.针刺解语穴治疗中风后遗症临床体会[J]浙江中医杂志,1999,34(10)：446
[30]李俊坤,李红珍.针刺舌下治疗假性球麻痹46例疗效观察[J].河北中医,2003 25(1)：47
[31]周志军.翳风穴电针治疗脑卒中吞咽障碍患者60例体会[J].中国临床康复,2004,8(19)：3848
[32]李骁飞,邢锐,高霞.舌三针为主治疗假性球麻痹47例疗效观察[J].河北中医,2006,28(9)：649
[33]刘孔江.咽三针治疗中风吞咽困难76例[J].南京中医药大学学报,2000,16(6)：361
[34]马培锋.针刺阿呛穴治疗中风后吞咽困难35例[J].中国针灸,2007,27(6)：472
[35]宋文革,刘萌,张彦.头针治疗假性延髓麻痹所致吞咽困难30例[J].针刺临床杂志,1999,15(12)：223
[36]干炳强,韩广顺,赵景波等.头针治疗中风后球麻痹所致吞咽困难[J].吉林中医药,2004,24(9)：49
[37]党读华,夏冰,杨晓兰.耳针治疗假性球麻痹120例[J].浙江中医杂志,1997,19(2)69-71
[38]Crary MA,Groher M E.Introduction to Adult Swallowing Disorders[M].2003:Elsevier Science:Butterworth Heinemann
[39]Leonard R, Kendall K. Dysphagia assessment and treatment planning, a team approach[M]. 1997:SingularPublishing Group
[40]Langmore SE. Evaluation of or opharyngeal dysphagia:which diagnostic tool is superior[J].Curr OpinOtolaryngol Head Neck Surg,2003,11:485-489
[41]Vanoo Jayasekeran,Emilia Michou,Shaheen Hamdy(著);张婧(译).卒中后口咽吞咽困难的治疗[J].中国卒中杂志,2007,2(3)：259
[42]Hmady S, Aziz Q, Rothwell JC, et al. Crnaial never modulation of human cortical swallowing motorPhatwyas[J].AmJPhysiol.1997.272:G802-6808
[43]HamdyS, RothwellJC, Aziz Q et al. Organization and reorganization swallowing motor cortex.imPlications for recovery after Clinsci (Lond),2000,99:151-157. of human stroke.
[44]Gordon C, Hewer RL, Wade DT. Dysphagia in acute stoke[J].J Bri Med,1987,295:411-414
[45]彭拥军.针药治疗假性球麻痹的临床进展.[J]甘肃中医,2003 (16)：1。史玉泉主编.实用神经病学.上海二上海科学技术出版社,2000;第二版：206。
[46]卓大宏.中国康复医学[M].北京：华夏出版社,2004;720-5.孙启良.吞咽困难的功能评价和康复治疗[J].中日友好医院学报,2006;20(5)：294-7.
[47]大西幸子,孙启良.摄食、吞咽障碍康复实用技术[M].赵俊译.北京：中国医药科学技术出版社,2000：7-18.
[48]Aral T,Yasuda Y,Takaya T,etal.Technetium tin colloid test detecting symptomless dysphagia and ACE inhibitor prevented occurrence of aspiration pneurnonia.Int J Mol Med,2000; 5 (6):609-610.
[49]李继安.吞咽困难临床评估与功能检查[J].中国综合临床,2005;21(11)：1045-6.
[50]孙启良.吞咽困难的功能评价和康复治疗[J].中日友好医院学报,2006;20(5)：294-
[51]Domenech E, Kelly J. Swallowing disorders. Med Clin North Am,1999 83:97-113
[52]Bastian Videoendoscopic evaluation of patients with dysphagia an adjunct to modified barium swallow. Otolaryngol Head Neck Sury,1991; 104:339-350
[53]Goulding R, Bakheit AM.Evalation of the benefits of monitoring fluid thickness in the dietary management of dysphagic stroke patients. Clin Rehabil,2000; 14 (2):119-124
[54]张婧,王拥军.卒中后吞咽困难的评估和治疗.国外医学脑血管分,2003：11 (4)263-265
[55]Wojner AW, Alexandrov AV. Preditors of tube feeding in acute stroke patients with dysphagia. AACN Clin Issues,2000,11 (4):531-540.
[56]Nakajon K,Nakagawa T, Sekizawa K, etal. Relation between incidence of pneumonia and protective reflexes in post-stroke patients with oral or tube feeding. Jintern Med,2000,247 (1):39-42.
[57]Cook IJ,Kahrilas PJ.AGA technical review on management of oropharyngeal dysphagia.Gastroenterology,1999,116:455-478.
[58]Runions S, Rodrigue N, White C.Practice on an acute stroke unit after implementation of a decision-making algorithm for dietary management of dysphagia.J Neurosci Nurs,2004 36 (5):200
[59]Besson G, Bogousslavasky J, Regli F, et al.Aeute pseudobulbar or suprabulbar palsy.Areh Neurol, 1991,48:501
[60]Perez I, Smit hard DG, Davies H, et al.Pharmacological treatment of dysphagia in stroke.Dysphagia,199813(1):1216
[61]Bakheit AMO.Management of neurogenic dysphagia.Postgrad Med[J],2001,77(913):694699
[62]James A, Kapur K, Hawthorne AB. Long-term outcome of percutesneous endoscopic gastrostomy feeding in patients with dysphagic stroke. Age Ageing,1998,27 (6):671-676.
[63]Smit hard DG, O'Neill PA, Parks C, et al.Coplications and out-come after aeute Stroke.Does dysphagia matter Stroke,1996,27(7):1200-1204
[64]Jacobsson C, Axelsson K, Norberg A, etal. Outcomes of individualized interventions in patients with severe eating dimculties. Clin Nurs Res,1997,6(1):25-44.
[65]罗秀忠.星状神经节阻滞对脑卒中吞咽障碍的疗效观察[[J].中国临床康复,2003,7,(22)：312
[66]Butefisch C, Hummelsheim H, Denzler P, et al. Repetitive training of isolated movements improves the outcome of motor rehabilitation of the centrally paretichand[J]. J Neur Sci,1995, (130):59-68
[67]曹一鸣.新中医药,1956；7(10)：458
[68]王立早.吉林中医药,1981；(4)： 34
[69]侯肇楷.广西中医药,1981；(6)24
[70]叶树培.福建中医药杂志,1957；2(3)：25
[71]曹一鸣.新中医药,1956；7(10)：458
[72]陈剑勇.浙江中医杂志,1960,(3)：120
[73]中国明.干龙海.颜贵明.人迎穴针刺安全深度的研究[J].安徽医学院学报.1999；18(5)：57-58
[74]仲跻尚.上海针灸杂志,1988；(4)：38
[75]胡芝兰等.浙江中医学院学报,1988；(3)：50
[76]宋江友.新中医,1987；(8)：：35
[77]许顺荣等.中华理疗杂志,1984；(3)：160
[78]曹一鸣.新中医药,1956；7(10)：458
[79]陈剑勇.浙江中医杂志,1960；(3)：120
[80]蒋松鹤,杨文秀,张慧玲.人迎穴的探讨及颈动脉窦定位实验[J].上海针灸杂志,1994：13(6)：269-270.
[81]卫彦.孙忠人.寇吉友.等.针刺人迎穴治疗高血压病120例临床观察[J].针灸临床杂志.2006；22(2)：4-5
[82]吴义新等.中国针灸,1982；(2)：9
[83]胡玉珍等.山东中医杂志.1991；(3)：29
[84]揭子慧,张玮.针刺人迎治疗椎动脉型颈椎病眩晕50例对照观察[J].山西中医,2007,23(4) 58—59
[85]刘之权等.新中医药.1979；(4)：119
[86]杨安生.深刺人迎穴点刺舌体治疗中风失语82例[J].湖南中医杂志,2000;16(2)：32
[87]富延萍.浅谈人迎穴的应用[J].陕西中医,2002,23(10)：926-927
[88]程正云等.陕西中医,1985；(2)：74
[89]周裕民.中国针灸,1992：(2)30
[90]胡芝兰等.浙江中医学院学报,1988；(3)：50
[91]高微,乔喜芹针刺人迎穴为卞治疗呃逆122例[J].针灸临床杂志,2003；19(8)：63-64。
[92]皮健.中国针灸,1987；(3)：17
[93]仲跻尚.上海针灸杂志,1988；(4)：38
[94]朱春晖,顺兆军.人迎、水突穴脉冲电刺激治疗慢性喉炎zo例临床观察[J],《江苏中医药》2007,39(12)：74
[95]吕美珍.电针夹脊穴配针刺人迎穴治疗乳腺增生病的临床研究[J].山东中医药大学学报,2004,；28(3)：214-219.
[96]许顺荣等.中华理疗杂志,1984；(3)：160
[97]朱广友等.针刺研究,1986；(3)：191
[98]周裕民等.中国针灸,1991；(3)：35
[99]中华医学会全国第四届脑血管病学术会议.各类脑血管病疾病诊断要点[J].中华神经科杂志,1996,29(6)：379.
[100]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 (1)：55-56.
[101]梁繁荣.针灸学[M].上海：上海科学技术出版社,2006：134.
[102]韩蓉蓉.脑梗塞合并假性球麻痹致吞咽困难的康复治疗[J].中国康复医学杂志,2001：15(2)：
[103]郭芳人迎穴临床应用举隅[J]山西中医,2009；5(25-5)
[104]高重阳脑卒中后吞咽困难康复训练加针刺治疗疗效观察[J]中国老年学杂习,2008；12(28)
[105]刘孔江针刺与康复训练治疗卒中后吞咽困难研究进展[J]中国卒中杂志2009；8;4(8)
[106]朱槦连.急性脑卒中的常见并发症的康复[J].中风与神经疾病医学杂志,1997,14：125
[107]大西幸子,孙启良.摄食吞咽障碍康复实用技术[M].北京：中国医药科学技术出版社,2000
[108]李敏.中风假性球麻痹吞咽困难的临床研究[M].南京中医药大学硕十 学位论文,2009,06：12
[109]Deborah JC DavidG,Lalit Kalra Early assessments of dysphagia and aspiration risk in acute stroke patients[J].Stoke 2003 34 1252-1257
[110]汪洁.吞咽的生理机制与卒中后吞咽障碍[J]中国卒中杂志.2007,2(3)：220-225.
[111]张婧,于丹丹,杨波,等.喉上提速度减慢是卒中后误吸的独立危险因素[J]中国卒中杂志.2007,2(3)：197-200.
[112]林文注.实验针灸学[M］上海：上海科学出版社,1994.35
[113]蒋文华.中枢神经解剖学[M]上海：上海医科人学出版社,1997.111
[114]蒋文华.中枢神经解剖学[M]上海：上海医科人学出版社,1997.111
[115]王长垠.淫春萍.程燕玲.针刺配合功能恢复训练治疗卒中后吞咽困难的观察[J]中国康复医学杂志.2004,19(4)：295.
[116]干英,刘玉擅.关于人迎穴的研究概况[J].上海针灸杂志.1996,15(2)：36.
[117]张诗兴,徐恒译.干玉生.人迎穴的解剖特征及其主治功能浅析[J].镇江医学院学报.1998,8(4)：448.
[118]Beverly Cmnphell.Arteral waveforms:monitoring chamges in configuration[J].Heart Lung,1997, 26(3):204-214
[119]高维滨.聂卉.唐强.等.项针疗法治疗假性延髓麻痹的临床及机理研究[J].针刺研究.1998,23(1)：15
[120]陈艺 针刺治疗假性球麻痹临床观察[J]浙江中西医结合杂志 2006；16(7)
[121]胡玉珍 针刺人迎穴治疗中风偏瘫234例[J]山东中医杂志,1991；10(3)
[122]蒋戈利,干国华,王鹤云.通关利窍针法治疗脑中风性假性延髓麻痹300例上海针灸杂志,1997,17 (2)：19
[123]王瑞华.神经源性吞咽困难障碍的评定和康复[J]中国康复论与实践,2002；8.(2)：109-11.
[2]王永炎.中医内科学[M].上海：上海科学技术出版社,1997：125
[3]张宏伟.醒脑汤治疗中风假性球麻痹[J].中国中医急症,1997,6(2)：92
[4]蒋戈利.针刺治疗假性延髓麻痹临床研究概况[J].中医药信息,1989}6(26)：3
[5]石学敏.通关利窍针法治疗脑中风性假性延髓麻痹300例[[J].上海针灸杂志,1997,(2)：17-18
[6]杨俊生.针刺治疗脑血管病所致假性球麻痹96例观察[[J].针灸临床杂志,1999,15(5)：9-11
[7]张青云.补肾法针刺治疗假性延髓麻痹的临床研究[J].天津医药,2000,9(9)：571
[8]夏永潮,李妍怡,韩滟,等.中风病合并假性球麻痹50例的临床观察[J].中医杂志,1993,(4)：227
[9]王辉.针刺治疗假性延髓麻痹61例［J].中国针灸,1998,(7)：423-424
[10]刘军,刘志顺,黄石玺,等.针刺治疗假性球麻痹吞咽障碍临床观察[J].中国针灸,1996,16(10)：18
[11]崔立俊,干文生.辩证论治球麻痹综合征20例[J].山东中医杂志,1995,14(5)：304-305
[12]陈英华,李岩,陈伊.项针疗法为主治疗延髓麻痹[J].中医药信息,1999,(5)：41-42
[13]赵晓峰.针刺治疗中风性假性延髓麻痹56例[J].江苏中医,2000,(1)：30-31
[14]赵晓峰.针刺治疗中风性假性延髓麻痹56例[J].江苏中医,2000,(1)：30-31
[15]任家训.多发性脑梗塞并假性球麻痹治验[J].湖北中医杂志,1992 14(2)：41
[16]刘香华.针刺治疗中风舌本病-假性球麻痹的临床观察[J].中国针2000,20(6)：326
[17]张金茹.针刺治疗脑卒中假性球麻痹30例[J].北京中医,2004,23(1)：41-2
[18]秦黎红,王艳昕.颈项九针疗法治疗中风后吞咽困难临床研究[J].中国中医药信息杂志,2003,10(8)：64
[19]周佛养,李中林,李飞,等.针刺廉泉、风池透风池穴对假性球麻痹患者TCD的影响[J].安徽中医学院学报,2007}26(4)：26
[20]杨永梅,罗守滨,岳卫东,等.脑卒中后假性球麻痹致吞咽困难的针刺治疗[J].天津中医药,2005,22(6)：475-476
[21]许晶,何淑艳,庞妹弘.针刺疗法治疗脑卒中假性球麻痹吞咽困难[J].针灸临床杂志,2001(17)8：14
[22]王秀杰,陈伊.针药并用治疗中风吞咽困难48例疗效观察[J].针刺临床杂志,1999,15(9)：12
[23]张若燕,冉茂东,郭蕴屏.针刺治疗假性球麻痹84例.[J]辽宁中医杂志,2002 29(6)：360
[24]赵长泉,张月峰.开窍降逆针刺治疗吞咽障碍13例[J].中国针刺,2001,21(10)：586
[25]农泽宁.预三针为主治疗假性球麻痹40例[J].中国针灸,2001 21(2)：126
[26]陆青,黄柳妮.脑卒中后吞咽障碍的康复治疗.[J]广西中医药,2002,25(3)：43
[27]张毅明,颜纷,张敏.针刺治疗脑血管意外假性球麻痹疗效观察[J].中华现代中医学杂志,2006,2(4)：357
[28]苏永立,李沛,赵高峰.电针治疗中风后吞咽困难45例[J].山东中医杂志,2003,22(3)：164
[29]包烨华.针刺解语穴治疗中风后遗症临床体会[J]浙江中医杂志,1999,34(10)：446
[30]李俊坤,李红珍.针刺舌下治疗假性球麻痹46例疗效观察[J].河北中医,2003 25(1)：47
[31]周志军.翳风穴电针治疗脑卒中吞咽障碍患者60例体会[J].中国临床康复,2004,8(19)：3848
[32]李骁飞,邢锐,高霞.舌三针为主治疗假性球麻痹47例疗效观察[J].河北中医,2006,28(9)：649
[33]刘孔江.咽三针治疗中风吞咽困难76例[J].南京中医药大学学报,2000,16(6)：361
[34]马培锋.针刺阿呛穴治疗中风后吞咽困难35例[J].中国针灸,2007,27(6)：472
[35]宋文革,刘萌,张彦.头针治疗假性延髓麻痹所致吞咽困难30例[J].针刺临床杂志,1999,15(12)：223
[36]干炳强,韩广顺,赵景波等.头针治疗中风后球麻痹所致吞咽困难[J].吉林中医药,2004,24(9)：49
[37]党读华,夏冰,杨晓兰.耳针治疗假性球麻痹120例[J].浙江中医杂志,1997,19(2)69-71
[38]Crary MA,Groher M E.Introduction to Adult Swallowing Disorders[M].2003:Elsevier Science:Butterworth Heinemann
[39]Leonard R, Kendall K. Dysphagia assessment and treatment planning, a team approach[M]. 1997:SingularPublishing Group
[40]Langmore SE. Evaluation of or opharyngeal dysphagia:which diagnostic tool is superior[J].Curr OpinOtolaryngol Head Neck Surg,2003,11:485-489
[41]Vanoo Jayasekeran,Emilia Michou,Shaheen Hamdy(著);张婧(译).卒中后口咽吞咽困难的治疗[J].中国卒中杂志,2007,2(3)：259
[42]Hmady S, Aziz Q, Rothwell JC, et al. Crnaial never modulation of human cortical swallowing motorPhatwyas[J].AmJPhysiol.1997.272:G802-6808
[43]HamdyS, RothwellJC, Aziz Q et al. Organization and reorganization swallowing motor cortex.imPlications for recovery after Clinsci (Lond),2000,99:151-157. of human stroke.
[44]Gordon C, Hewer RL, Wade DT. Dysphagia in acute stoke[J].J Bri Med,1987,295:411-414
[45]彭拥军.针药治疗假性球麻痹的临床进展.[J]甘肃中医,2003 (16)：1。史玉泉主编.实用神经病学.上海二上海科学技术出版社,2000;第二版：206。
[46]卓大宏.中国康复医学[M].北京：华夏出版社,2004;720-5.孙启良.吞咽困难的功能评价和康复治疗[J].中日友好医院学报,2006;20(5)：294-7.
[47]大西幸子,孙启良.摄食、吞咽障碍康复实用技术[M].赵俊译.北京：中国医药科学技术出版社,2000：7-18.
[48]Aral T,Yasuda Y,Takaya T,etal.Technetium tin colloid test detecting symptomless dysphagia and ACE inhibitor prevented occurrence of aspiration pneurnonia.Int J Mol Med,2000; 5 (6):609-610.
[49]李继安.吞咽困难临床评估与功能检查[J].中国综合临床,2005;21(11)：1045-6.
[50]孙启良.吞咽困难的功能评价和康复治疗[J].中日友好医院学报,2006;20(5)：294-
[51]Domenech E, Kelly J. Swallowing disorders. Med Clin North Am,1999 83:97-113
[52]Bastian Videoendoscopic evaluation of patients with dysphagia an adjunct to modified barium swallow. Otolaryngol Head Neck Sury,1991; 104:339-350
[53]Goulding R, Bakheit AM.Evalation of the benefits of monitoring fluid thickness in the dietary management of dysphagic stroke patients. Clin Rehabil,2000; 14 (2):119-124
[54]张婧,王拥军.卒中后吞咽困难的评估和治疗.国外医学脑血管分,2003：11 (4)263-265
[55]Wojner AW, Alexandrov AV. Preditors of tube feeding in acute stroke patients with dysphagia. AACN Clin Issues,2000,11 (4):531-540.
[56]Nakajon K,Nakagawa T, Sekizawa K, etal. Relation between incidence of pneumonia and protective reflexes in post-stroke patients with oral or tube feeding. Jintern Med,2000,247 (1):39-42.
[57]Cook IJ,Kahrilas PJ.AGA technical review on management of oropharyngeal dysphagia.Gastroenterology,1999,116:455-478.
[58]Runions S, Rodrigue N, White C.Practice on an acute stroke unit after implementation of a decision-making algorithm for dietary management of dysphagia.J Neurosci Nurs,2004 36 (5):200
[59]Besson G, Bogousslavasky J, Regli F, et al.Aeute pseudobulbar or suprabulbar palsy.Areh Neurol, 1991,48:501
[60]Perez I, Smit hard DG, Davies H, et al.Pharmacological treatment of dysphagia in stroke.Dysphagia,199813(1):1216
[61]Bakheit AMO.Management of neurogenic dysphagia.Postgrad Med[J],2001,77(913):694699
[62]James A, Kapur K, Hawthorne AB. Long-term outcome of percutesneous endoscopic gastrostomy feeding in patients with dysphagic stroke. Age Ageing,1998,27 (6):671-676.
[63]Smit hard DG, O'Neill PA, Parks C, et al.Coplications and out-come after aeute Stroke.Does dysphagia matter Stroke,1996,27(7):1200-1204
[64]Jacobsson C, Axelsson K, Norberg A, etal. Outcomes of individualized interventions in patients with severe eating dimculties. Clin Nurs Res,1997,6(1):25-44.
[65]罗秀忠.星状神经节阻滞对脑卒中吞咽障碍的疗效观察[[J].中国临床康复,2003,7,(22)：312
[66]Butefisch C, Hummelsheim H, Denzler P, et al. Repetitive training of isolated movements improves the outcome of motor rehabilitation of the centrally paretichand[J]. J Neur Sci,1995, (130):59-68
[67]曹一鸣.新中医药,1956；7(10)：458
[68]王立早.吉林中医药,1981；(4)： 34
[69]侯肇楷.广西中医药,1981；(6)24
[70]叶树培.福建中医药杂志,1957；2(3)：25
[71]曹一鸣.新中医药,1956；7(10)：458
[72]陈剑勇.浙江中医杂志,1960,(3)：120
[73]中国明.干龙海.颜贵明.人迎穴针刺安全深度的研究[J].安徽医学院学报.1999；18(5)：57-58
[74]仲跻尚.上海针灸杂志,1988；(4)：38
[75]胡芝兰等.浙江中医学院学报,1988；(3)：50
[76]宋江友.新中医,1987；(8)：：35
[77]许顺荣等.中华理疗杂志,1984；(3)：160
[78]曹一鸣.新中医药,1956；7(10)：458
[79]陈剑勇.浙江中医杂志,1960；(3)：120
[80]蒋松鹤,杨文秀,张慧玲.人迎穴的探讨及颈动脉窦定位实验[J].上海针灸杂志,1994：13(6)：269-270.
[81]卫彦.孙忠人.寇吉友.等.针刺人迎穴治疗高血压病120例临床观察[J].针灸临床杂志.2006；22(2)：4-5
[82]吴义新等.中国针灸,1982；(2)：9
[83]胡玉珍等.山东中医杂志.1991；(3)：29
[84]揭子慧,张玮.针刺人迎治疗椎动脉型颈椎病眩晕50例对照观察[J].山西中医,2007,23(4) 58—59
[85]刘之权等.新中医药.1979；(4)：119
[86]杨安生.深刺人迎穴点刺舌体治疗中风失语82例[J].湖南中医杂志,2000;16(2)：32
[87]富延萍.浅谈人迎穴的应用[J].陕西中医,2002,23(10)：926-927
[88]程正云等.陕西中医,1985；(2)：74
[89]周裕民.中国针灸,1992：(2)30
[90]胡芝兰等.浙江中医学院学报,1988；(3)：50
[91]高微,乔喜芹针刺人迎穴为卞治疗呃逆122例[J].针灸临床杂志,2003；19(8)：63-64。
[92]皮健.中国针灸,1987；(3)：17
[93]仲跻尚.上海针灸杂志,1988；(4)：38
[94]朱春晖,顺兆军.人迎、水突穴脉冲电刺激治疗慢性喉炎zo例临床观察[J],《江苏中医药》2007,39(12)：74
[95]吕美珍.电针夹脊穴配针刺人迎穴治疗乳腺增生病的临床研究[J].山东中医药大学学报,2004,；28(3)：214-219.
[96]许顺荣等.中华理疗杂志,1984；(3)：160
[97]朱广友等.针刺研究,1986；(3)：191
[98]周裕民等.中国针灸,1991；(3)：35
[99]中华医学会全国第四届脑血管病学术会议.各类脑血管病疾病诊断要点[J].中华神经科杂志,1996,29(6)：379.
[100]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 (1)：55-56.
[101]梁繁荣.针灸学[M].上海：上海科学技术出版社,2006：134.
[102]韩蓉蓉.脑梗塞合并假性球麻痹致吞咽困难的康复治疗[J].中国康复医学杂志,2001：15(2)：
[103]郭芳人迎穴临床应用举隅[J]山西中医,2009；5(25-5)
[104]高重阳脑卒中后吞咽困难康复训练加针刺治疗疗效观察[J]中国老年学杂习,2008；12(28)
[105]刘孔江针刺与康复训练治疗卒中后吞咽困难研究进展[J]中国卒中杂志2009；8;4(8)
[106]朱槦连.急性脑卒中的常见并发症的康复[J].中风与神经疾病医学杂志,1997,14：125
[107]大西幸子,孙启良.摄食吞咽障碍康复实用技术[M].北京：中国医药科学技术出版社,2000
[108]李敏.中风假性球麻痹吞咽困难的临床研究[M].南京中医药大学硕十 学位论文,2009,06：12
[109]Deborah JC DavidG,Lalit Kalra Early assessments of dysphagia and aspiration risk in acute stroke patients[J].Stoke 2003 34 1252-1257
[110]汪洁.吞咽的生理机制与卒中后吞咽障碍[J]中国卒中杂志.2007,2(3)：220-225.
[111]张婧,于丹丹,杨波,等.喉上提速度减慢是卒中后误吸的独立危险因素[J]中国卒中杂志.2007,2(3)：197-200.
[112]林文注.实验针灸学[M］上海：上海科学出版社,1994.35
[113]蒋文华.中枢神经解剖学[M]上海：上海医科人学出版社,1997.111
[114]蒋文华.中枢神经解剖学[M]上海：上海医科人学出版社,1997.111
[115]王长垠.淫春萍.程燕玲.针刺配合功能恢复训练治疗卒中后吞咽困难的观察[J]中国康复医学杂志.2004,19(4)：295.
[116]干英,刘玉擅.关于人迎穴的研究概况[J].上海针灸杂志.1996,15(2)：36.
[117]张诗兴,徐恒译.干玉生.人迎穴的解剖特征及其主治功能浅析[J].镇江医学院学报.1998,8(4)：448.
[118]Beverly Cmnphell.Arteral waveforms:monitoring chamges in configuration[J].Heart Lung,1997, 26(3):204-214
[119]高维滨.聂卉.唐强.等.项针疗法治疗假性延髓麻痹的临床及机理研究[J].针刺研究.1998,23(1)：15
[120]陈艺 针刺治疗假性球麻痹临床观察[J]浙江中西医结合杂志 2006；16(7)
[121]胡玉珍 针刺人迎穴治疗中风偏瘫234例[J]山东中医杂志,1991；10(3)
[122]蒋戈利,干国华,王鹤云.通关利窍针法治疗脑中风性假性延髓麻痹300例上海针灸杂志,1997,17 (2)：19
[123]王瑞华.神经源性吞咽困难障碍的评定和康复[J]中国康复论与实践,2002；8.(2)：109-11.