天突深刺治疗中风后吞咽障碍临床疗效观察
|
摘要
目的:观察天突深刺对中风后吞咽障碍患者吞咽功能的影响。方法:70例中风后吞咽障碍患者随机分成治疗组和对照组,每组35例。两组均进行康复训练,治疗组在康复训练的基础上采用天突深刺,对照组采用指南推荐的针灸组穴(风府、双侧百劳、双侧人迎、廉泉、双侧夹廉泉)进行治疗,两组均每周治疗5次,共治疗3周。于入组前及治疗后进行洼田氏饮水试验(KWST)、藤岛一郎吞咽评分(FIRS)及动态吞咽检查(VFSS)。根据以上3项评分计算临床有效率。结果:两组治疗后KWST评分较治疗前均降低,治疗组KWST评分差值大于对照组(P<0.05)。治疗后两组FIRS和VFSS评分较治疗前均升高(P<0.05),治疗组治疗前后评分差值大于对照组(P<0.05)。治疗组总有效率为88.57%(31/35),优于对照组的74.29%(26/35,P<0.05)。结论:天突深刺联合康复训练对中风后吞咽障碍患者的吞咽功能指标均有不同程度的改善,疗效优于使用指南推荐的针灸穴组。
Objective To observe the effect of deep acupuncture of Tiantu(CV22),etc.in combination with rehabilitation training on swallowing function of patients with post-stroke dysphasia.Methods A total of 70 patients suffering from poststroke dysphagia were randomly divided into control group(conventional acupuncture+swallowing rehabilitation training)and treatment group(deep acupuncture of CV22+rehabilitation training,n=35 cases in each group).The swallowing rehabilitation procedure was conducted 30 min every time,twice daily,5 times a week for 3 weeks.In patients of the treatment group,after deep insertion(about 80 mm)along the posterior margin of the manubrium sterna,the filiform needle in CV22 was lifted and thrusted repeatedly 9 times till the patient experienced a feeling of foreign matter blocking,followed by retaining the needle for 30 min.For patients of the control group,Lianquan(CV23)was punctured with 3 acupuncture needles(one vertical needling and bilateral slope needling toward the tongue root),and Fengfu(GV16),bilateral Bailao(EX-NH23),bilateral Renying(ST9)and bilateral Jialianquan(Extra)were punctured vertically with filiform needles.The treatment was conducted once daily,5 times a week for 3 weeks.The swallowing function was evaluated by using Kubota water swallowing test(KWST)scale(0-5 points),Fujishima Ichiro rating scale(FIRS,0-10 points),and video fluoroscopic swallowing study(VFSS,0-10 points),separately.The therapeutic effect was also assessed according to the clinical scale scores and VFSS results.Results Following the treatment,of the two 35 cases in the control and treatment groups,4(11.43%)and 8(22.86%)experienced marked improvement in their symptoms,22(62.86%)and 23(65.71%)were effective,and 9(25.71%)and 4(11.43%)were failed,with the effective rates being 74.29%and 88.57%,respectively.After the treatment,the KWST score of the two groups were significantly decreased in comparison with their own pre-treatment(P<0.05),while the FIRS and VFSS scores of the two groups were considerably increased in comparison with their own pre-treatment(P<0.05).The therapeutic effects of the treatment group were obviously superior to those of the control group in the effective rate,lowering KWST score and in raising FIRS and VFSS scores(P<0.05).Conclusion Acupuncture plus swallowing rehabilitation training is effective in improving the swallowing function of stroke patients with dysphagia,and the deep acupuncture stimulation of CV22 is apparently better than conventional acupuncture in the therapeutic effect.
Objective To observe the effect of deep acupuncture of Tiantu(CV22),etc.in combination with rehabilitation training on swallowing function of patients with post-stroke dysphasia.Methods A total of 70 patients suffering from poststroke dysphagia were randomly divided into control group(conventional acupuncture+swallowing rehabilitation training)and treatment group(deep acupuncture of CV22+rehabilitation training,n=35 cases in each group).The swallowing rehabilitation procedure was conducted 30 min every time,twice daily,5 times a week for 3 weeks.In patients of the treatment group,after deep insertion(about 80 mm)along the posterior margin of the manubrium sterna,the filiform needle in CV22 was lifted and thrusted repeatedly 9 times till the patient experienced a feeling of foreign matter blocking,followed by retaining the needle for 30 min.For patients of the control group,Lianquan(CV23)was punctured with 3 acupuncture needles(one vertical needling and bilateral slope needling toward the tongue root),and Fengfu(GV16),bilateral Bailao(EX-NH23),bilateral Renying(ST9)and bilateral Jialianquan(Extra)were punctured vertically with filiform needles.The treatment was conducted once daily,5 times a week for 3 weeks.The swallowing function was evaluated by using Kubota water swallowing test(KWST)scale(0-5 points),Fujishima Ichiro rating scale(FIRS,0-10 points),and video fluoroscopic swallowing study(VFSS,0-10 points),separately.The therapeutic effect was also assessed according to the clinical scale scores and VFSS results.Results Following the treatment,of the two 35 cases in the control and treatment groups,4(11.43%)and 8(22.86%)experienced marked improvement in their symptoms,22(62.86%)and 23(65.71%)were effective,and 9(25.71%)and 4(11.43%)were failed,with the effective rates being 74.29%and 88.57%,respectively.After the treatment,the KWST score of the two groups were significantly decreased in comparison with their own pre-treatment(P<0.05),while the FIRS and VFSS scores of the two groups were considerably increased in comparison with their own pre-treatment(P<0.05).The therapeutic effects of the treatment group were obviously superior to those of the control group in the effective rate,lowering KWST score and in raising FIRS and VFSS scores(P<0.05).Conclusion Acupuncture plus swallowing rehabilitation training is effective in improving the swallowing function of stroke patients with dysphagia,and the deep acupuncture stimulation of CV22 is apparently better than conventional acupuncture in the therapeutic effect.
引文
[1]BARER D H.The natural history and functional consequences of dysphagia after hemispheric stroke[J].J Neurol Neurosurg Psychiatry,1989,52(2):236-241.
[2]MENG N H,WANG T G,LIEN I N.Dysphagia in patients with brainstem stroke:incidence and outcome[J].Am JPhysic Med Rehabil,2000,79(2):170-175.
[3]MARIK P E,KAPLAN D.Aspiration pneumonia and dysphagia in the elderly[J].Chest,2003,124(1):328-336.
[4]SHARMA J C,FLETCHER S,VASSALLO M,et al.What influences outcome of stroke-pyrexia or dysphagia[J].Int JClin Pract,2001,55(1):17-20.
[5]ICKENSTEIN G W,STEIN J,AMBROSI D,et al.Predictors of survival after severe dysphagic stroke[J].J Neurol,2005,252(12):1510-1516.
[6]UMAY E K,YAYLACI A,SAYLAM G.The effect of sensory level electrical stimulation of the masseter muscle in early stroke patients with dysphagia:a randomized controlled study[J].Neurol India,2017,65(4):734-742.
[7]冯声旺,曹淑华,杜淑佳,等.针刺配合吞咽训练治疗脑卒中后吞咽障碍:随机对照研究[J].中国针灸,2016,36(4):347-350.
[8]卫生部疾病控制司,中华医学会神经病学分会.中国脑血管病防治指南[M].北京:人民卫生出版社,2005:30.
[9]Scottish Intercollegiate Guidelines Network(SIGN).Management of Patients with Stroke PartⅢ:Identification and Management of Dysphagia[M].Edinburgh:SIGN,2004.
[10]国家中医管理局.中医病证诊断疗效标准[S].南京:南京大学出版社,1994:119.
[11]国家中医药管理局脑病急症协作组.中风病中医诊断与疗效评定标准(试行)[J].北京中医药大学学报,1996,19(1):55-56.
[12]中国中医科学院.WHO中医循证临床实践指南-中医内科分册[M].北京:中国中医药出版社,2011:286.
[13]大西幸子,孙启良.脑卒中患者摄食吞咽障碍的评价与训练[J].中国康复医学杂志,1997,12(3):414-415.
[14]藤岛一郎,太熊るリほか.假性球麻痹による咽下障害とリハヒリテ-シヨン[J].神经内科,1997,47(10):32-39.
[15]陈启波,谭毅.针刺与康复训练治疗脑卒中后吞咽功能障碍的研究进展[J].中国临床新医学,2013,22(8):829-833.
[16]ELMER S,HANGGI J,JANCKE L.Interhemispheric transcallosal connectivity between the left and right planum temporale predicts musicianship,performance in temporal speech processing,and functional specialization[J].Brain Struct Funct,2016,221(1):331-344.
[17]万民生.大针深刺临证探究[J].内蒙古中医药,2017,4(7):59-61.
[18]马宁.任脉、督脉的胚胎发生学探讨[J].山东中医药大学学报,2017,41(5):412-416.
[2]MENG N H,WANG T G,LIEN I N.Dysphagia in patients with brainstem stroke:incidence and outcome[J].Am JPhysic Med Rehabil,2000,79(2):170-175.
[3]MARIK P E,KAPLAN D.Aspiration pneumonia and dysphagia in the elderly[J].Chest,2003,124(1):328-336.
[4]SHARMA J C,FLETCHER S,VASSALLO M,et al.What influences outcome of stroke-pyrexia or dysphagia[J].Int JClin Pract,2001,55(1):17-20.
[5]ICKENSTEIN G W,STEIN J,AMBROSI D,et al.Predictors of survival after severe dysphagic stroke[J].J Neurol,2005,252(12):1510-1516.
[6]UMAY E K,YAYLACI A,SAYLAM G.The effect of sensory level electrical stimulation of the masseter muscle in early stroke patients with dysphagia:a randomized controlled study[J].Neurol India,2017,65(4):734-742.
[7]冯声旺,曹淑华,杜淑佳,等.针刺配合吞咽训练治疗脑卒中后吞咽障碍:随机对照研究[J].中国针灸,2016,36(4):347-350.
[8]卫生部疾病控制司,中华医学会神经病学分会.中国脑血管病防治指南[M].北京:人民卫生出版社,2005:30.
[9]Scottish Intercollegiate Guidelines Network(SIGN).Management of Patients with Stroke PartⅢ:Identification and Management of Dysphagia[M].Edinburgh:SIGN,2004.
[10]国家中医管理局.中医病证诊断疗效标准[S].南京:南京大学出版社,1994:119.
[11]国家中医药管理局脑病急症协作组.中风病中医诊断与疗效评定标准(试行)[J].北京中医药大学学报,1996,19(1):55-56.
[12]中国中医科学院.WHO中医循证临床实践指南-中医内科分册[M].北京:中国中医药出版社,2011:286.
[13]大西幸子,孙启良.脑卒中患者摄食吞咽障碍的评价与训练[J].中国康复医学杂志,1997,12(3):414-415.
[14]藤岛一郎,太熊るリほか.假性球麻痹による咽下障害とリハヒリテ-シヨン[J].神经内科,1997,47(10):32-39.
[15]陈启波,谭毅.针刺与康复训练治疗脑卒中后吞咽功能障碍的研究进展[J].中国临床新医学,2013,22(8):829-833.
[16]ELMER S,HANGGI J,JANCKE L.Interhemispheric transcallosal connectivity between the left and right planum temporale predicts musicianship,performance in temporal speech processing,and functional specialization[J].Brain Struct Funct,2016,221(1):331-344.
[17]万民生.大针深刺临证探究[J].内蒙古中医药,2017,4(7):59-61.
[18]马宁.任脉、督脉的胚胎发生学探讨[J].山东中医药大学学报,2017,41(5):412-416.