针刺联合康复治疗对脑卒中后阻塞性睡眠呼吸暂停并吞咽障碍临床观察  

Clinical Observation of Acupuncture-moxibustion plus Rehabilitation for Post-stroke Obstructive Sleep Apnea Coupled with Deglutition Disorders

作　　者：朱金妹[1] 何俊[1] 焦素芹[1] 韩乐园 ZHU Jin-mei;HE Jun;JIAO Su-qin;HAN Le-yuan(Changzhou Dean Hospital,Changzhou 213000,China)

机构地区：[1]常州市德安医院,常州213000

出　　处：《上海针灸杂志》2018年第12期1368-1372,共5页Shanghai Journal of Acupuncture and Moxibustion

基　　金：江苏省科技厅资助项目(BE2017752);常州市科技局资助项目(CE20175033)

摘　　要：目的观察针刺及口咽部综合康复训练治疗脑卒中后阻塞性睡眠呼吸暂停并吞咽障碍的临床疗效。方法筛选入院后经头颅CT或头颅MRI检查、多导睡眠监测(PSG)、洼田饮水试验、数字化吞咽造影检查(VFSS)确诊为脑卒中后同时有吞咽障碍和阻塞性睡眠呼吸暂停患者80例,随机分为治疗组40例、对照组40例。治疗组给予针刺联合口咽部综合康复治疗及常规神经内科治疗;对照组行口咽部综合康复治疗及常规神经内科治疗。疗程为30 d,并采用目前国际公认的吞咽评定项目洼田饮水试验评定、VFSS评定吞咽障碍,PSG中的低通气指数(AHI值)、夜间最低血氧饱和度(LSaO_2)对患者进行临床评估分析。结果两组治疗后洼田饮水试验评分、VFSS评分均显著好转(P<0.05),LSaO_2、低通气指数均显著好转(P<0.05),治疗组与对照组比较差异有统计学意义(P<0.05)。治疗组治疗后洼田饮水试验总有效率为90.0%,对照组为70.0%;治疗组VFSS总有效率为92.5%,对照组为75.0%;两组比较差异均有统计学意义(P<0.05)。结论针刺联合口咽部综合康复治疗脑卒中后阻塞性睡眠呼吸暂停并吞咽障碍疗效优于单纯口咽部康复治疗;通过针刺和口咽部康复治疗吞咽障碍可以有效改善阻塞性睡眠呼吸暂停。Objective To observe the clinical efficacy of acupuncture-moxibustion plus oropharyngeal rehabilitation training in treating post-stroke obstructive sleep apnea （OSA） coupled with deglutition disorders. Method After screened by head CT or MRI, polysomnography （PSG）, Kubota’s water drinking test and videofluoroscopic swallowing study （VFSS）, 80 patients diagnosed with post-stroke deglutition disorders and OSA were randomized into a treatment group of 40 cases and a control group of 40 cases. The treatment group was intervened by acupuncture-moxibustion plus oropharyngeal rehabilitation training and routine neurological treatment. The control group was only given oropharyngeal rehabilitation training and neurological treatment. The treatment lasted for 30 d. The clinical efficacy was evaluated by Kubota’s water drinking test, VFSS, apnea-hypopnea index （AHI） of PSG and lowest oxygen saturation （LSaO2）. Result The scores of Kubota’s water drinking test and VFSS were significantly improved after the intervention in the two groups （P〈0.05）, as well as the levels of LSaO2 and AHI （P〈0.05）, and the between-groupdifferences were statistically significant （P〈0.05）. The total effective rate in improving the Kubota’s water drinking test was 90.0% in the treatment group, versus 70.0% in the control group; the total effective rate for VFSS was 92.5% in the treatment group, versus 75.0% in the control group, and the between-group differences were statically significant （P〈0.05）. Conclusion Acupuncture-moxibustion plus oropharyngeal rehabilitation training can produce more significant efficacy than oropharyngeal rehabilitation training alone in treating post-stroke OSA coupled with deglutition disorders; acupuncture-moxibustion plus oropharyngeal rehabilitation training can effectively improve OSA via treating deglutition disorders.

关 键 词：针刺疗法 电针 中风后遗症 睡眠呼吸暂停 阻塞性 吞咽障碍 康复 洼田饮水试验 VFSS评分 夜间最低血氧饱和度 低通气指数 

分 类 号：R246.6[医药卫生—针灸推拿学]