舌三针为主治疗脑卒中后吞咽功能障碍的临床研究  

Clinical Study of Dysphasia After Cerebral Stroke Mainly Treated with Three Tongue Needle Therapy

作　　者：江一静 林凌 游咏梅 林志诚 詹增土 夏敏 薛偕华 JIANG Yi-jing;LIN Ling;YOU Yong-mei;LIN Zhi-cheng;ZHAN Zeng-tu;XIA Min;XUE Xie-hua(Rehabilitation Hospital Affiliated to Fujian University of Traditional Chinese Medicine,Fuzhou 350003,China;Key Laboratory of Rehabilitation Technology of Fujian Province,Fuzhou 350003,China)

机构地区：[1]福建中医药大学附属康复医院,福州350003 [2]福建省康复技术重点实验室,福州350003

出　　处：《上海针灸杂志》2020年第5期530-535,共6页Shanghai Journal of Acupuncture and Moxibustion

基　　金：福建省科技厅对外合作项目(201710005);福建省科技厅平台建设项目(2015Y2001)。

摘　　要：目的观察舌三针为主治疗脑卒中后吞咽功能障碍的临床疗效及其对脑神经机制的影响。方法将130例脑卒中后吞咽功能障碍患者随机分为治疗组和对照组,每组65例。对照组采用康复训练配合低频脉冲电刺激治疗,治疗组在对照组基础上采用舌三针治疗。观察两组治疗前后吞咽功能(洼田饮水试验评分)、精神状态[汉密尔顿焦虑量表(HAMA)评分、汉密尔顿抑郁量表(HAMD)评分]及表面肌电图各项指标[平均振幅值(AEMG)、持续时间(t)]的变化情况。结果两组治疗后洼田饮水试验评分、HAMA评分及HAMD评分与同组治疗前比较,差异均具有统计学意义(P<0.05)。治疗组治疗后洼田饮水试验评分、HAMA评分及HAMD评分与对照组比较,差异均具有统计学意义(P<0.05)。两组治疗后空吞咽时及吞咽5 mL水时sEMG各项指标(颏下肌群及舌骨下肌群的AEMG和t)与同组治疗前比较,差异均具有统计学意义(P<0.05)。治疗组治疗后空吞咽时及吞咽5 mL水时sEMG各项指标与对照组比较,差异均具有统计学意义(P<0.05)。治疗组治疗后误吸及肺部感染的发生率分别为16.1%和17.7%,对照组分别为36.2%和32.8%,两组比较差异均具有统计学意义(P<0.05)。结论舌三针配合康复训练及低频脉冲电刺激能有效改善脑卒中患者的吞咽功能。Objective To observe the clinical efficacy of treating dysphasia after cerebral stroke mainly with three tongue needle therapy and its effect on cranial nerve mechanism.Method A total of 130 patients with dysphasia after cerebral stroke were randomized into a treatment group and a control group,with 65 cases in each group.The control group was treated with rehabilitation training plus low-frequency electric impulse stimulation,based on which the treatment group was given three tongue needle therapy.The two groups were observed before and after treatment through the changes of the following items:swallowing function(Kubota’s water swallowing test),mental state[Hamilton Anxiety Scale(HAMA),Hamilton Depression Scale(HAMD)]and surface electromyography(sEMG)parameters[average electromyogram(AEMG)and time(t)].Result The Kubota’s water swallowing test score,HAMA score and HAMD score changed significantly after treatment in both groups(P<0.05).After treatment,there were significant differences comparing the Kubota’s water swallowing test score,HAMA score and HAMD score between the two groups(P<0.05).The sEMG parameters(the AEMG and t of submental muscles and infrahyoid muscles)changed significantly after treatment in the test of swallowing without water and swallowing 5 mL of water in both groups(P<0.05).The sEMG parameters in the treatment group were significantly different from those in the control group after treatment in the test of swallowing without water and swallowing 5 mL of water(P<0.05).After treatment,the incidence rates of aspiration and pulmonary infection were 16.1%and 17.1%in the treatment group,versus 36.2%and 32.8%in the control group,and the between-group differences were statistically significant(P<0.05).Conclusion The three tongue needle therapy plus rehabilitation training and low-frequency electric impulse stimulation can effectively improve the swallowing function of cerebral stroke patients.

关 键 词：针刺疗法 中风 吞咽障碍 中风后遗症 洼田饮水试验 汉密尔顿焦虑量表 汉密尔顿抑郁量表 表面肌电图 舌三针 康复训练 

分 类 号：R246.6[医药卫生—针灸推拿学]