“启闭利咽”针刺法配合导尿管球囊扩张术治疗脑梗死环咽肌失弛缓症所致吞咽障碍疗效观察  

Observation on the curative effect of acupuncture of“opening-closing for disinhibiting the pharynx”combined with urinary catheter balloon dilatation on dysphagia caused by achalasia of the cricopharyngeus muscle after cerebral infarction

作　　者：骆华[1] 张丽曼[1] 杜美茹[1] 刘宏斌[1] 石惠君 LUO Hua;ZHANG Liman;DU Meiru;LIU Hongbin;SHI Huijun(Shijiazhuang Hospital of Traditional Chinese Medicine,Shijiazhuang 050051,Hebei,China)

机构地区：[1]河北省石家庄市中医院,河北石家庄050051

出　　处：《现代中西医结合杂志》2020年第29期3231-3235,共5页Modern Journal of Integrated Traditional Chinese and Western Medicine

摘　　要：目的探讨“启闭利咽”针刺法配合导尿管球囊扩张术治疗脑梗死环咽肌失弛缓症所致吞咽障碍的临床疗效。方法将2017年4月—2019年5月石家庄市中医院收治的67例脑梗死环咽肌失弛缓症所致吞咽障碍患者随机分为2组,对照组33例给予常规吞咽康复训练及导尿管球囊扩张术治疗,观察组34例在对照组治疗基础上给予“启闭利咽”针刺法治疗,2组疗程均为4周。统计2组临床疗效,记录2组干预前后日本洼田饮水试验分级及评分、环咽肌开放情况和误吸情况、吞咽功能造影检查(VFSS)评分、咽通过时间、中文版生活质量量表(EDQoL)评分,疗程结束时评定患者进食水情况。结果观察组治疗总有效率为88.2%(30/34),对照组为69.7%(23/33),观察组明显高于对照组(P<0.05);治疗后2组日本洼田饮水试验分级及评分均明显降低(P均<0.05),且治疗后观察组的分级和评分均明显低于对照组(P均<0.05)。治疗后2组环咽肌开放情况均明显改善,误吸发生率均明显降低,VFSS评分明显增加,吞咽通过时间明显缩短,且观察组改善情况优于对照组,差异有统计学意义(P均<0.05)。治疗后2组生理/认知维度、工作/学习维度、心理维度、经济状况维度评分和总分均明显降低(P均<0.05),且治疗后观察组上述评分均低于对照组(P均<0.05)。疗程结束后,观察组可进水、可进食流质物、可进食糊状物、可进食固体食物率明显高于对照组(P均<0.05)。结论“启闭利咽”针刺法配合导尿管球囊扩张术可显著改善脑梗死环咽肌失弛缓症所致吞咽障碍患者的吞咽功能,缩短吞咽障碍恢复时间,降低误吸率,改善进食水能力,提高生活质量。Objective It is to explore the clinical curative effect of acupuncture of“opening-closing for disinhibiting the pharynx”combined with urinary catheter balloon dilatation on dysphagia caused by achalasia of the cricopharyngeus muscle after cerebral infarction.Methods 67 patients with dysphagia caused by achalasia of the cricopharyngeus muscle after cerebral infarction who were admitted to Shijiazhuang Hospital of Traditional Chinese Medicine from April 2017 to May 2019 were randomly divided into 2 groups,33 patients in the control group were treated with conventional swallowing rehabilitation training and urinary catheter balloon dilatation,34 cases in the observation group were treated with acupuncture of“opening-closing for disinhibiting pharynx”on the basis of the treatment of the control group.The course of treatment in both groups was 4 weeks.The clinical efficacy of the 2 groups was evaluated,and the classification and score of the Japanese Kubota drinking water test,the opening of cricopharyngeus muscle and aspiration status,the scores of videofluoroscopic swallowing study(VFSS),the pharynx passage time,and the scores of the eating disorders quality of life(EDQoL)were recorded,the water and food intake of the patients at the end of the treatment was evaluated.Results The total effective rate of treatment in the observation group was 88.2%(30/34),and the rate in the control group was 69.7%(23/33),the observation group was significantly higher than the control group(P<0.05).After treatment,the classification and score of the Japanese Kubota drinking water test in the two groups were significantly reduced(P<0.05),and the classification and scores of the observation group after treatment were significantly lower than those of the control group(P<0.05).After treatment in the two groups,the opening of the cricopharyngeal muscle in the two groups was significantly improved(P<0.05),the incidence of aspiration was significantly reduced(P<0.05),the VFSS scores were significantly increased(P<0.05),and the swal

关 键 词：启闭利咽 针刺 导尿管球囊扩张术 脑梗死 环咽肌失弛缓症 吞咽障碍 

分 类 号：R743.3[医药卫生—神经病学与精神病学]