颈项围刺结合口腔点刺治疗脑卒中后吞咽障碍临床研究  

Clinical study on treatment of stroke dysphagia with neck pricking combined with oral pricking

作　　者：夏秋芳 孙亚男 朱慧雯 梁文玉 李海燕 Xia Qiufang;Sun Yanan;Zhu Huiwen;Lian Wenyu;Li Haiyan(Rehabilitation Department of Traditional Chinese Medicine,Shanghai First Rehabilitation Hospital,Shanghai 200090,China)

机构地区：[1]上海市第一康复医院中医康复科,200090

出　　处：《国际中医中药杂志》2020年第8期728-732,共5页International Journal of Traditional Chinese Medicine

基　　金：上海市进一步加快中医药事业发展三年行动计划[ZY(2018-2020)-FWTX-8015];杨浦区科委和卫健委中医专项科研课题(YP17ZQ03)。

摘　　要：目的评价颈项围刺结合口腔点刺治疗脑卒中后吞咽障碍的疗效。方法将符合纳入标准的2017年5月-2019年4月本院74例脑卒中后吞咽障碍患者按随机数字表法分为2组,每组37例。对照组在西医常规疗法及常规针刺治疗基础上配合吞咽功能康复训练,治疗组在对照组基础上配合颈项围刺结合口腔点刺治疗。2组均治疗3周。采用标准吞咽功能评价量表(Standardized Swallowing Assessment,SSA)评价患者的吞咽功能,采用电视透视X线吞咽造影(videofluoroscopic swallowing study,VFSS)观察液体状、稀糊状和糊状钡剂从患者口腔到咽喉、食道吞咽移动全过程的动态情况,采用Rosenbek渗透/误吸量表进行渗透-误吸程度分级,评价临床疗效。结果治疗后,治疗组SSA评分[(25.05±5.27)分比(28.66±5.33)分,t=2.884]低于对照组(P<0.05)。与同组治疗前比较,治疗组与对照组VFSS口腔期液体状(t值分别为5.199、5.413)、稀稠状(t值分别为4.761、4.824)、糊状(t值分别为5.295、4.428)评分及咽喉期液体状(t值分别为4.986、3.919)、稀稠状(t值分别为4.789、4.170)、糊状(t值分别为4.136、3.673)评分均升高(P<0.01),但组间比较差异无统计学意义(P>0.05)。治疗组与对照组患者治疗后Rosenbek渗漏-误吸程度分级均明显降低(Z值分别为4.224、2.956,P值均<0.01),但组间比较差异无统计学意义(P>0.05)。治疗组总有效率高于对照组[89.2%(33/37)比74.3%(26/35),Z=1.125],但差异无统计学意义(P=0.261)。结论颈项围刺结合口腔点刺配合康复训练可改善脑卒中后吞咽障碍患者的吞咽-摄食功能,疗效优于单纯康复训练。Objective To evaluate the clinical efficacy of neck pricking combined with oral pricking in the treatment of dysphagia after stroke.Methods Seventy-four patients with post-stroke dysphagia who met the inclusion criteria were randomly divided into the treatment group(acupuncture+rehabilitation training group)and the control group(rehabilitation training group)according to random number table method,37 cases for each group.Both groups of patients were given conventional drug therapy and rehabilitation of Chinese and Western medicine.On this basis,the control group used swallowing rehabilitation training.The treatment group used acupuncture combined with neck pricking and oral pricking based on swallowing rehabilitation training.Both groups were treated for 3 weeks.Before and after the treatment,three different traits of sputum(liquid,mushy and paste)videofluoroscopic swallowing study(VFSS)were observed for each patient,and the swallowing conditions were observed.The primary outcome measures were the oral swallowing scale score,the pharyngeal swallowing scale score,the Rosenbek infiltration/aspiration scale score,and the standard swallowing function rating scale(SSA).The improvement in swallowing function and aspiration was compared between the two groups.Results After treatment,the SSA score of the treatment group(25.05±5.27 vs.28.66±5.33,t=2.884)was lower than that of the control group(P<0.05).Compared with the same group before treatment,treatment group and control group of oral stage VFSS liquid(t=5.199,5.413),mushy(t=4.761,4.824)and pasty(t=5.295,4.428)scores,throat stage liquid(t=4.986,3.919),mushy(t=4.789,4.170)and pasty(t=4.136,3.673)scores were increased(P<0.01),but there was no statistically significant difference between the groups(P>0.05).After treatment,Rosenbek's leakage-aspiration degree classification was significantly reduced(Z values were 4.224,2.956,all Ps<0.01),but there was no statistically significant difference between the groups(P>0.05).The total effective rate was 89.2%(33/37)in the treatm

关 键 词：卒中 中风(中医) 吞咽障碍 围刺 点刺 中西医结合疗法 

分 类 号：R246.6[医药卫生—针灸推拿学]