针刺廉泉联合经颅直流电刺激治疗脑卒中后吞咽障碍临床观察  

Observation on the Clinical Effect of Acupuncture Lianquan (RN23) Combined with Transcranial Direct Current Stimulation in the Treatment of Dysphagia after Stroke

作　　者：李南华 方荣金 陈重捷[1] 汪庆华[1] LI Nanhua;FANG Rongjin;CHEN Chongjie;WANG Qinghua(Department of Rehabilitation Medicine,Xiamen Third Hospital,Fujian Province,Xiamen 361100,China;Urology Department,Haicang hospital,Fujian Province,Xiamen 361026,China)

机构地区：[1]厦门市第三医院康复医学科,福建厦门361100 [2]厦门市海沧医院泌尿外科,福建厦门361026

出　　处：《光明中医》2020年第22期3607-3610,共4页GUANGMING JOURNAL OF CHINESE MEDICINE

摘　　要：目的观察针刺廉泉联合经颅直流电刺激(t DCS)治疗脑卒中后吞咽障碍的临床疗效。方法选取2017年1月—2019年12月在厦门市第三医院康复医学科治疗的90例脑卒中后吞咽障碍患者,随机分为3组:廉泉组、t DCS组、廉泉结合t DCS组3组。廉泉组予以针刺廉泉及旁廉泉三针治疗,每次20 min,每日1次,每周6次,10 d为一个疗程,连续2个疗程;t DCS组接受阳极t DCS刺激,刺激部位为患侧口咽皮质头皮投影区,每次20 min,刺激强度为0~2 m A,每日1次,每周6次,10 d为一个疗程,连续2个疗程;廉泉结合t DCS组患者接受针刺廉泉旁廉泉三针外还接受阳极t DCS刺激,治疗强度同t DCS组。每日1次,每周6次,10 d为一个疗程,连续2个疗程;观察对比治疗前、治疗2个疗程后改良曼恩吞咽能力评估量表(MMASA)及Murray等制定的分泌物严重程度四级评分量表得分。结果治疗后3组间改良曼恩吞咽能力评估量表(MMASA)评分及Murray等制定的分泌物严重程度四级评分进行两两比较,结果显示廉泉组与t DCS组评分比较,差异无统计学意义,P>0.05;而廉泉结合t DCS组评分分别优于廉泉组及t DCS组,差异均有统计学意义(P<0.05)。结论针刺廉泉联合经颅直流电刺激治疗脑卒中后吞咽障碍可提高临床疗效,具有临床推广意义。Objective To observe the clinical effect of acupuncture Lianquan( RN23) combined with transcranial direct current stimulation( t DCS) on dysphagia after stroke. Methods Ninety patients with post-stroke dysphagia treated in the department of rehabilitation medicine of Xiamen Third Hospital from January 2017 to December 2019 were randomly divided into three groups: Lianquan group,t DCS group,and Lianquan combined t DCS group. The Lianquan group received acupuncture Lianquan and Pianlianquan three needles for 20 minutes,once a day,6 times a week,10 days as a course of treatment,2 consecutive courses. The t DCS group received t DCS stimulation,the site is the projection area of the affected oropharyngeal cortex,20 minutes each time,the stimulation intensity is 0 ~ 2 mA,once a day,6 times a week,10 days is a course of treatment,2 consecutive courses. Lianquan combined with t DCS group patients received acupuncture beside Lianquan three needles and received t DCS stimulation with the same treatment intensity as t DCS group,1 time a day,6 times a week,10 days for 1 course,2 consecutive courses. The severity of secretions developed by the modified Mann Swallowing Capacity Assessment Scale( MMASA)and Murray before treatment and after 2 courses of treatment,the scores of the four-level scoring scale were observed. The clinical efficacy was compared. Results After treatment,the Modified Mann Swallowing Ability Assessment Scale( MMASA) scores and Murray’s fourlevel secretion severity scores were compared in pairs. The results showed that there was no statistically significant difference between the Lianquan group and the t DCS group( P > 0. 05) The efficacy of Lianquan combined with t DCS group was better than that of Lianquan group and t DCS group,respectively,and the difference was statistically significant( P < 0. 05). Conclusion Acupuncture Lianquan( RN23)combined with transcranial direct current stimulation to treat dysphagia after stroke can improve the clinical therapeutic effect and has clinical significance.

关 键 词：吞咽障碍 脑卒中 廉泉三针 经颅直流电治疗 改良曼恩吞咽能力评估量表 纤维内视镜吞咽检查 

分 类 号：R246.6[医药卫生—针灸推拿学]