头项针辅助治疗脑卒中恢复期咽期吞咽障碍:随机对照试验  

Scalp-nape acupuncture as adjuvant therapy for pharyngeal dysphagia of stroke at recovery stage: a randomized controlled trial

作　　者：余静[1] 朱颖 毛君慧 袁健辉 徐亚林 黄金秀[1] YU Jing;ZHU Ying;MAO Jun-hui;YUAN Jian-hui;XU Ya-lin;HUANG Jin-xiu(Department of Acupuncture-Moxibustion and Rehabilitation,Hangzhou Hospital of TCM,Hangzhou 310007,Zhejiang Province,China;Third Clinical College,Zhejiang Chinese Medical University;Community Health Service Center,Xianlin Street,Yuhang District,Hangzhou)

机构地区：[1]杭州市中医院针灸康复科,浙江杭州310007 [2]浙江中医药大学第三临床医学院 [3]杭州市余杭区闲林街道社区卫生服务中心

出　　处：《中国针灸》2022年第5期481-485,497,共6页Chinese Acupuncture & Moxibustion

基　　金：浙江省中医药科技计划项目:2018ZA083;杭州市医学重点学科建设项目。

摘　　要：目的:观察在神经肌肉电刺激及康复训练基础上,联合头项针治疗脑卒中恢复期咽期吞咽障碍的临床疗效。方法:将42例脑卒中恢复期咽期吞咽障碍患者随机分为观察组和对照组,各21例。两组均予内科常规对症治疗,对照组采用神经肌肉电刺激及康复训练治疗,各30 min;观察组在对照组基础上加用头项针治疗,头针穴取顶颞前斜线、顶颞后斜线下2/5,项针穴取风池、翳明、供血、治呛、吞咽等。两组均每日治疗1次,每周5 d,共治疗3周。分别于治疗前后观察两组患者吞咽障碍造影评分量表(VDS)评分、洼田饮水试验评级、功能性经口摄食量表(FOIS)评级和吞咽障碍特异性生活质量(SWAL-QOL)评分。结果:治疗后,两组患者VDS评分较治疗前降低、SWAL-QOL评分较治疗前升高(P<0.05),洼田饮水试验及FOIS评级均较治疗前改善(P<0.05);观察组患者VDS、SWAL-QOL评分改善程度及洼田饮水试验、FOIS评级均优于对照组(P<0.05)。结论:在神经肌肉电刺激及康复训练基础上联合头项针可提高脑卒中恢复期咽期吞咽障碍的临床疗效,改善患者吞咽功能及生活质量。Objective To observe the therapeutic effect of scalp-nape acupuncture for pharyngeal dysphagia of stroke at recovery stage on the basis of neuromuscular electrical stimulation(NMES) and rehabilitation training. Methods A total of 42 patients with pharyngeal dysphagia of stroke at recovery stage were randomized into an observation group and a control group, 21 cases in each group. Conventional medical symptomatic treatment was given in both groups. NMES and rehabilitation training were adopted in the control group, 30 min for each one. On the basis of the treatment in the control group, scalp-nape acupuncture was given in the observation group, scalp acupuncture was applied at lower 2/5 of anterior and posterior oblique lines of parietal and temporal, nape acupuncture was applied at Fengchi(GB 20), Yiming(EX-HN 14), Gongxue(Extra), Zhiqiang(Extra), Tunyan(Extra), etc. The treatment was given once a day, 5 days a week for 3 weeks in both groups. Before and after treatment, the videofluoroscopic dysphagia scale(VDS) score, the Kubota water swallowing test grade, the functional oral intake scale(FOIS) grade and the swallowing quality of life(SWAL-QOL) score were observed in both groups. Results After treatment, the VDS scores were decreased and the SWAL-QOL scores were increased compared before treatment(P<0.05), the Kubota water swallowing test grade and FOIS grade were improved compared before treatment(P<0.05) in both groups. The changes of VDS score and SWAL-QOL score, Kubota water swallowing test grade and FOIS grade in the observation group were superior to those in the control group(P<0.05). Conclusion Based on NMES and rehabilitation training, scalp-nape acupuncture can enhance the therapeutic effect on pharyngeal dysphagia of stroke at recovery stage, and improve the patients’ swallowing function and quality of life.

关 键 词：脑卒中 吞咽障碍 咽期 头项针 神经肌肉电刺激(NMES) 康复训练 随机对照试验(RCT) 

分 类 号：R246.6[医药卫生—针灸推拿学]