针刺联合冰棉棒刺激对卒中后假性球麻痹吞咽障碍患者表面肌电图及血清GFAP、GDF-15的影响  

Effects of Acupuncture Combined with Iced Cotton Swab Stimulation on Surface Electromyogram and Serum GFAP and GDF-15 in Patients with Dysphagia Due to Post-stroke Pseudobulbar Paralysis

作　　者：杨晶[1] 张京兰[1] 王非[1] YANG Jing;ZHANG Jinglan;WANG Fei(Wuhan Hospital of Traditional Chinese Medicine of Hubei Province,Wuhan 430000,China)

机构地区：[1]湖北省武汉市中医医院,武汉430000

出　　处：《上海针灸杂志》2022年第8期765-770,共6页Shanghai Journal of Acupuncture and Moxibustion

基　　金：武汉市医学科研项目(WZ21C42)。

摘　　要：目的观察针刺联合冰棉棒刺激对卒中后假性球麻痹吞咽障碍患者表面肌电图及血清神经胶质纤维酸性蛋白(GFAP)、生长分化因子(GDF)-15的影响。方法将74例卒中后假性球麻痹吞咽障碍患者随机分为对照组和观察组,每组37例。对照组予冰棉棒刺激,观察组在此基础上予针刺治疗。比较两组洼田饮水试验评定等级、标准吞咽功能评价量表(SSA)评分、舌骨上肌群及舌骨下肌群吞咽时程及最大波幅值、血清GFAP和GDF-15水平,比较两组临床疗效。结果观察组总有效率高于对照组(P<0.05)。治疗后,两组洼田饮水试验评定等级均改善(P<0.05),且观察组优于对照组(P<0.05);两组SSA评分均降低(P<0.05),观察组低于对照组(P<0.05);两组患者舌骨上、下肌群的吞咽时程均缩短(P<0.05),最大波幅值均增高(P<0.05),且观察组舌骨上、下肌群的吞咽时程及最大波幅值均优于对照组(P<0.05);两组血清GFAP和GDF-15水平均降低(P<0.05),且观察组低于对照组(P<0.05)。结论针刺联合冰棉棒刺激治疗卒中后假性球麻痹吞咽障碍疗效优于单纯冰棉棒刺激,可促进吞咽功能恢复,改善舌骨上、下肌群表面肌电图的吞咽时程及最大波幅值,降低血清GFAP和GDF-15水平。Objective To observe the effects of acupuncture plus iced cotton swab stimulation on the surface electromyogram and serum glial fibrillary acidic protein(GFAP)and growth differentiation factor(GDF)-15 in patients with dysphagia due to post-stroke pseudobulbar paralysis.Method Seventy-four patients with dysphagia due to post-stroke pseudobulbar paralysis were randomized into a control group and an observation group,with 37 cases in each group.The control group was treated with iced cotton swab stimulation,and the observation group was given additional acupuncture treatment.The Kubota’s water swallowing test grade,standardized swallowing assessment(SSA)score,swallowing durations of the suprahyoid and infrahyoid muscle groups and the maximum amplitudes,and serum GFAP and GDF-15 levels were compared.The clinical efficacy was also compared between the two groups.Result The observation group had a higher total effective rate than the control group(P<0.05).After the treatment,the Kubota’s water swallowing test grade improved in both groups(P<0.05)and was better in the observation group than in the control group(P<0.05).The SSA score dropped in both groups(P<0.05)and was lower in the observation group than in the control group(P<0.05).The swallowing durations of the suprahyoid and infrahyoid muscle groups became shorter(P<0.05)with elevated maximum amplitudes(P<0.05)in both groups,and better results were found in the observation group(P<0.05).The serum GFAP and GDF-15 levels declined in the two groups(P<0.05)and were lower in the observation group than in the control group(P<0.05).Conclusion Compared with iced cotton swab stimulation alone,the addition of acupuncture can produce more outstanding efficacy in treating dysphagia due to post-stroke pseudobulbar paralysis;it can foster recovering the swallowing function,ameliorating the swallowing durations and maximum amplitude of the suprahyoid and infrahyoid muscle groups on surface electromyogram,and down-regulating serum GFAP and GDF-15 levels.

关 键 词：针刺疗法 中风后遗症 假性球麻痹 吞咽障碍 肌电图 神经胶质纤维酸性蛋白 生长分化因子15 

分 类 号：R246.6[医药卫生—针灸推拿学]