“通关利窍”针刺法联合吞咽训练治疗脑卒中后吞咽障碍临床疗效及对表面肌电图和脑微循环的影响  

Clinical effect of“Tong Guan Li Qiao”needling method combined with swallowing training in the treatment of post-stroke dysphagia and its influence on surface electromyography and cerebral microcirculation

作　　者：张雯[1] 王非[1] 金海涛[1] 鲁铭[1] 杨晶[1] ZHANG Wen;WANG Fei;JIN Hai-tao;LU Ming;YANG Jing(Department of Encephalopathy,Wuhan Hospital of Traditional Chinese Medicine,Wuhan 430014,China)

机构地区：[1]武汉市中医医院脑病科,武汉430014

出　　处：《针刺研究》2022年第11期1025-1030,共6页Acupuncture Research

基　　金：湖北省武汉市医学科研项目(No.WZ20C36)。

摘　　要：目的:观察“通关利窍”针刺法联合吞咽训练治疗脑卒中后吞咽障碍(PSD)的临床疗效及对表面肌电图(sEMG)和脑微循环的影响。方法:PSD患者采用简单随机分组法分为观察组(59例)和对照组(57例),两组均在常规治疗基础上进行吞咽训练,观察组另加用“通关利窍”针刺法针刺水沟、内关、三阴交、风池、完骨、翳风等穴,两组均治疗4周。采用电视透视吞咽功能检查及标准吞咽功能评分(SSA)对吞咽功能进行评定并比较临床疗效;采用全功能肌电仪检测sEMG并计算波形平均值(AEMG)、波形面积(IEMG)、峰值;采用彩色多普勒超声仪检测脑血流收缩期峰值血流速度(PSV)、舒张期末峰值血流速度(EDV)、平均血流速度(MV)及血管搏动指数(PI)。结果:观察组总有效率为94.92%(56/59),对照组为82.46%(47/57),观察组高于对照组(P<0.05)。两组治疗后SSA初步评分、饮水5 mL评分和饮水60 mL评分均较本组治疗前明显降低(P<0.05),且观察组SSA饮水5 mL评分和饮水60 mL评分低于对照组(P<0.05)。两组治疗后AEMG、峰值和IEMG均较本组治疗前明显升高(P<0.05),且观察组AEMG、峰值和IEMG高于对照组(P<0.05)。两组治疗后脑血流PSV、EDV和MV均较本组治疗前明显加快(P<0.05),两组PI均明显降低(P<0.05),且观察组PSV、EDV和MV均快于对照组(P<0.05),PI低于对照组(P<0.05)。结论:“通关利窍”针刺法联合吞咽训练可有效改善PSD患者脑微循环,增强吞咽肌运动功能并促进吞咽功能恢复。Objective To observe the clinical efficacy of“Tong Guan Li Qiao”(unblocking gates and orifices)needling method combined with swallowing training in the treatment of post-stroke dysphagia(PSD)and its effect on surface electromyography(sEMG)and cerebral microcirculation.Methods A total of 116 patients with PSD were randomly divided into observation group(n=59)and control group(n=57).Patients in the control group received swallowing training on the basis of conventional treatment,whereas those in the observation group additionally received“Tong Guan Li Qiao”needling treatment,both groups were treated for 4 weeks.Swallowing function was assessed by video fluoroscopic swallowing study(VFSS)and standar-dized swallowing assessment(SSA)scale,the clinical efficacy was calculated.The sEMG was detected by a full-featured electromyography,the average EMG(AEMG),integrated EMG(IEMG)and peak value were calculated.Cerebral blood flow peak systolic velocity(PSV),end-diastolic velocity(EDV),mean velocity(MV)and pulse index(PI)were detected by cerebrovascular color Doppler ultrasound.Results The total effective rate of the observation group was 94.92%(56/59),higher than 82.46%(47/57)of the control group(P<0.05).After treatment,the initial scores,the scores of drinking 5 mL and 60 mL of water in the two groups were significantly lower than those before treatment(P<0.05),and the scores of drinking 5 mL and 60 mL of water in the observation group were lower than those in the control group(P<0.05).Compared with the same group before treatment,the AEMG,peak value,IEMG were higher(P<0.05),PSV,EDV and MV were faster(P<0.05)while PI was lower(P<0.05)in the two groups after treatment.Compared with the control group,the AEMG,peak value,IEMG were higher(P<0.05),PSV,EDV and MV were faster(P<0.05)while PI was lower(P<0.05)in the observation group.Conclusion“Tong Guan Li Qiao”needling method combined with swallowing training can effectively improve cerebral microcirculation,enhance the motor function of swallowing muscles and promote

关 键 词：脑卒中 针刺 吞咽障碍 脑微循环 

分 类 号：R245.311[医药卫生—针灸推拿学]