针灸治疗对脑卒中患者吞咽障碍远期预后的影响  

Effect of Acupuncture on Long-term Outcomes in Patients with Post-stroke Dysphagia

作　　者：姚路路 梁伟[1] 杜鑫[2] 黄小波[1] YAO Lu-lu;LIANG Wei;DU Xin;HUANG Xiao-bo(Xuan Wu Hospital Capital Medical University,Beijing 100053,China;Beijing Hospital of Traditional Chinese Medicine,Capital Medical University,Beijing 100010,China)

机构地区：[1]首都医科大学宣武医院,北京100053 [2]首都医科大学附属北京中医医院,北京100010

出　　处：《神经损伤与功能重建》2022年第12期705-709,729,共6页Neural Injury and Functional Reconstruction

基　　金：国家自然科学基金青年项目(No.82004443)。

摘　　要：目的:观察针灸治疗对脑卒中后吞咽障碍患者的远期疗效。方法:从2020年6月至2021年10月在首都医科大学宣武医院和北京中医医院的住院患者中选取符合标准的研究对象。根据患者接受的治疗方法,分为对照组(接受常规治疗)和针灸组(在对照组基础上增加针灸治疗)。提取患者的一般信息,通过6个月的随访,获得患者吞咽功能恢复所需的时间和相关临床数据。主要结局指标定义为吞咽障碍量表(FILS)评分提高3分所需的时间,通过构建Cox风险模型评价针灸治疗和吞咽功能恢复之间的关系。结果:在研究期间共纳入375例患者,经倾向性评分匹配法处理后2组各入组129例患者。针灸组患者吞咽功能达到临床改善所需的中位时间为97 d(95%CI 93-124),对照组为119 d(95%CI 108-145),2组存在统计学差异(HR=1.48;95%CI 1.14-1.92;P<0.05)。针灸组118例(91.47%)吞咽功能达到临床改善,对照组107例(82.95%)达到临床改善(RR=1.10;95%CI 1.05-1.22;P<0.05)。6个月时,针灸组有78例(60.5%)达到功能独立,对照组有61例(47.3%)达到功能独立(RR=1.279;95%CI 1.019-1.616;P<0.05)。针灸组有106例(82.2%)达到功能良好,对照组有91例(70.5%)达到功能良好(RR=1.165;95%CI 1.017-1.346;P<0.05)。针灸组中治疗时间>1个月亚组(76例)的患者吞咽功能达到临床改善的中位时间为87.5 d(95%CI 84-95),治疗时间<1个月亚组(53例)为109 d(95%CI 94-123),差异有统计学意义(P<0.05)。纳入多变量调整Cox回归模型后2组患者吞咽功能恢复的时间仍存在差异(HR=1.79,95%CI 1.34-2.39)。针灸组最常见的不良事件是疼痛(36例,27.9%),2组基础治疗相关不良事件、肺部感染和卒中复发的发生率无统计学差异(P>0.05)。结论:针灸治疗可促进脑卒中吞咽障碍患者吞咽功能恢复,减轻残障程度,改善患者的远期生存质量。Objective:This study involves an analysis investigating the association of receiving acupuncture with long-term clinical outcomes of patients with post-stroke dysphagia.Methods:From June,2020 to October,2021,recruited patients from Xuanwu Hospital Capital Medical University and Beijing Hospital of Traditional Chinese Medicine who met the inclusion criteria.The patients in acupuncture group received acupuncture treatment,and the patients who did not receive acupuncture treatment in the same period were selected as the control group.The general information of patients was extracted,and the time required for the recovery of swallowing function and related clinical data were obtained through 6 months follow-up.The main outcome index is defined as the time required for clinical improvement of swallowing function(FILS score increased by 3 points).Cox risk model was established to evaluate the relationship between acupuncture treatment and swallowing function recovery.Results:During the study period,a total of 375 patients were included,and 129 patients in each group were enrolled after being treated by propensity score matching method.It took 97 days(95%CI 93-124)for patients in acupuncture group and 119 days(95%CI 108-145)for patients in control group to achieve clinical improvement,and there was a statistical difference between the two groups(HR=1.48;95%CI 1.14-1.92;P<0.05).118 patients in acupuncture treatment group achieved clinical improvement(91.47%),while 107 patients(82.95%)in control group achieved clinical improvement(RR=1.10;95%CI 1.05-1.22;P<0.05).At 6 months,78 patients(60.5%)in the acupuncture treatment group achieved functional independence,while 61 patients(47.3%)in the control group(RR=1.279;95%CI 1.019-1.616;P<0.05).106 patients(82.2%)in the acupuncture treatment group had good function,and 91 patients(70.5%)in the control group(RR=1.165;95%CI 1.017-1.346;P<0.05).In the acupuncture group,the clinical improvement time of patients with acupuncture treatment time longer than one month was 87.5 days(95%CI

关 键 词：针灸 吞咽障碍 吞咽功能 卒中 神经调控 

分 类 号：R741[医药卫生—神经病学与精神病学] R741.05[医药卫生—临床医学] R743R245