针刺联合间接吞咽训练对重型脑损伤后气管切开患者吞咽功能及拔管成功率的影响  

Effect of Acupuncture Combined with Indirect Swallowing Training on Swallowing Function and Extubation Success Rate of Patients with Tracheotomy after Severe Brain Injury

作　　者：李落意[1] 胡梦露 江幸福[1] 王萍[1] 阮薇 洪伟[1] 汪学鹏 李飞[2] 杨骏[1] LI Luoyi;HU Menglu;JIANG Xingfu;WANG Ping;RUAN Wei;HONG Wei;WANG Xuepeng;LI Fei;YANG Jun(Department of Neurosurgery,The First Affiliated Hospital of Anhui University of Chinese Medicine,Hefei 230031,Anhui,China;Department of Rehabilitation,The Second Affiliated Hospital of Anhui University of Chinese Medicine,Hefei 230061,Anhui,China)

机构地区：[1]安徽中医药大学第一附属医院神经外科,安徽合肥230031 [2]安徽中医药大学第二附属医院康复二科,安徽合肥230061

出　　处：《辽宁中医杂志》2023年第5期207-210,共4页Liaoning Journal of Traditional Chinese Medicine

基　　金：国家自然科学基金项目(81873370);安徽省高等学校自然科学研究项目(KJ2021A0549);安徽中医药大学第一附属医院优秀医学人才基金项目(院发[2019]118号)。

摘　　要：目的观察针刺联合间接吞咽训练对重型脑损伤后气管切开患者吞咽功能、拔管成功率及格拉斯哥评分(GCS)的影响。方法将重型脑损伤后气管切开患者随机分为A、B、C 3组,每组30例。A组、B组分别为对照组,C组为观察组,3组均行基础治疗。A组行间接吞咽训练,B组行针刺治疗,C组采用针刺联合间接吞咽训练治疗。3组均每日治疗1次,每周6次,休息1 d,共治疗4周,疗程结束后比较3组拔除气管套管的成功率、吞咽功能痊愈率和总改善率及GCS评分变化。结果(1)疗程结束后,C组的拔管成功率为64.29%(18/28)明显高于A组的32.14%(9/28)和B组的34.48%(10/29)(P<0.05);(2)疗程结束后,3组GCS评分均较前升高,其中C组评分高于A、B两组(P<0.05),A、B两组相比,差异无统计学意义(P>0.05);(3)疗程结束后,C组的痊愈率和总改善率明显高于A、B两组(P<0.01),且A、B两组相比,差异无统计学意义(P>0.05)。结论针刺联合间接吞咽训练能改善吞咽功能及促进意识恢复,能显著提高重型脑损害后气管切开患者拔管成功率,优于间接吞咽训练及针刺治疗。Objective To observe the effects of acupuncture combined with indirect swallowing training on swallowing function,success rate of extubation and Glasgow score(GCS)in patients with tracheotomy after severe brain injury.Methods Patients with tracheotomy after severe brain injury were randomly divided into three groups:A,B and C,with 30 cases in each group.Group A and B were the control groups,and group C was the observation group.Three groups all received basic treatment.Group A received indirect swallowing training,group B received acupuncture treatment,and group C received acupuncture combined with indirect swallowing training.The three groups were treated once a day,6 times a week,with a day's rest,for a total of 4 weeks.After the treatment,the success rate of tracheal tube removal,the recovery rate of swallowing function,the total improvement rate and GCS score of the three groups were compared.Results(1)After treatment,the success rate of extubation in group C(64.29%,18/28)was significantly higher than that in group A(32.14%,9/28)and group B(34.48%,10/29)(P<0.05).(2)After the treatment,the GCS score of the three groups was higher than that before treatment,and the score of group C was higher than that of group A and group B(P<0.05),but there was no statistical significance between the two groups(P>0.05).(3)After treatment,the recovery rate and total recovery rate of group C were significantly higher than those of group A and group B(P<0.01),and there was no statistical significance between group A and group B(P>0.05).Conclusion Acupuncture combined with indirect swallowing training can improve the swallowing function and promote the consciousness recovery,and can significantly improve the success rate of extubation in patients with tracheotomy after severe brain injury,which is superior to indirect swallowing training and acupuncture.

关 键 词：重症脑损伤 气管切开 针刺 间接吞咽训练 拔管有效率 

分 类 号：R651.15[医药卫生—外科学]