开窍利咽四步针法联合神经肌肉电刺激治疗脑卒中后吞咽障碍:随机对照试验  

Post-stroke dysphagia treated with four-step acupuncture therapy for opening orifices and benefiting throat combined with neuromuscular electrical stimulation:a randomized controlled trial

作　　者：曹雪 张红娟 徐刚 马星星 蒲秀玲 马文娟 张迪 田兆迪 张卫华[3] CAO Xue;ZHANG Hong-juan;XU Gang;MA Xing-xing;PU Xiu-ling;MA Wen-juan;ZHANG Di;TIAN Zhao-di;ZHANG Wei-hua(Department of Rehabilitation Medicine,Xianyang Central Hospital,Xianyang 712000,Shaanxi Province,China;Department of Rehabilitation Medicine,Xi'an Third Hospital;Chinese Medicine Studio of Renown and Veteran Doctors,Second Affiliated Hospital of Shaanxi University of CM,Xianyang 712046)

机构地区：[1]咸阳市中心医院康复医学科,陕西咸阳712000 [2]西安市第三医院康复医学科 [3]陕西中医药大学第二附属医院名老中医工作室,咸阳712046

出　　处：《中国针灸》2023年第6期611-614,678,共5页Chinese Acupuncture & Moxibustion

基　　金：咸阳市科技局社会发展项目:2021ZDYF-SF-0051。

摘　　要：目的:观察开窍利咽四步针法联合神经肌肉电刺激治疗脑卒中后吞咽障碍的临床疗效。方法:将60例脑卒中后吞咽障碍患者随机分为观察组和对照组,每组30例。对照组采用神经肌肉电刺激治疗;在对照组治疗的基础上,观察组加用开窍利咽四步针法,第一步针刺病灶侧头针三区,第二步点刺咽后壁,第三步金津、玉液放血,第四步深刺咽三穴,头针三区、咽三穴留针30 min。两组均每日1次,每周治疗6次,休息1 d,1周为一疗程,共治疗4个疗程。观察两组患者治疗前后洼田饮水试验评级、标准吞咽功能评估量表(SSA)评分、Rosenbek渗漏/误吸量表(PAS)评级,比较两组并发症发生率,并评定临床疗效。结果:与治疗前比较,两组患者治疗后洼田饮水试验评级、SSA评分、RosenbekPAS评级均降低(P<0.01),且观察组低于对照组(P<0.05);观察组并发症发生率为13.3%(4/30),低于对照组的36.7%(11/30,P<0.05);观察组总有效率为93.3%(28/30),高于对照组的70.0%(21/30,P<0.05)。结论:开窍利咽四步针法联合神经肌肉电刺激可改善脑卒中后吞咽障碍患者吞咽功能,降低并发症发生率。Objective To observe the clinical efficacy on post-stroke dysphagia treated with four-step acupuncture therapy for opening orifices and benefiting throat combined with neuromuscular electrical stimulation.Methods Sixty patients with post-stroke dysphagia were randomly divided into an observation group and a control group,with 30 cases in each group.The neuromuscular electrical stimulation was adopted in the control group.Besides the treatment as the control group,in the observation group,the four-step acupuncture therapy for opening orifices and benefiting throat was supplemented.Step 1:the three areas of scalp acupuncture on the affected side were stimulated.Step 2:pricking method was operated on the posterior pharyngeal wall.Step 3:bleeding technique was operated at Jinjin(EX-HN 12)and Yuye(EX-HN 13).Step 4:deep insertion of needle was operated at three-pharynx points.The needles were retained for 30 min at the three areas of scalp acupuncture and the three-pharynx points.The intervention of each group was delivered once daily,6 times a week,at the interval of 1 day.One course of treatment was 1 week and 4 successive courses were required.The rating of Kubota water swallow test,the score of standardized swallowing assessment(SSA)and the rating of Rosenbek penetrationaspiration scale(PAS)were observed before and after treatment in patients of the two groups.The incidence of clinical complications and clinical efficacy were compared between the two groups.Results Compared with those before treatment,the rating of Kubota water swallow test,the scores of SSA and the rating of PAS of patients in the two groups were decreased after treatment(P<0.01),and the values of the observation group were lower than those of the control group after treatment(P<0.05).The incidence of clinical complications in the observation group was 13.3%(4/30),lower than 36.7%(11/30)in the control group(P<0.05).The total effective rate in the observation group was 93.3%(28/30),which was better than 70.0%(21/30)in the control group(P<0.05).Conc

关 键 词：脑卒中后吞咽障碍 开窍利咽四步针法 针刺 神经肌肉电刺激 吞咽功能 

分 类 号：R246.6[医药卫生—针灸推拿学]