低频电刺激联合针刺治疗神经重症昏迷合并吞咽障碍临床观察  

Clinical Effect of Low-frequency Electrical Stimulation Combined with Acupuncture in Treatment of Severe Neurosurgical Coma with Dysphagia

作　　者：汪学鹏 李伟 肖洪波[1] 齐敦兴 陈亚芬 阮薇 WANG Xuepeng;LI Wei;XIAO Hongbo;QI Dunxing;CHEN Yafen;RUAN Wei(Department of Neurosurgery,The First Affiliated Hospital of Anhui University of Chinese Medicine,Anhui Hefei 230031,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

出　　处：《安徽中医药大学学报》2023年第4期56-60,共5页Journal of Anhui University of Chinese Medicine

基　　金：安徽省2020年度中央财政中医药事业传承与发展专项资金项目(皖卫中医药发〔2020〕5号);安徽中医药大学第一附属医院院内课题(2020yfyzc38)。

摘　　要：目的观察低频电刺激联合针刺疗法治疗神经重症昏迷合并吞咽障碍的疗效。方法选取神经重症昏迷合并吞咽障碍患者63例,按照随机数字表法分为对照组、低频组、联合组,每组21例。3组患者均给予常规吞咽训练,低频组在常规吞咽训练基础上给予低频电刺激治疗,联合组在低频组疗法基础上予以针刺治疗。观察3组临床疗效,采用标准吞咽功能评价量表(standardized swallowing assessment,SSA)、洼田饮水试验、吞咽障碍程度分级、吞咽时间参数[口腔运送时间(oral transit time,OTT)和舌骨运动时间(hyoid movement time,HMT)]和舌骨喉复合体活动度评价吞咽功能。结果联合组患者临床疗效显著优于对照组(P<0.05),但与低频组比较,差异无统计学意义(P>0.05)。与治疗前比较,治疗后3组患者SSA评分、洼田饮水试验评分、OTT、HMT均显著降低(P<0.05),吞咽障碍程度、舌骨移动幅度、甲状软骨移动幅度均显著增加(P<0.05);联合组患者SSA评分、洼田饮水试验评分、OTT、HMT降低程度和吞咽障碍程度评分、舌骨移动幅度、甲状软骨移动幅度增加程度均显著大于对照组、低频组(P<0.05)。结论在常规吞咽训练和低频电刺激治疗的基础上联合应用针刺疗法,可有效改善神经重症昏迷合并吞咽障碍患者的吞咽功能,改善舌部肌肉运动,缩短吞咽时间,提高舌骨喉复合体活动度。Objective To investigate the clinical effect of low-frequency electrotherapy combined with acupuncture in the treatment of severe neurosurgical coma with dysphagia.Methods A total of 63 patients with severe neurosurgical coma and dysphagia were enrolled and divided into control group,low-frequency group,and combination group using a random number table,with 21 patients in each group.All three groups were given routine swallowing function training;the patients in the low-frequency group were given low-frequency electrical stimulation in addition to routine swallowing function training,and those in the combination group were given acupuncture in addition to the treatment in the low-frequency group.Clinical outcome was observed for all three groups,and swallowing function was evaluated based on standard swallowing assessment(SSA),water swallow test,dysphagia grade,swallowing time parameters[oral transit time(OTT)and hyoid movement time(HMT)],and mobility of hyoid laryngeal complex.Results The combination group had a significantly better clinical outcome than the control group(P<0.05),with no significant difference between the combination group and the low-frequency group(P>0.05).After treatment,all three groups had significant reductions in SSA score,water swallow test classification,OTT,and HMT(P<0.05)and significant increases in dysphagia grade,hyoid displacement,and thyroid cartilage displacement(P<0.05);compared with the control group and the low-frequency group,the combination group had significantly greater reductions in SSA score,water swallow test classification,OTT,and HMT and significantly greater increases in dysphagia grade,hyoid displacement,and thyroid cartilage displacement(P<0.05).Conclusion Routine swallowing function training and low-frequency electrical stimulation combined with acupuncture therapy can effectively improve the swallowing function and tongue muscle movement of patients with severe neurosurgical coma and dysphagia,shorten swallowing time,and increase the mobility of hyoid laryngeal c

关 键 词：重症昏迷 吞咽障碍 吞咽训练 低频电刺激 针刺 吞咽功能 舌骨喉复合体活动度 

分 类 号：R256.24[医药卫生—中医内科学]