通关利窍四步针法联合涤痰化浊利咽方治疗缺血性脑卒中后吞咽障碍临床研究  

Clinical Study on Tongguan Liqiao Four-step Needling Combined with Ditan Huazhuo Liyan Prescription for Ischemic Post-stroke Dysphagia

作　　者：孟占鹏 郭子华 张丹 刘作印 MENG Zhanpeng;GUO Zihua;ZHANG Dan;LIU Zuoyin(Kaifeng Hospital of Traditional Chinese Medicine,Kaifeng Henan 475000,China)

机构地区：[1]开封市中医院,河南开封475000

出　　处：《新中医》2024年第10期119-125,共7页New Chinese Medicine

基　　金：河南省科技攻关项目(232102310453)。

摘　　要：目的:观察通关利窍四步针法联合涤痰化浊利咽方治疗缺血性脑卒中后吞咽障碍的临床疗效,以及对舌骨肌群表面肌电图、神经因子水平的影响。方法:选取126例缺血性脑卒中后吞咽障碍患者,采用随机数字表法分为对照组和试验组各63例。2组均进行常规治疗,对照组在此基础上给予涤痰化浊利咽方治疗,试验组在对照组基础上给予通关利窍四步针法治疗。2组均治疗8周。比较2组临床疗效、吞咽功能、舌骨肌群表面肌电图及血清神经因子水平。结果:治疗后,试验组总有效率93.65%,高于对照组80.95%(P<0.05)。2组标准吞咽功能评价量表(SSA)、洼田氏饮水试验评分均较治疗前降低(P<0.05),电视透视吞咽功能检查(VFSS)评分均较治疗前升高(P<0.05);试验组SSA、洼田氏饮水试验评分均低于对照组(P<0.05),VFSS评分高于对照组(P<0.05)。2组舌骨上肌群、舌骨下肌群最大波幅均较治疗前增加(P<0.05),舌骨上肌群、舌骨下肌群吞咽时程均较治疗前缩短(P<0.05);试验组舌骨上肌群、舌骨下肌群最大波幅均大于对照组(P<0.05),舌骨上肌群、舌骨下肌群吞咽时程均短于对照组(P<0.05)。2组血清生长分化因子15(GDF-15)水平均较治疗前降低(P<0.05),血清中枢神经特异蛋白(S-100β)、脑源性神经营养因子(BDNF)、神经生长因子(NGF)水平均较治疗前升高(P<0.05);试验组血清GDF-15水平低于对照组(P<0.05),血清S-100β、BDNF、NGF水平均高于对照组(P<0.05)。结论:通关利窍四步针法联合涤痰化浊利咽方能够有效改善缺血性脑卒中后吞咽障碍患者的吞咽功能,提高舌骨肌群神经传导速度,调节神经因子水平。Objective:To observe the clinical effect of the therapy of Tongguan Liqiao Four-Step Needling combined with Ditan Huazhuo Liyan Prescription on ischemic post-stroke dysphagia and its effects on the surface electromyography of muscle groups of hyoid bone and the levels of neurotrophic factors.Methods:A total of 126 cases of patients with ischemic post-stroke dysphagia were selected and divided into the control group and the trial group according to the random number table method,with 63 cases in each group.The two groups were given routine treatment;the control group was additionally treated with Ditan Huazhuo Liyan Prescription based on this,and the trial group was additionally treated with Tongguan Liqiao Four-Step Needling based on the treatment of the control group.The two groups were treated for 8 weeks.The clinical effects,swallowing function,surface electromyography of muscle groups of hyoid bone and the levels of neurotrophic factors were compared between the two groups.Results:After treatment,the total effective rate was 93.65%in the trial group,higher than that of 80.95%in the control group(P<0.05).The scores of Standardized Swallowing Assessment(SSA)and Water Swallowing Test in the two groups were decreased when compared with those before treatment(P<0.05),and the scores of Video Fluoroscopic Swallowing Study(VFSS)were increased when compared with those before treatment(P<0.05);the scores of SSA and Water Swallowing Test in the trial group were lower than those in the control group(P<0.05),and the VFSS score was higher than that in the control group(P<0.05).The biggest amplitude of suprahyoid muscles and infrahyoid muscles was increased when compared with that before treatment(P<0.05),and the time course of suprahyoid muscles and infrahyoid muscles was shortened when compared with that before treatment(P<0.05);the biggest amplitude of suprahyoid muscles and infrahyoid muscles in the trial group was higher than that in the control group(P<0.05),and the time course of suprahyoid muscles and infrahyoid mus

关 键 词：缺血性脑卒中 吞咽障碍 通关利窍四步针法 涤痰化浊利咽方 舌骨肌群表面肌电图 神经因子 

分 类 号：R246.6[医药卫生—针灸推拿学]