短疗程针刺疗法治疗脑型肝豆状核变性吞咽功能障碍疗效观察  

Clinical efficacy of short-term acupuncture in treatment of swallowing dysfunction in Wilson's disease

作　　者：周浩 汪世靖 刘一文 华磊 韩永升 ZHOU Hao;WANG Shijing;LIU Yiwen;HUA Lei;HAN Yongsheng(Graduate School,Anhui University of Traditional Chinese Medicine,Hefei 230031,China)

机构地区：[1]安徽中医药大学研究生院,合肥230031 [2]安徽中医药大学神经病学研究所附属医院 [3]皖南医学院

出　　处：《山东医药》2024年第26期10-14,共5页Shandong Medical Journal

基　　金：安徽省中医药传承创新科研立项(2022CCZD05);安徽省重点研究与开发计划项目(202204295107020047)。

摘　　要：目的观察短疗程针刺疗法治疗脑型肝豆状核变性(WD)吞咽功能障碍的疗效。方法选择脑型WD吞咽功能障碍患者90例,随机分为针刺组、假针刺组和对照组,每组各30例。对照组给予常规药物治疗;针刺组在常规药物治疗的基础上采取针刺治疗,选取金津、玉液、人迎、廉泉、廉泉旁开、天突进行针刺或放血;假针刺组在常规药物治疗的基础上采取穴位旁开浅刺,不进行任何行针手法;每天1次,每周5次,2周为一个疗程。于针刺治疗前和治疗2周后进行疗效评估,使用表面肌电测试仪采集表面肌电图,MR3.14软件进行数据处理,记录相关肌群的频率中值(MF);采用洼田饮水试验(WST)和标准吞咽功能评价量表(SSA)评价患者吞咽功能;采用吞咽生存质量量表(SWAL-QOL)评价患者生存质量;采集患者静脉血,采用免疫比浊法检测血清白蛋白(Alb),评价患者营养状况。结果治疗后针刺组颏下肌群、舌骨下肌群MF高于假针刺组和对照组,假针刺组高于对照组(P<0.05或<0.01),三组咬肌、口轮匝肌MF比较差异无统计学意义(P均>0.05)。治疗后三组WST、SSA评分均较治疗前降低,且针刺组和假针刺组低于对照组(P<0.05或<0.01),针刺组与假针刺组比较差异无统计学意义(P均>0.05)。治疗后针刺组SWAL-QOL评分、血清Alb均较治疗前提高,且高于假针刺组和对照组(P均<0.01),假针刺组和对照组的SWALQOL评分、血清Alb无明显变化(P均>0.05)。结论短疗程针刺治疗对脑型WD吞咽障碍患者的颏下肌群、舌骨下肌群具有明显改善作用,通过改善吞咽功能进而提高患者的生活质量和营养状况。Objective To investigate the effect of short-term acupuncture on dysphagia in patients with cerebraltype Wilson's disease(WD).Methods Ninety patients with cerebral WD and swallowing dysfunction were randomly assigned to acupuncture(n=30),sham acupuncture(n=30),and control(n=30)groups.Patients in all groups received conventional drug treatment,while patients in the acupuncture group received additional acupuncture at Jingjin(EXHN12),Yuye(EX-HN13),Renying(ST9),Lianquan(RN23),Lianquan lateral point,and Tiantu(RN22).Patients in the sham acupuncture group received shallow puncture beside the acupoints without needle manipulation.Treatment frequency was once a day for 5 days a week over 2 weeks.Surface electromyography(sEMG)was collected using a Noraxon surface EMG tester,and data were processed with MR3.14 software to record the median frequency(MF)of relevant muscle groups.Swallowing function was evaluated using the Watian Water Drinking Test(WST)and the Standardized Swallowing Assessment(SSA).Quality of life was assessed using the Swallowing Quality of Life(SWAL-QOL).Nutritional status was evaluated by measuring serum albumin(Alb)using an immunoturbidimetric assay.Results After treatment,the MF of the submental and infrahyoid muscle groups in the acupuncture group was significantly higher than in the sham acupuncture and control groups(P<0.05 or P<0.01);the sham acupuncture group had higher MF than the control group(P<0.05 or P<0.01);there were no significant differences in the masseter or orbicularis oris muscle MF among the three groups(all P>0.05).WST and SSA scores after treatment in all groups were lower than those before treatment,and those were lower in the acupuncture and sham acupuncture groups than in the control group(P<0.05 or P<0.01);there was no significant difference between the acupuncture and sham acupuncture groups(P>0.05).The SWAL-QOL score and serum Alb levels after treatment in the acupuncture group were higher than those before treatment,which were higher than those in the sham acupuncture and

关 键 词：针刺疗法 吞咽障碍 肝豆状核变性 表面肌电图 

分 类 号：R742.4[医药卫生—神经病学与精神病学]