经颅重复针刺联合运动疗法治疗卒中后吞咽障碍的临床研究  

Clinical Study of Repeated Transcranial Acupuncture Combined with Exercise Therapy in Treatment of Post-Stroke Dysphagia

作　　者：孙妍 周琛[1,2] 孙远征 孙颖哲[1,2] SUN Yan;ZHOU Chen;SUN Yuanzheng;SUN Yingzhe(The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine,Harbin 150001,China;Heilongjiang University of Chinese Medicine,Harbin 150040,China)

机构地区：[1]黑龙江中医药大学附属第二医院,黑龙江哈尔滨150001 [2]黑龙江中医药大学,黑龙江哈尔滨150040

出　　处：《针灸临床杂志》2024年第10期27-31,共5页Journal of Clinical Acupuncture and Moxibustion

基　　金：黑龙江省博士后资助面上项目,编号:LBH-Z21031;黑龙江省博士后科研启动金,编号:LBH-Q21183;孙申田青年人才基金,编号:2021KY-01;黑龙江省中医药科研项目,编号:GY2022-08;哈尔滨市科技计划自筹经费项目,编号:2022ZCZJNS054;黑龙江中医药大学科研基金,编号:2019MS21。

摘　　要：目的:观察经颅重复针刺联合运动疗法对卒中后吞咽障碍患者吞咽功能和生活质量的影响。方法:符合纳入标准的82例卒中后吞咽障碍患者作为研究对象,将其随机分为观察组和对照组。两组均进行基础治疗,对照组予常规针刺,头项面部穴取天柱、风池、完骨与廉泉,肢体部穴取合谷、手三里、曲池、肩髃、太冲、悬钟、足三里与伏兔,针刺同时嘱患者进行重复吞咽运动,10次/min,共运动5 min;观察组在对照组治疗基础上予经颅重复针刺刺激作用于焦氏头针运动区、足运感区,5 min/次,吞咽运动在此期间进行。两组均留针30 min,治疗1次/d,以治疗6 d休息1 d为1个疗程,共治疗4个疗程。于治疗前、后分别对两组患者的标准吞咽功能评定量表(SSA)评分、吞咽障碍特异性生活质量量表(SWAL-QOL)评分及颏下肌群和舌骨下肌群表面肌电图(sEMG)的变化进行观察。结果:治疗后,两组患者SSA、SWAL-QOL评分及sEMG变化均较治疗前有所改善(P<0.01),且观察组各项评分及sEMG变化均优于对照组(P<0.05或P<0.01)。结论:经颅重复针刺联合运动疗法可缓解卒中后吞咽障碍患者颏下肌群、舌骨下肌群麻痹状态,提高吞咽运动能力,改善生活质量,临床疗效确切。Objective:To observe the effect of repeated transcranial acupuncture combined with exercise therapy on swallowing function and quality of life in patients with post-stroke dysphagia.Methods:82 patients were randomly divided into the observation group(n=41,2 cases dropped out)and the control group(n=41,1 case dropped out).Both groups were treated with basic treatment;on which basis,the control group received routine acupuncture,the points chosen around the head,face and neck included Tianzhu(BL10),Fengchi(GB20),Wangu(GB12)and Lianquan(RN23),and the points chosen in the four limbs included Hegu(LI4),Shousanli(LI10),Quchi(LI11),Jianyu(LI15),Taichong(LR3),Xuanzhong(GB39),Zusanli(ST36)and Futu(ST32);meanwhile the patients were instructed to perform repeated swallowing exercises,10 times/min,for a total of 5 minutes.The observation group received repeated transcranial acupuncture stimulation on the motor area and foot movement area of Jiao's scalp acupuncture on the treatment basis of the control group,5min/time,with swallowing exercise during this period.The needles were retained for 30 minutes in both groups,and the treatment was performed once a day,with 6 days of treatment as a course,one day interval between each course,and a total of 4 courses of treatment.The standard swallowing function assessment scale(SSA)score,the swallowing disorder-specific quality of life scale(SWAL-QOL)score,and the surface electromyography(sEMG)of the submental and subhyoid muscles were compared between before and after the treatment in the two groups.Results:The scores of SSA and SWAL-QOL,as well as sEMG were all improved after the treatment compared with those before the treatment in the two groups(P<0.01),and the improvements were more significant in the observation group than those in the control group(P<0.05,P<0.01).Conclusion:Transcranial repeated acupuncture combined with exercise therapy can relieve the paralysis of submental and subhyoid muscles in patients with post-stroke dysphagia,it can improve ability of swallowing and lif

关 键 词：经颅重复针刺 运动疗法 吞咽障碍 脑卒中 

分 类 号：R246.6[医药卫生—针灸推拿学]