揿针联合重复经颅磁刺激治疗脑卒中后吞咽困难的临床观察  

Clinical Observation on Thumb-Tack Needling for Subcutaneous Embedding Combined with Repetitive Transcranial Magnetic Stimulation in the Treatment of Post-Stroke Dysphagia

作　　者：杨博[1] 宋薇薇[1] 张细庆 李夏珍 吁巧智 YANG Bo;SONG Weiwei;ZHANG Xiqing;LI Xiazhen;YU Qiaozhi(The 908th Hospital of the Joint Logistics Support Force of the People's Liberation Army of China,Nanchang 330002 Jiangxi,China)

机构地区：[1]中国人民解放军联勤保障部队第九〇八医院,江西南昌330002

出　　处：《广州中医药大学学报》2025年第2期397-402,共6页Journal of Guangzhou University of Traditional Chinese Medicine

基　　金：江西省中医药管理局科技计划资助项目(编号:2021B241)。

摘　　要：【目的】观察揿针联合重复经颅磁刺激(rTMS)治疗脑卒中后吞咽困难的临床疗效。【方法】将2022年2月至2024年2月中国人民解放军联勤保障部队第九〇八医院病房及门诊收治的120例脑卒中后吞咽困难患者按随机数字表法随机分为观察组和对照组,每组各60例。2组患者均给予营养神经、改善循环等常规对症支持治疗,对照组给予高频rTMS治疗,观察组在对照组治疗的基础上,联合揿针疗法进行治疗。连续治疗4周。治疗1个月后,评价2组临床疗效,观察2组患者治疗前后中医证候积分、功能性经口摄食评价量表(FOIS)评分与标准吞咽功能评定量表(SSA)评分的变化情况,以及血清总蛋白(TP)、血清白蛋白(ALB)、血红蛋白(Hb)的情况。比较2组患者治疗前后吞咽波幅、吞咽时程的变化情况。【结果】(1)研究过程中,观察组无失访,对照组失访8例。最终观察组64例,对照组56例纳入疗效统计。(2)观察组的总有效率为92.19%(59/64),对照组为76.79%(43/56),观察组疗效优于对照组,差异有统计学意义(P<0.05)。(3)治疗后,2组患者中医证候积分均明显改善(P<0.05),且观察组在改善中医证候积分方面明显优于对照组,差异有统计学意义(P<0.05)。(4)治疗后,2组患者的FOIS评分、SSA评分明显改善(P<0.05),且观察组在改善FOIS评分、SSA评分方面明显优于对照组,差异有统计学意义(P<0.05)。(5)治疗后,2组患者的吞咽波幅、吞咽时程明显改善(P<0.05),且观察组在改善吞咽波幅、吞咽时程方面明显优于对照组,差异有统计学意义(P<0.05)。(6)治疗后,2组患者的TP、ALB、Hb水平明显改善(P<0.05),且观察组在改善TP、ALB、Hb水平方面明显优于对照组,差异有统计学意义(P<0.05)。【结论】揿针联合重复经颅磁刺激治疗脑卒中后吞咽困难,能明显缩短患者的吞咽时程,增大吞咽波幅,从而改善患者的吞咽功能,提高患者的生活质量,临床疗效显�Objective To observe the clinical efficacy of thumb-tack needling for subcutaneous embedding combined with repetitive transcranial magnetic stimulation(rTMS)in the treatment of post-stroke dysphagia.Methods A total of 120 cases of patients with post-stroke dysphagia admitted to the 908th Hospital of the Joint Logistics Support Force of the People's Liberation Army of China from February 2022 to February 2024 were randomly divided into the observation group and the control group according to random number table method,with 60 cases in each group.Both groups of patients were given conventional symptomatic supportive treatment,such as trophic nerve,improving circulation,etc.,and the control group was given high-frequency rTMS treatment,while the observation group was treated with thumb-tack needling for subcutaneous embedding therapy on the basis of the treatment in the control group.The course of treatment covered four weeks continuously.After one month of treatment,the clinical efficacy of the two groups was evaluated,and the changes in scores of traditional Chinese medicine(TCM)syndrome,Functional Oral Intake Scale(FOIS)and Standardized Swallowing Assessment(SSA),as well as levels of serum total protein(TP),serum albumin(ALB),and hemoglobin(Hb)before and after treatment were observed in the patients of the two groups.The changes in swallowing wave amplitude and swallowing duration before and after treatment were compared between the two groups of patients.Results(1)During the study,there were none in the observation group and eight cases in the control group were failed to follow-up.Finally,64 cases in the observation group and 56 cases in the control group were included in the efficacy statistics.(2)The total effective rate was 92.19%(59/64)in the observation group and 76.79%(43/56)in the control group,and the efficacy of the observation group was superior to that of the control group,the difference being statistically significant(P<0.05).(3)After treatment,the TCM syndrome scores of the patients in the two grou

关 键 词：揿针疗法 重复经颅磁刺激 脑卒中 吞咽障碍 康复效果 临床观察 

分 类 号：R246.9[医药卫生—针灸推拿学]