“通督调神”针法联合舌三针对结核性脑膜炎吞咽障碍的临床疗效  

Clinical efficacy of Tongdu Tiaoshen acupuncture combined with Tongue Three-Needle for dysphagia in tuberculous meningitis

作　　者：潘静洁[1] 黄晋 黎仁彬 刘堂营 PAN Jing-jie;HUANG Jin;LI Ren-bin;LIU Tang-ying(Department of Traditional Chinese Medicine,Guangzhou Chest Hospital,Guangzhou 510095,Guangdong,China)

机构地区：[1]广州市胸科医院中医科,广东广州510095

出　　处：《广东医学》2025年第1期59-65,共7页Guangdong Medical Journal

基　　金：广东省中医药局科研立项项目(20231269)。

摘　　要：目的探究通督调神针法联合舌三针治疗结核性脑膜炎(tuberculous meningitis,TBM)吞咽障碍的效果,为“通督调神”针法联合舌三针在结核性脑膜炎吞咽障碍诊治中的应用提供临床数据。方法选取广州市胸科医院2023年3月至2024年5月的TBM吞咽障碍患者进行前瞻性研究,100例患者随机分为观察组和对照组,每组50例,分别予TBM治疗+常规吞咽功能康复治疗+针刺治疗和TBM治疗+常规吞咽功能康复治疗,比较两组治疗前后洼田饮水试验结果、标准吞咽功能评定量表(SSA)评分评价临床疗效,比较治疗前后神经生长因子(NGF)、脑源性神经营养因子(BDNF)、脑脊液压力(CSF)和舌骨下肌群、颏下肌群的表面肌电图平均振幅和持续时间探讨其作用机制。结果以洼田饮水试验结果等级Ⅱ以下为“治愈”标准,观察组和对照组的治愈率分别为90%(45/50)和68%(34/50),观察组远高于对照组(χ^(2)=12.8525,P=0.000337);SSA评分治疗前两组间差异无统计学意义(Z=-0.575,P=0.565),但治疗后SSA评分观察组远低于对照组(Z=-3.330,P=0.001),治疗前后SSA评分差值观察组远大于对照组(Z=-3.339,P=0.001);治疗后BDNF、NGF、CSF压力与治疗前相比,两组间BDNF比值差异无统计学意义(Z=-1.820,P=0.068),NGF比值观察组显著高于对照组(Z=-6.922,P=0.000),CSF压力则反之(Z=-2.735,P=0.006);两种治疗前后,舌骨下肌群、颏下肌群的持续时间均有缩短、平均振幅均有减小,但变化幅度观察组远大于对照组(均P<0.05)。结论通督调神针法联合舌三针治疗TBM吞咽障碍疗效显著,改善颅脑神经作用微环境和恢复吞咽相关肌肉功能可能为其作用机制。Objective To investigate the efficacy of Tongdu Tiaoshen acupuncture combined with Tongue Three-Needle in treating dysphagia caused by tuberculous meningitis(TBM),providing clinical evidence for its application in managing dysphagia in TBM patients.Methods A prospective study was conducted involving 100 TBM patients with dysphagia treated at Guangzhou Chest Hospital between March 2023 and May 2024.Patients were randomly assigned to an observation group and a control group(50 cases each).The observation group received TBM treatment combined with standard swallowing rehabilitation and acupuncture,while the control group received TBM treatment and standard swallowing rehabilitation only.Clinical efficacy was assessed by comparing changes in Kubota drinking test grades and Standardized Swallowing Assessment(SSA)scores before and after treatment.The study also examined serum nerve growth factor(NGF),brain-derived neurotrophic factor(BDNF),cerebrospinal fluid(CSF)pressure,and surface electromyography(sEMG)of suprahyoid and submental muscle groups to explore the potential mechanisms.Results Using a Kubota drinking test grade of≤Ⅱ as the criterion for cure,the cure rates were significantly higher in the observation group(90%,45/50)than in the control group(68%,34/50)(χ^(2)=12.8525,P=0.000337).Pre-treatment SSA scores showed no significant differences between groups(Z=-0.575,P=0.565),but post-treatment SSA scores were significantly lower in the observation group than in the control group(Z=-3.330,P=0.001).The improvement in SSA scores was significantly greater in the observation group(Z=-3.339,P=0.001).After treatment,NGF levels were significantly higher in the observation group than in the control group(Z=-6.922,P=0.000),while CSF pressure was lower(Z=-2.735,P=0.006).No significant difference was observed in BDNF levels between groups(Z=-1.820,P=0.068).Both groups exhibited shortened sEMG durations and reduced amplitudes in the suprahyoid and submental muscle groups,with significantly greater changes in the observat

关 键 词：通督调神 舌三针 结核性脑膜炎 吞咽障碍 

分 类 号：R246.6[医药卫生—针灸推拿学] R529.3[医药卫生—中医临床基础]