涤痰汤结合子午流注针刺治疗卒中后环咽肌失缓型吞咽障碍临床研究  

Clinical Study on Treatment of Swallowing Dysfunction in Post-Stroke Patient with Cricopharyngeal Dysphagia with Ditan Decoction Combined with Midnight-Noon Ebb-Flow Acupuncture

作　　者：朱莉莉 张垣[1] 唐李莹 ZHU Lili;ZHANG Yuan;TANG Liying(Department of Rehabilitation,Wenzhou Traditional Chinese Medicine Hospital of Zhejiang Chinese Medical University,Wenzhou Zhejiang 325000,China)

机构地区：[1]浙江中医药大学附属温州市中医院康复科,浙江温州325000

出　　处：《新中医》2025年第7期77-82,共6页New Chinese Medicine

基　　金：浙江省温州市科技局基础性医疗卫生科技项目(Y20211107)。

摘　　要：目的:观察涤痰汤联合子午流注针刺治疗卒中后环咽肌失缓(CPD)吞咽功能障碍患者的临床疗效。方法:筛选2022年1月—2023年1月温州市中医院收治的84例卒中后CPD患者,按随机数字表法分为对照组、涤痰汤(DTD)组、子午流注针刺(MLA)组、涤痰汤联合子午流注针刺(DTD+MLA)组,各21例。4组均给予基础治疗和标准吞咽康复治疗,DTD组给予涤痰汤鼻饲,MLA组给予子午流注针灸治疗,DTD+MLA组给予涤痰汤鼻饲和子午流注针刺治疗,4组均治疗6周。比较4组治疗前后吞咽功能视频透视检查评分(VFSS)、简化吞咽评估评分(SSA)、吞咽质量生命问卷评分(SWAL-QOL)、吞咽肌群表面肌电信号,比较4组不良反应。结果:治疗后,4组VFSS评分均升高(P<0.05),且MLA+DTD组VFSS评分高于其余3组(P<0.05)。治疗4周、6周后,4组SSA评分均降低(P<0.05),且MLA+DTD组SSA评分低于其余3组(P<0.05)。治疗后,4组在空吞咽和吞服5 mL温水时的AEMG值均降低(P<0.05),MLA组、DTD组、MLA+DTD组空吞咽时的平均吞咽时间均缩短(P<0.05),DTD组、MLA+DTD组、对照组吞咽5 mL温水时的平均吞咽时间均缩短(P<0.05);MLA+DTD组在空吞咽和吞咽5 mL温水时的AEMG值低于MLA组和对照组(P<0.05);MLA+DTD组空吞咽时的平均吞咽时间短于其它3组(P<0.05),MLA+DTD组吞咽5 mL温水时的平均吞咽时间短于MLA组和对照组(P<0.05)。治疗4周、6周,MLA组、DTD组、MLA+DTD组SWAL-QOL评分均逐渐升高(P<0.05),且MLA+DTD组高于其它3组(P<0.05),MLA组、DTD组高于对照组(P<0.05)。4组并发症总发生率比较,差异无统计学意义(P>0.05)。结论:涤痰汤联合子午流注针刺可改善卒中后CPD患者吞咽功能,提高生活质量,安全性高。Objective:To observe the clinical effect of Ditan Decoction(DTD)combined with Midnight-Noon Ebb-Flow Acupuncture(MLA)on the treatment of swallowing dysfunction in post-stroke patients with cricopharyngeal dysphagia(CPD).Methods:A total of 84 post-stroke patients with CPD adimitted to Wenzhou Hospital of Traditional Chinese Medicine form January 2022 to January 2023 were randomly divided into the control group,the DTD group,the MLA group,and the DTD plus MLA(DTD+MLA)group,with 21 patients in each group.All four groups received basic treatment and standard swallowing rehabilitation therapy.The DTD group received nasogastric feeding of Ditan Decoction,the MLA group received Midnight-Noon Ebb-Flow Acupuncture for treatment,and the DTD+MLA group received both nasogastric feeding of Ditan Decoction and Midnight-Noon Ebb-Flow Acupuncture for treatment.All groups were treated for six weeks.The scores of Video Fluoroscopic Swallowing Study(VFSS),Simplified Swallowing Assessment(SSA)and Swallowing Quality of Life Questionnaire(SWAL-QOL),and surface electromyography(sEMG)signals of swallowing muscles were compared before and after treatment among the four groups.Adverse reactions were also compared.Results:After treatment,the VFSS scores in all four groups were increased(P<0.05),and the VFSS score in the MLA+DTD group was higher than that in the other three groups(P<0.05).At four and six weeks of treatment,the SSA scores in all four groups were decreased(P<0.05),and the SSA score in the MLA+DTD group was lower than that in the other three groups(P<0.05).After treatment,the average electromyography(AEMG)values during dry swallowing and swallowing of 5 mL of warm water were decreased in all four groups(P<0.05).The mean swallowing time during dry swallowing shortened in the MLA group,the DTD group,and the MLA+DTD group(P<0.05),and the mean swallowing time when swallowing 5 mL of warm water shortened in the DTD group,the MLA+DTD group,and the control group(P<0.05).The AEMG values during dry swallowing and swallowing of 5 mL of

关 键 词：脑卒中后 环咽肌失缓 吞咽障碍 涤痰汤 子午流注针刺 吞咽功能 生活质量 

分 类 号：R246.6[医药卫生—针灸推拿学]