通脑活络利咽法针刺联合康复训练治疗脑卒中后吞咽障碍:随机对照试验  

Tongnao Huoluo Liyan acupuncture combined with rehabilitation training for post-stroke dysphagia:a randomized controlled trial

作　　者：徐洁淼 刘剑[1] 彭拥军 XU Jiemiao;LIU Jian;PENG Yongjun(Department of Rehabilitation,Pukou District Hospital of TCM,Nanjing211800,Jiangsu Province,China;Department of Acupuncture-Moxibustion and Rehabilitation,Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing 210029,Jiangsu Province)

机构地区：[1]南京市浦口区中医院康复科,江苏南京211800 [2]南京中医药大学附属医院针灸康复科,江苏南京210029

出　　处：《中国针灸》2025年第4期435-441,共7页Chinese Acupuncture & Moxibustion

基　　金：国家自然科学基金资助项目:82374565、82174484;江苏省中医院高峰学术人才项目:k2021rc24;江苏省中医院专项课题项目:Y2022ZR20;南京中医药大学自然科学基金项目:XZR2023096;江苏省南京市医学科技发展一般性课题项目:YKK20211。

摘　　要：目的:观察通脑活络利咽法针刺联合康复训练治疗脑卒中后吞咽障碍(PSD)的疗效。方法:将92例PSD患者随机分为观察组(46例,中止1例)、对照组(46例,中止1例,脱落1例)。对照组采用康复训练治疗,包括吞咽神经肌肉低频电刺激、唇舌部运动训练和口腔感觉功能训练,每天1次,每周连续治疗5 d,共治疗4周;观察组在对照组基础上,采用通脑活络利咽法针刺,穴取廉泉、夹廉泉(双侧)、金津、玉液、百会、水沟、内关(双侧)等,每天1次,每周连续治疗5 d,共治疗4周。于治疗前后,观察两组患者洼田饮水试验分级、标准吞咽功能评价量表(SSA)评分、藤岛一郎吞咽疗效评分、吞咽困难特异性生活质量问卷(SWAL-QOL)评分,并应用表面肌电图检测颏下肌群和舌骨下肌群平均振幅(AEMG)和平均吞咽时间。结果:治疗后,两组患者洼田饮水试验分级Ⅰ级、Ⅱ级例数较治疗前增多(P<0.05),观察组洼田饮水试验分级优于对照组(P<0.05)。治疗后,两组患者SSA评分较治疗前降低(P<0.05),观察组低于对照组(P<0.05);两组患者藤岛一郎吞咽疗效评分、SWAL-QOL评分较治疗前升高(P<0.05),观察组高于对照组(P<0.05)。治疗后,两组患者颏下肌群、舌骨下肌群AEMG较治疗前升高(P<0.05),平均吞咽时间较治疗前缩短(P<0.05);观察组患者较对照组颏下肌群、舌骨下肌群AEMG升高(P<0.05),平均吞咽时间缩短(P<0.05)。观察组总有效率为97.8%(44/45),高于对照组的84.1%(37/44,P<0.05)。结论:通脑活络利咽法针刺联合康复训练治疗能增强PSD患者吞咽肌群的收缩运动功能,促进吞咽功能恢复,改善患者生活质量,疗效优于单纯康复训练治疗。ObjectiveTo observe the efficacy of the Tongnao Huoluo Liyan(unblocking brain,activating collaterals and relaxing throat)acupuncture combined with rehabilitation training for post-stroke dysphagia(PSD).MethodsA total of 92 PSD patients were randomly assigned to an observation group(46 cases,1 case was discontinued)and a control group(46 cases,1 case was discontinued,1 case dropped out).The patients in the control group received rehabilitation training,including low-frequency neuromuscular electrical stimulation for swallowing,lip and tongue movement training,and oral sensory function training,once daily,five times per week,for four weeks.The patients in the observation group received the Tongnao Huoluo Liyan acupuncture method in addition to the same rehabilitation training.Acupoints included Lianquan(CV23),bilateral Jia Lianquan,Jinjin(EX-HN12),Yuye(EX-HN13),Baihui(GV20),Shuigou(GV26),and bilateral Neiguan(PC6),once daily,five times per week,for four weeks.Before and after treatment,Kubota water stvallowing test grading standardized swallowing assessment(SSA)scores,Fujishima Ichiro swallowing efficacy scores,and swallowing quality of life questionnaire(SWAL-QOL)scores were assessed in both groups.Surface electromyography(sEMG)was used to evaluate the average amplitude(AEMG)and mean swallowing time of the suprahyoid and infrahyoid muscle groups.Results After treatment,the proportion of patients classified as Grade I or II in the Kubota water stvallowing test was increased in both groups(P<0.05),with better results in the observation group compared to the control group(P<0.05).Compare before treatment,SSA scores were decreased in both groups after treatment(P<0.05),with lower scores in the observation group than in the control group(P<0.05).Compare before treatment,Fujishima Ichiro swallowing eficacy scores and SWAL-QOL scores were improved in both groups after treatment(P<0.05),with significantly higher scores in the observation group than those in the control group(P<0.05).Compare before treatment,AEMG values of

关 键 词：脑卒中 吞咽障碍 通脑活络利咽法针刺 表面肌电图 随机对照试验 

分 类 号：R246.6[医药卫生—针灸推拿学]