“调神益咽”针刺法配合康复训练治疗缺血性中风后吞咽障碍的疗效观察

Therapeutic Effect of "Tiaoshen Yiyan" Acupuncture Combined with Rehabilitation Training on Dysphagia after Ischemic Stroke

目的探讨"调神益咽"针刺法配合康复训练治疗缺血性中风所致吞咽障碍的临床疗效。方法选取天津市第四中心医院、天津中医药大学第二附属医院收治的缺血性中风后吞咽障碍患者90例,随机分为试验组和对照组,每组45例。两组患者均予神经内科基础治疗,对照组采用康复训练治疗,试验组在康复训练基础上采用"调神益咽"针刺法治疗。分别在入组当天、治疗4周后采用洼田饮水试验、电视透视吞咽功能检查(VFSS)评分及标准吞咽功能评定量表(SSA)评价患者吞咽功能的改善情况,以美国国立卫生研究院卒中量表(NIHSS)、改良的Barthel指数(MBI)评价患者神经功能、日常生活自理能力的疗效水平,并比较两组患者治疗期间吸入性肺炎的发生率和安全性评价。结果在改善患者吞咽功能方面,治疗后试验组总有效率优于对照组(88.37%vs 71.43%),差异具有统计学意义(P<0.05)。两组患者治疗后SSA、VFSS、NIHSS、MBI均有显著改善,试验组各项评分改善情况均优于对照组,差异具有统计学意义(P<0.05)。试验组吸入性肺炎发生率低于对照组(9.30%vs 26.19%),差异具有统计学意义(P<0.05)。结论 "调神益咽"针刺法配合康复训练治疗缺血性中风所致吞咽障碍的疗效显著,并能有效降低患者肺炎发生率,同时在改善患者神经功能情况、提高日常生活能力方面疗效值得肯定。

Objective To investigate the clinical effect of "Tiaoshen Yiyan" acupuncture combined with rehabilitation training on dysphagia caused by ischemic stroke. Methods 90 patients with dysphagia after ischemic stroke were enrolled in the Fourth Central Hospital of Tianjin and the Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine. They were randomly divided into the experimental group and the control group, with 45 cases in each group. Both groups were treated with neurology basic treatment, the control group was treated with rehabilitation training, and the experimental group was treated with acupuncture treatment of "Tiaoshen Yiyan" on the basis of rehabilitation training. On the day of enrollment and 4 weeks after treatment, the Putian drinking test, the TV fluoroscopy function test score (VFSS) and the standard swallowing function rating scale (SSA) were used to evaluate the improvement of swallowing function, and the National Institutes of Health stroke was used. The scale (NIHSS) and the modified Barthel index (MBI) were used to evaluate the neurological function and self-care ability of daily living, and the incidence and safety of aspiration pneumonia were compared between the two groups. Results In the improvement of patients' swallowing function, the total effective rate of the experimental group after treatment was better than that of the control group (88.37% vs 71.43%),the difference was statistically significant (P<0.05). SSA, VFSS, NIHSS and MBI were significantly improved in the two groups after treatment. The improvement of the scores in the experimental group was better than that in the control group,the difference was statistically significant (P<0.05). The incidence of aspiration pneumonia in the experimental group was lower than that in the control group (9.30% vs 26.19%),the difference was statistically significant (P<0.05). Conclusion "Tiaoshen Yiyan" acupuncture combined with rehabilitation training for the treatment of ischemic stroke caused by dysphagia is significant, and can effectively reduce the incidence of pneumonia, while improving the patient's neurological function, improve the ability of daily life is worthy of recognition.