Vitalstim穴位电针法联合康复训练治疗脑卒中后吞咽障碍的疗效观察

Clinical Trials for Treatment of Stroke Patients with Dysphagia by Vitalstim Electroacupuncture Combined with Swallowing Rehabilitation Training

目的:观察Vitalstim穴位电针法联合康复训练治疗脑卒中后吞咽障碍的临床疗效和患者的生存生活质量。方法:80例脑卒中后吞咽功能障碍患者随机分成治疗组40例及对照组40例。治疗组在予以基础脑卒中治疗的同时使用改装的Vitalstim电针仪刺激风池、廉泉、天突、金津、玉液等穴;对照组仅进行常规基础治疗。治疗前后对洼田吞咽能力、脑卒中患者神经功能缺损程度评分标准中的吞咽困难亚量表、电视透视、生存生活质量评价量表(SF-36)进行评价。结果:治疗组和对照组在治疗后洼田吞咽功能障碍、吞咽困难评分,以及生理功能、精神健康、情感职能、社会功能、总体健康指标均较治疗前改善(P<0.05),治疗组较对照组改善更明显,电视透视疗效高于对照组(P<0.05)。结论:运用Vitalstim穴位电针疗法联合康复训练治疗脑卒中后吞咽障碍疗效明显,且能更有效地改善患者的生存和生活质量。

Objective To observe the clinical effect of vitalstim electroacupuncture （EA） combined with swallowing re- habilitation training in the treatment of stroke patients with dysphagia. Methods A total of 80 stroke patients with dysphagia were randomized into treatment and control groups （n = 40 in each group）. Patients of the control group were treated by regular medication for anti-platelet aggregation and anti-coagulation, lipid-lowering, neuroprotection, blood glucose control and blood pressure control, etc. and swallowing function rehabilitation training, and those of the treatment group treated by EA stimulation of Fengchi （GB 20）, Jinjin （EX-HN 12） and Yuye （EX-HN 13） with a Vitalstim Electrostimulator and manual acupuncture stimulation of Lianquan （CV 23）, Tiantu （CV 22） in combination with regular medication plus swallowing function training as those mentioned in the control group. The EA and manual acupuncture stimulation treatment was conducted once daily, 6 times a week and 4 weeks altogether. The therapeutic effect was assessed by using Kubota swallowing ability test （6 levels）, dysphagia subscale （0 - 6 scores） of the neurological deficit degrees, videofluorography （VFG） assessment （markedly effective, effective and invalid, for evaluating the function and symmetry state of the swallowing movements）, and the MOS Item Short Form Health Survey （SF-36, 8 minor items of two major aspects in physiological function, mental health, emotional function, social function and overall health） for assessing the patients＇ daily-life quality. Results After the treatment, the dysphagia score of the treatment group was signi- ficantly lower than that of the control group （P〈0.05）. VFG outcomes showed that, of the two 40 patients in the control and treatment groups, 16 and 23 experienced a marked improvement, 20 and 15 were effective, 4 and 2 were ineffective, with the markedly effective rate being 40.0% and 57.5%, respectively. The daily-life quality scores for physiological function, mental health, e- motional function, social function and overall health were all notably increased after the treatment in both groups, particularly in the treat-merit group （P〈0.05）. The therapeutic effects of the treatment group were remarkably superior to those of the control group in improving dysphagia （showed by dysphagia score and VFG outcomes） and life quality. Conclusion EA treatment combined with swallowing func- tion rehabilitation training is effective in improving swallowing ability and daily-life quality in stroke patients with dysphagia.