急性脑卒中后吞咽困难的中医治疗

Traditional Chinese medical therapy for dysphagia caused by acute stroke

目的:从中医药角度综述急性脑卒中后吞咽困难的治疗方法、作用机制及临床展望。资料来源:应用计算机检索中国期刊全文数据库1979-01/2006-12相关吞咽困难、障碍的文献,检索词“吞咽困难、吞咽障碍,疗法、治疗”,并限定语言种类为中文。资料选择:对资料进行初审,选取包括吞咽困难、障碍的文献,开始查找全文。纳入标准:①吞咽困难、障碍。②吞咽困难、障碍的中医治疗或中西医结合治疗。排除标准:①非急性脑卒中导致的吞咽困难、障碍。②重复研究、综述文献、病例报道类文章。资料提炼:共收集到49篇关于急性脑卒中后吞咽困难的文献,纳入21篇符合标准的文献。资料综合:对于脑卒中后吞咽困难,针刺治疗可达到迅速改善脑细胞功能的作用,使受损神经细胞苏醒,促进吞咽反射弧的重建与恢复,恢复咽部的神经支配,使吞咽动作得以协调和改善。中医病机在于痰浊、瘀血互结,上扰髓海。髓海为元神之府,元神受扰可致吞咽失常、言语蹇涩等症。治则为充脑益髓,通经活络,调养气血,开关启闭。针药并用是目前中医药疗法运用最普遍的一种互补,结合的治法。中西医结合一直是整个医学界追逐的目标之一,也是世界医学未来发展的一个必经之路。结论:对于脑卒中后的吞咽困难,单纯的西医治疗效果比较局限,而随着中医药治疗的逐步推广,针灸、中药的介入,使得中西医多种疗法相互渗参,相辅相成,疗效显著。

OBJECTIVE： To discuss the treating methods, mechanisms and clinical outlook of dysphagia caused by acute stroke from the traditional Chinese medical therapy. DATA SOURCES： A computer-based online search of CNKI was undertaken for articles about dysphagia published in Chinese between January 1979 and December 2006 with the key words of ＂dysphagia, methods, treatmen＂ in Chinese. STUDY SELECTION： The literatures were selected firstly to select those about dysphagia and look up the full texts. Inclusive criteria：①dysphagia; ②treatment with traditional Chinese modicine or integrated therapy of Chinese and western medicine for dysphagia. Exclusive criteria： ①dysphagia not caused by acute stroke; ②repeated study, review articles and case report. DATA EXTRACTION： Totally 49 literatures about dysphagia after acute stroke were collected and 21 papers met the inclusive criteria were selected. DATA SYNTHESIS： Acupuncture therapy in treating dysphagia caused by stroke can effectively improve cerebrocellular function, waken the injured nerve cells, promote the reconstruction and recovery of swallowing reflex arc, recover the innervation of pharynx and coordinate the swallowing. The pathogenesis in traditional Chinese medicine focuses on combination of stagnation of phlegm and blood stasis, and interference of reservoir sea of marrow, the house of mental activity, which can cause dysphagia and dysphasia. The treatment of dysphagia emphasizes tonifying the brain to benefit the marrow, clearing and activating the channels and collaterals and nursing qi and blood. Acupuncture combined with medicine is the common therapy in traditional Chinese medicine. Integrated Chinese and western medicine is one of the aims for the whole medical field, which is also the tendency of future medicine of the world. CONCLUSION： The curative effect of simple western medical therapy for dysphagia caused by acute stroke is very limited; with the wide usage of traditional Chinese medicine treatment especially the intervention of acupuncture and Chinese herbs, more and more western medicine are combined with traditional Chinese medicine, which display a better curative effect.