针刺联合康复治疗脑卒中后吞咽障碍的临床观察

Clinical Observations on Treatment of Pseudobulbar Palsy Induced Dysphagia by Acupuncture plus Rehabilitation Therapy

目的在卒中单元中应用针刺联合康复治疗假性延髓麻痹所导致的吞咽障碍,并与同期单纯应用康复及单纯应用针刺的患者进行疗效对比,以观察针刺联合康复治疗假性延髓麻痹所致吞咽障碍的临床疗效。方法用层内随机配对法将患者分为治疗组(针刺联合康复),对照I组(单纯康复),对照Ⅱ组(单纯针刺)。运用吞咽困难评定量表分别于治疗第1天、第3天、第6天、第14天对患者进行定量评分。结果治疗组治疗第3天与第1天比较,吞咽困难评定量表评分差异有统计学意义(P<0.05),表明治疗组治疗第3天起效。而对照I组和对照Ⅱ组治疗第6天起效。各组均于15天达到高峰。说明治疗组具有起效快,疗效确切的特点。以洼田氏饮水试验作为吞咽障碍评测标准,对治疗前后三组疗效进行对比观察,治疗组疗效优于对照I组和对照Ⅱ组(P<0.01)。结论结果表明针刺联合康复治疗可改善假性延髓麻痹所导致的吞咽障碍。

Objective To investigate the clinical efficacy of acupuncture plus rehabilitation therapy in treating pseudobulbar palsy induced dysphagia in a stroke unit by comparing the therapeutic effect of it with simple rehabilitation or acupuncture. Methods The patients were randomly allocated, by a intra-stratum random paired design, to a treatment group （ acupuncture plus rehabilitation therapy）, a control group Ⅰ （simple rehabilitation therapy）, and a control group Ⅱ （simple acupuncture）. A dysphagia assessment scale was used to count the score in the patients on day 1,3, 6 and 14 of treatment. Results There was a significant difference in the dysphagia assessment scale score between day 1 and 3 of treatment in the treatment group （ P 〈 0.05 ）, indicating that the therapeutic effect appeared on the third day of treatment in the treatment group. But the therapeutic effect appeared on the sixth day of treatment in the control group Ⅰ and group Ⅱ. The effect reached the peak in each group on the fifteenth day of treatment. It was indicated that the therapy was characterized by a quick and exact effect in the treatment group. The Watian＇ s water drinking test was used as a standard for evaluating dysphagia to compare the therapeutic effects between the three groups. The effect was better in the treatment group than in the control group Ⅰ and group Ⅱ （P 〈0. O1 ）. Conclusion The results indicate that acupuncture plus rehabilitation therapy can improve pseudobulbar palsy induced dysphagia, which shows the advantage of combined traditional Chinese and western medicine.