深刺崇骨穴为主治疗中风后吞咽困难:随机对照研究

Randomized controlled study on dysphagia after stroke treated with deep insertion of Chonggu(EX-HN 27) by electroacupuncture

目的：探讨针刺崇骨穴不同深度对中风后吞咽困难临床疗效的影响。方法：采用多中心、随机对照、盲法原则，将283例中风后吞咽困难患者随机分为崇骨深刺组（99例）、崇骨浅刺组（94例）和传统针刺组（90例）。在常规治疗的基础上，崇骨深刺组、崇骨浅刺组均取崇骨、廉泉穴，崇骨深刺组崇骨针刺60-75mm，崇骨浅刺组崇骨针刺30mm，并通以电针；传统针刺组穴取风池、翳风、完骨、廉泉等，3组均留针30min，每天2次，共治疗30天。以洼田氏饮水试验评价量表、标准吞咽功能评价量表（SSA）、中风后吞咽障碍中医评价量表进行临床疗效评定。结果：崇骨深刺组总有效率为97．0％（96／99），优于崇骨浅刺组的64．9％（61／94）及传统针刺组的70．0％（63／90）（均P〈0．05）。各组内治疗前后分值比较，崇骨浅刺组仅中医评价量表评分下降差异有统计学意义（P〈0．01），崇骨深刺组及传统针刺组洼田氏饮水试验评分、SSA评分、中医评价量表评分均下降明显（均P〈0．01）；各组间治疗后分值比较，崇骨深刺组各项评分均较崇骨浅刺组、传统针刺组分值下降更明显（P〈0．05，P〈0．01）。结论：针刺崇骨能有效改善中风后吞咽功能障碍，是治疗中风后吞咽困难安全而有效的方法，但必须深刺。

Objective To explore the therapeutic effect of dysphagia after stroke treated with different depth of Chonggu （EX-HN 27） by eleetroacupuncture. Methods Two hundreds and eighty-three cases of dysphagia after stroke were randomly divided into Chonggu （EX-HN 27） deep insertion group （99 cases）, Chonggu （EX-HN 27） shallow insertion group （94 cases） and traditional acupuncture group （90 Cases） based on multi-central randomized control and blinding methods. Besides routine therapy, Chonggu （EX-HN 27） and Lianquan （CV 23） were selected in the Chonggu （EX-HN 27） deep insertion group and the Chonggu （EX-HN 27） shallow insertion group; the needles were inserted for 60~75 mm and 30 mm respectively and the electroacupuncture was applied in both groups; in traditional acupuncture group, Fengehi （GB 20）, Yifeng （TE 17）, Wangu （GB 12） and Lianquan （CV 23）, etc. were selected. The needles were retained for 30 min, twice a day and 30 treatments totally in 3 groups. The clinical therapeutic effects were evaluated by Kubota＇s Water Drinking Test Scale, Standard Swallowing Function Scale and TCM Scale of Dysphagia After Stroke. Results The total effective rate was 97.0% （96/99） in the Chonggu （EX-HN 27） deep insertion group, superior to that of 64.9% （61/94） in Chonggu （EX-HN 27） shallow insertion group and 70.0% （63/90） in traditional acupuncture group （both P〈0. 05）. Compared with the scores before and after treatment, significant differences were presented statistically in score reduction of TCM Scale in Chonggu （EX-HN 27） shallow insertion group （P〈0.01）; the Scores of Kubota＇s Water Drinking Test Scale, Standard Swallowing Function Scale and TCM Scale of Dysphagia After Stroke were obviously reduced in Chonggu （EX-HN 27） deep insertion group and traditional acupuncture group （all P〈0.01）; compared with the scores between groups after treatment, the reduction of scores in Chonggu（EX-HN 27） deep insertion group was superiorto those in Chonggu （EX-HN 27） shallow insertion group and traditional acupuncture group （ P〈0.05, P〈（0.01） respectively. Conclusion Puncture at Chonggu （EX-HN 27） can improve the dysfunction of swallowing after stroke; it is safe and effective, and the needle should be inserted deeply.