多种针法联合治疗卒中恢复期吞咽困难疗效观察

Effect of Acupuncture on Dysphagia of Convalescent Stroke Patients

目的探讨体针、头皮针加电针联合应用对卒中恢复期吞咽困难患者的吞咽功能改善是否优于常规康复训练。方法将148例卒中恢复期吞咽困难的患者随机分配至针刺组和康复训练组,每组74例。针刺组取患侧风池、完骨、翳风、廉泉、金津、玉液穴;头皮针围刺;体针、头皮针加电针联合应用,每天针刺1次,每周5次为1个疗程,共2~4个疗程。对照组由语言治疗师进行康复训练。治疗后3~6个月对主要结局同时使用意向性分析和符合方案数据分析两种方法评价,并报告＂为了避免1例不良事件发生必须治疗的患者数（num-ber needed to treat,NNT）＂、＂处理多少病例可以引起1次副作用（number needed to harm,NNH）＂及其95%的可信区间。治疗结束时评价次要结局。结果治疗结束时和治疗后3个月针刺组洼田吞咽功能痊愈率、洼田饮水试验痊愈率优于康复训练组,差异有统计学意义（P〈0.05）。治疗结束时肺部感染率和病死率、治疗后6个月病死率两组比较差异无统计学意义（P〉0.05）。两组依从性均为100%,针刺组未出现不良反应。结论针刺对卒中恢复期吞咽困难患者的吞咽功能改善优于常规康复训练,且安全、耐受性好。

Objective To discuss the therapeutic effect on dysphagia of the convalescent stroke by combination of the body acupuncture,the scalp acupuncture and the electric acupuncture could be better than that by routine rehabilitation training.Methods 148 patients with dysphagia of convalescent stroke were randomly assigned to the acupuncture group and rehabilitation group,74 in each group.Fengchi（GB20）,Wangu（GB12）,Yifeng（SJ17）,Lianquan（RN23）,Jinjin（EX-HN12）,Yuye（EX-HN12） on the affected side were needled,and the scalp acupuncture was needled.The body acupuncture,the electric acupuncture,and the scalp acupuncture were applied in combination in the acupuncture group.The acupuncture was performed once a day,five times as one therapeutic course,2-4 courses totally.Rehabilitation training was performed by language therapists in the control group.The main outcomes were assessed with both intention-to-treat analysis and on-treatment/per-protocol analysis at the same time.The value of number needed to treat（NNT）/number needed to harm（NNH） and their 95% confidence intervals were also reported.The secondary outcomes were assessed by the end of the treatment.Results The recovery rate assessed by Watian swallowing ability,water drinking test in the acupuncture group were better than those of the control group by the end of the treatment and three months after treatment（P0.05）.There was no statistical significance in the pulmonary infection rate and the mortality or in the 6-month mortality after treatment by the end of the treatment between the two groups（P0.05）.The compliance was 100% in the two groups.No adverse reaction occurred in the acupuncture group.Conclusion Acupuncture for dysphagia of convalescent stroke was better than routine rehabilitation training with safety and high tolerance.