针刺结合功能性电刺激治疗急性脑卒中后吞咽困难疗效观察

Efficacy observation of dysphagia after acute stroke treated with acupuncture and functional electric stimulation

目的:观察针刺结合功能性电刺激与单纯电刺激对急性脑卒中后吞咽困难患者吞咽功能恢复的影响,为治疗吞咽障碍提供较佳方法。方法:将74例患者随机分为针刺电刺激组(38例)和电刺激组(36例)。两组均采用功能性电刺激治疗仪,将电极片分别置于舌骨、甲状软骨上方、咬肌、下颌关节处,每次治疗时间为30min;针刺电刺激组加用针刺双侧焦氏头针运动区、感觉区下2/5,百会、廉泉、金津、玉液;每次治疗时间为30min。两组均每天治疗1次,6天为一疗程,疗程间休息1天,共治疗4个疗程。两组患者均于治疗前和治疗4个疗程后采用吞咽障碍程度评分评定疗效,并于治疗后观察鼻饲管的拔除率。结果:两组患者治疗后吞咽障碍程度评分均较治疗前明显增高(均P<0.05);治疗后针刺电刺激组吞咽障碍程度评分较电刺激组增加更明显(8.01±1.25vs 6.73±1.36,P<0.05)。针刺电刺激组显效率为84.2%(32/38),优于电刺激组的58.3%(21/36,P<0.05);针刺电刺激组鼻饲管拔除率为89.5%(34/38),高于电刺激组的50.0%(18/36,P<0.05)。结论:针刺配合电刺激治疗急性脑卒中后吞咽困难效果更好,有利于鼻饲管的及早拔出,疗效优于单纯电刺激治疗。

ABSTRACT Objective To observe the impacts on the recovery of swallowing function in patients of dysphagia after acute stroke treated with acupuncture and functional electric stimulation. Methods Seventy-four patients were randomized into an acupuncture plus electric stimulation group （38 cases） and an electric stimulation group （36 cases）. The functional electric stimulator was used in the two groups. The electric pads were placed on the hy- oid bone, the upper part of thyroid cartilage, the masseter muscle and the mandibular joint. The treatment lasted for 30 rain each time. In the acupuncture plus electric stimulation group, acupuncture was supplemented at motor area of Jiao＇s scalp acupuncture, lower 2/5 of sensory area, Baihui （GV 20）, Lianquan （CV 23）, Jinjin （EX-HN 12） and Yuye （EX-HN 13）, 30 min each time. The treatment was given once a day, 6 treatments for one session and there was 1 day at interval between the sessions, 4 sessions were required totally in the two groups. The dys- phagia scale was adopted for efficacy evaluation before treatment and after 4 sessions of treatment in the two groups. The removal rate of nasal feeding tube was observed after treatment. Results The dysphagia score was increased apparently after treatment compared with that before treatment in the two groups （both P〈O. 05）. After treatment, in the acupuncture plus electric stimulation group, the dysphagia score was increased much more appar- ently than that in the electric stimulation group （8.01 i 1.25 vs 6.73=t= 1.36,P〈0.05）. The remarkably effective rate was 84.2% （32/38） in the acupuncture plus electric stimulation group, better than 58.3%（21/36） in the e- lectric stimulation group （P%0.05）. The removal rate of nasal feeding tube was 89.5% （34/38） in the acupunc- ture plus electric stimulation group, which was higher than 50.0%（18/36） in the electric stimulation group （P〈0.05）. Conclusion Acupuncture combined with electric stimulation achieves the much better efficacy on dysphagia after acute stroke and promotes the early removal of nasal feeding tube. The efficacy is better than that of the sim- ple electric stimulation therapy.