穴位注射结合神经电刺激治疗卒中后吞咽障碍临床观察

Post-stroke dysphagia treated with acupoint injection combined with neural electrical stimulation

目的:观察穴位注射结合神经电刺激与单纯行穴位注射、神经电刺激及吞咽训练治疗脑卒中后吞咽障碍的疗效差异,为治疗本病选择适宜方法提供参考。方法:将183例脑卒中后吞咽障碍患者随机分为综合治疗组42例、穴位注射组44例、神经电刺激组49例、吞咽训练组48例,分别予以穴位注射结合神经电刺激、穴位注射、神经电刺激、吞咽训练治疗,10天为一疗程,疗程间休息3天,共治疗3个疗程。并与47例脑卒中后吞咽障碍患者进行空白对照,所有患者予以基础康复治疗。采用改良洼田饮水试验分别于治疗前、治疗10天后、治疗30天后对各组进行疗效评价,比较各组临床疗效、洼田饮水试验评分、洼田饮水改善程度的差异。结果:经10天治疗,各组有效率、洼田饮水试验评分比较差异均无统计学意义(均P>0.05);经30天治疗,综合治疗组有效率(94.29%,33/35)明显优于穴位注射组(68.75%,22/32)、神经电刺激组(80.00%,32/40)、吞咽训练组(67.50%,27/40)、空白组(42.86%,12/28),且综合治疗组洼田饮水试验评分低于其他各组(1.37±0.60vs 2.03±1.00、1.90±0.90、2.20±0.72、2.71±0.90,均P<0.05)。而穴位注射组、神经电刺激组、吞咽训练组三组在有效率、洼田饮水试验评分方面差异无统计学意义(均P>0.05),说明综合治疗组的吞咽功能改善程度显著优于其他组(均P<0.05)。结论:穴位注射结合神经电刺激的综合治疗方法能更好的治疗脑卒中后吞咽障碍。

Objective To observe the effect differences on post-stroke dysphagia among acupoint injection combined with neural electrical stimulation,acupoint injection,neural electrical stimulation,and swallowing training respectively,so eligible intervention can be applied to this kind of disease.Methods One hundred and eight-three patients of post-stroke dysphagia were randomized into a comprehensive treatment group（42 cases）,an acupoint injection group（44 cases）,a neural electrical stimulation group（49 cases）and a swallow training group（48 cases）and were treated with the comprehensive therapy of acupoint injection and neural electrical stimulation,acupoint injection,neural electrical stimulation and swallowing training separately.The treatments for 10 days made one session.There were 3days at the interval among treatment sessions and 3 sessions were required totally.The cases in those treatment groups were blankly controlled with the other 47 patients of post-stroke dysphagia.All the patients received basic rehabilitation treatment.The modified water swallowing test was conducted to assess the efficacy before treatment,10 days after treatment and 30 days after treatment in each group separately.The clinical efficacy,score of water swallowing test and improvement in water swallow test were compared among the groups.Results After 10-day treatment,the differences in efficacy and score of water swallow test were not significant in each group（all P〉0.05）.After 30-day treatment,the effective rate（94.29%,33/35）in the comprehensive treatment group was apparently better than 68.75%（22/32）in the acupoint injection group,80.00%（32/40）in the neural electrical stimulation group,67.50%（27/40）in the swallowing training group and 42.86%（12/28）in the blank group separately.The score in water swallow test in the comprehensive treatment group was lower than that in each of the other groups（1.37±0.60 vs 2.03±1.00,1.90±0.90,2.20±0.72,2.71±0.90,all P〈0.05）.The differences in the effective rate and score in water swallow test were not significant among the acupoint injection group,neural electrical stimulation group and swallowing training group（all P〉0.05）,which indicated that the improvement in swallowing function in the comprehensive treatment group was significantly superior to the other groups（all P〈0.05）.Conclusion The comprehensive therapy of acupoint injection and neural electrical stimulation achieves the much better efficacy on post-stroke dysphagia.