摘要
Objective To observe the clinical efficacy of acupuncture combined with speech rehabilitation training for post-stroke spasmodic dysphonia and compare the differences in efficacy among the therapy of acupuncture combined with speech rehabilitation training and the monotherapy.Methods Two hundred and seventy cases of patients with post-stroke spasmodic dysarthria were randomly divided into three groups with the ratio of 1：1：1.Group A：acupuncture combined with speech rehabilitation training group（90 cases）,group B：acupuncture group（90 cases）,group C：speech rehabilitation training group（90 cases）.In the group B,acupuncture treatment was given at Baihui（百会 GV 20）,JTnjin（金津 EX-HN 12） and Yuye（玉液 EX-HN13） as well as tongue-three needles.In the group C,the treatment of speech rehabilitation training was provided.The two treatments mentioned above were combined in the group A.Patients were treated once a day for a month with improved Frenchay dysarthria rating scale as the indices of therapeutic effect evaluation.Results ① Group A：the cured and markedly effective rate was 88.7%,and total effective rate was 94.3%;group B：the cured and markedly effective rate was 44.2%and total effective rate was 81.4%;group C：the cured and markedly effective rate was 23.5%and total effective rate was 61.2%.Both the cured and markedly effective rate and the total effective rate in the group A were significantly higher than those in the group B or group C（all P0.05）;both the cured and markedly effective rate and the total effective rate in the group B were higher than those of group C（both P0.05）;② In comparison of functional recovery of tongue in accordance with the Frenchay dysarthria rating scale,the recovery rate of the tongue-stationary state was 71.74%in the group A,18.87%in the group B and 4.44%in the group C;the recovery rate of tongue lolling out was 66.23%in the group A,27.63%in the group B and 1.59%in the group C;the recovery rate of tongue up and down motion was 44.19%in the group A,4.94%in the group B and 1.35%in the group C;the recovery rate of lateral motion was 40.24%in the group A,7.59%in the group B and 0.00%in the group C;the recovery rate of alternating motion was 29.07%in the group A,7.14%in the group B and 1.23%in the group C;the recovery rate of speech was 29.07%in the group A,5.88%in the group B and 1.22%in the group C.In the three groups,the recovery rates of stationary state and tongue lolling out were superior to those of up and down movement,lateral movement,alternating movement and speech（all P0.05）.Conclusion The clinical efficacy of acupuncture combined with speech rehabilitation training for patients with post-stroke spasmodic dysarthria is significant,and the efficacy of acupuncture is superior to that of speech rehabilitation training;as for functional recovery of tongue like stationary state and tongue out,the therapy of acupuncture combined with speech rehabilitation training is effective.
目的:观察针刺结合言语康复训练治疗脑卒中后构音障碍的临床疗效,比较针刺与言语康复训练相结合治疗较之单一治疗之间的疗效差异。方法:将270例脑卒中构音障碍患者按1:1:1比例采用完全随机方法分为3组:针刺结合言语康复训练组(A组,90例)、针刺组(B组,90例)、言语康复训练组(C组,90例)。B组采用针刺百会、舌三针、金津、玉液等穴位,C组采用言语训练方法,A组实施方案为针刺结合言语训练。均每日治疗1次,共治疗1个月。以改良的Frenchay构音障碍评价量表作为疗效评价指标。结果:①A组愈显率为88.7%、总有效率为94.3%,B组愈显率为44.2%、总有效率为81.4%,C组愈显率为23.5%、总有效率为61.2%,A组愈显率、总有效率明显高于单一治疗组(均P<0.05);B组显愈率、总有效率高于C组(均P<0.05);②Frenchay构音障碍评价量表中舌功能恢复的疗效比较,舌-静止状态复常率A组为71.74%,B组为18.87%,C组为4.44%;舌-伸舌方面复常率A组为66.23%,B组为27.63%,C组为1.59%;舌-上下运动复常率A组为44.19%,B组为4.94%,C组为1.35%;舌-两侧运动复常率A组为40.24%,B组为7.59%,C组为0.00%;舌-交替运动复常率A组为29.07%,B组为7.14%,C组为1.23%;舌-言语方面复常率A组为29.07%,B组为5.88%,C组为1.22%。3组在舌-静止状态及舌-伸舌方面复常率优于舌-上下运动、舌-两侧运动、舌-交替运动及舌-言语方面(均P<0.05)。结论:针刺结合言语康复训练的综合治疗方法,对脑卒中患者构音障碍的临床疗效显著,且针刺疗效优于言语康复训练治疗;在舌功能恢复方面,针刺及言语康复治疗对舌静止及伸舌运动疗效佳。
