电刺激及针刺联合吞咽训练治疗脑卒中后吞咽功能障碍的疗效观察

Curative Effect of Stroke Patients with Swallowing Dysfunction after Treated with Electric Stimulation Combining Acupuncture and Swallowing Training

目的观察神经肌肉电刺激及针刺联合吞咽康复训练治疗100例脑卒中后吞咽功能障碍患者的疗效。方法将100例脑卒中伴吞咽功能障碍患者随机分成4组,每组25例,分别为对照组、针刺组、电刺激组和综合组。对照组仅给予脑卒中常规治疗及吞咽康复训练,针刺组在对照组基础上增加针刺疗法,电刺激组在对照组基础上增加神经肌肉电刺激疗法,综合组则采用以上所有的治疗方法进行综合治疗。分别在治疗1、2、3个疗程后对4组患者采用视频透视吞咽检查(videofluoroscopic swallowing study,VFSS)评分评估疗效。结果治疗1、2、3个疗程后,每组的VFSS评分都呈递增趋势,其中针刺组、电刺激组和综合组较治疗前均有明显增高,差异有统计学意义(P<0.05);相同时间点的VFSS评分,针刺组、电刺激组和综合组分别与对照组比较,差异均有统计学意义(P<0.05),且综合组与针刺组、电刺激组比较,差异有统计学意义(P<0.05)。在3个疗程后,各组的VFSS评分改善值均有提高,综合组的VFSS评分改善值最高,与其它3组比较差异有统计学意义(P<0.05)。结论吞咽康复训练、针刺及神经肌肉电刺激疗法治疗脑卒中后吞咽功能障碍均有效,但3种治疗联合应用效果更佳。

Objective To observe the curative effect of 100 cases of stroke patients with swallowing dysfunction after given neuromuscular electric stimulation combined with acupuncture and swallowing rehabilitation training treatment.Methods 100 stoke patients with swallowing dysfunction were randomized into 4groups with25 cases in each group as follows：control group,acupuncture group,electric stimulation group and comprehensive group.Conventional treatment combined with swallowing training was given to control group;additional acupuncture was added in acupuncture group on the basis of control group;additional neuromuscular electric stimulation was added in electric stimulation group on the basis of control group;and all the treatments were combined in comprehensive group.Video fluoroscopic swallowing study（VFSS）evaluation was used to assess the curative effect of 4groups after 3courses of treatment.Results After 3courses of treatment,the VFSS score of each group showed a trend of increase,and there were obvious growth in acupuncture group,electric stimulation group and comprehensive group,the differences of which were statistically significant（P〉0.05）;the VFSS scores of acupuncture group,electric stimulation group and comprehensive group had statistically significant differences with control group at the same time（P〉0.05）,and the VFSS score of comprehensive group had a statistically significant difference with acupuncture and electrical stimulation group;after 3courses of treatment,the VFSS scores of all groups has risen,among which the score of comprehensive group had the highest growth,the differences of which were statistically significant（P〉0.05）.Conclusion The swallowing rehabilitation training,acupuncture and neuromuscular electric stimulation can effectively improve the swallowing dysfunction of stroke patients,and the curative effect of combing all the methods was the best.