针刺康复综合治疗脑卒中后吞咽障碍临床观察

Clinical Observation of Acupuncture plus Rehabilitation in Treating Deglutition Disorders Due to Cerebral Stroke

目的观察针刺康复综合治疗脑卒中后吞咽障碍的疗效及对患者吞咽功能神经通路各环节的影响。方法选取99例脑卒中后吞咽障碍患者,采用前瞻性随机对照研究方法,分成针康综合组、咽部针刺组和对照组,分别为33例、34例、32例。针康综合组采用皮层咽部舌根针刺法及基础治疗,咽部针刺组采用吞咽穴单穴治疗及基础治疗,对照组仅应用基础治疗,每日1次,疗程为4星期。收集治疗前后FOIS评分及CNSAT评分,并进行统计学分析。结果针康综合组治疗后CNSAT各项评分均较治疗前明显改善(P<0.01),咽部针刺组治疗前后CNSAT各项评分比较差异有统计学意义(P<0.05),针康综合组治疗后CNSAT各项评分与咽部针刺组及对照组比较差异有统计学意义(P<0.01),咽部针刺组治疗后CNSAT各项评分与对照组比较差异有统计学意义(P<0.05);各组治疗后FOIS评分较治疗前均有提高,针康综合组治疗前后比较差异有显著统计学意义(P<0.01),咽部针刺组治疗前后比较差异有统计学意义(P<0.05);但针康综合组和咽部针刺组治疗后FOIS评分均高于对照组(P<0.01,P<0.05)。结论采用皮层咽部舌根序贯针刺法配合康复手法,能够有效干预脑卒中后口咽相各种吞咽问题,改善口咽相吞咽障碍患者进食能力,减少误吸风险。

Objective To observe the effect of acupuncture plus rehabilitation in treating deglutition disorders due to cerebral stroke and its effect on each link of the neural pathway of deglutition function.Method By adopting the prospective randomized controlled method,ninety-nine patients with deglutition disorders after cerebral stroke were recruited and divided into an acupuncture-rehabilitation group,a pharyngeal acupuncture group,and a control group,respectively 33 cases,34 cases,and 32 cases in each group.The acupuncture-rehabilitation group was intervened by acupuncture respectively at scalp,pharyngeal,and the root of tongue plus basic treatment,the pharyngeal acupuncture group was by acupuncture at the deglutition point（Extra） plus basic treatment,while the control group was by the basic treatment alone,once a day,4 weeks in total.The Functional Oral Intake Scale（FOIS） and Clinical Nursing Swallowing Assessment Tool（CNSAT） were evaluated and statistically analyzed before and after intervention.Result The component scores of CNSAT were significantly improved after intervention in the acupuncturerehabilitation group（P〈0.01）;the component scores of CNSAT were significantly changed after intervention in the pharyngeal acupuncture group（P〈0.05）;the CNSAT component scores in the acupuncture-rehabilitation group were significantly different from that in the pharyngeal acupuncture group and control group after intervention（P〈0.01）;the CNSAT component scores in the pharyngeal acupuncture group were significantly different from that in the control group after intervention（P〈0.05）.The FOIS scores were enhanced in the three groups after treatment;the FOIS score was significantly changed in the acupuncture-rehabilitation group after intervention（P〈0.01）;the FOIS score was markedly changed in the pharyngeal acupuncture group after intervention（P〈0.05）;the FOIS scores in the acupuncture-rehabilitation group and pharyngeal acupuncture group were both significantly higher than that in the control group（P 〈0.01,P〈 0.05）.Conclusion The scalp-pharyngeal-root of tongue sequential-acupuncture plus rehabilitation can effectively mitigate the deglutition problems after cerebral stroke,improve the food-intake ability of the patients,and reduce the risk of mistake inhalation.