针刺阿呛组穴联合吞咽功能训练治疗脑卒中后吞咽障碍随机平行对照研究

Randomized Parallel Control Study about Acupuncture Aqiang Acupoints combined with Swallowing Function Training Treatment of Dysphagia After Stroke

[目的]观察针刺阿呛组穴联合吞咽功能训练治疗脑卒中后吞咽障碍疗效。[方法]使用随机平行对照方法,将110例住院及门诊患者按随机数字表方法简单随机分为两组。对照组50例常规吞咽功能训练：尽力朝前方或两侧进行伸舌,舌根逐渐抬高,反复训练;下颌-嘱患者尽量张口,然后松弛,反复训练;上下唇-让患者带手套将拇指及食指放在上下唇内外两侧,向上或向下牵拉5~10次,训练3~5次/d。治疗组60例针刺阿呛组穴（阿呛、治呛、吞咽）,阿呛：患者仰卧位,以食指从患者喉结逐渐滑向其下方凹陷处进行针刺,当患者出现剧烈咳嗽后立即出针;治呛：患者仰卧位,穴位在舌骨及甲状软骨上切迹之间位置,针刺,留针30min;吞咽：患者仰卧位,穴位在舌骨及甲状软骨上切迹之间,正中线旁开0.5寸凹陷位置,针刺时向外推开颈总动脉,留针30min;常规吞咽功能训练同对照组。连续治疗4周为1疗程。观测临床症状、吞咽功能评分、洼田氏饮水实验、生命体征、血尿常规、肝肾功能、心电图、不良反应。治疗1疗程（4周）,判定疗效。[结果]治疗组痊愈7例,显效17例,有效31例,无效5例,总有效率91.67%;对照组痊愈2例,显效10例,有效25例,无效13例,总有效率74.00%;治疗组疗效优于对照组（P〈0.05）。吞咽功能评分两组均明显改善（P〈0.01）,治疗组改善优于对照组（P〈0.01）。[结论]针刺阿呛组穴联合常规吞咽功能训练治疗脑卒中后吞咽障碍,疗效满意,无严重不良反应,值得推广。

[Objective] Observe curative effect of acuquncture Aqiangzu acupoints combined with swallowing function training treatment of Dysphagia after stroke. ]Methods] Using random parallel control method, 110 inpatients and outpatients samples are simply divided into two groups according to random number table method. Normal swallowing function training is used in the control group of 50 cases： tongue---try to move the tongue ahead or to both sides of the mouth as far as possible, and gradually raised the root of the tongue, repeated training in such a way; mandible--ask patients to open their mouths as widely as possible, and then relax, repeated training; lips --let patients place their thumbs and index fingers with gloves on inner and outer sides of each lip, and pull upward or downward 5 to 10 times ,training 3 to 5 times per day. Acupuncture Aqiang acupoints （Aqiang, Zhiqiang, Swallowing） is adopted in the treatment group of 60 cases. Acupuncture Aqiang point： keep patients supine, with the index finger sliding along the patients ＇ throats down to the sunken point, and then acupuncture it. Extract the needle immediately after a fit of severe cough occurs to the patients; Zhiqiang point： keep patients supine, acupuncture the point of the incisure between hyoid and thyroid cartilage, retaining the needle 30 minutes; Swallowing point： keep patients supine, acupuncture the sunken point 0.5 cun （1/6 decimetre） away from the middle line of the incisure between hyoid and thyroid cartilage, after pushing outward common carotid artery, retaining the needle 30 minutes; the normal swallowing function training in the treatment group is the same as that of the control group. A continuous 4-week treatment is one course, during which the clinical symptoms, swallowing functional scores, water swallow test, vital signs, blood and urine routine, liver and kidney functions, ECG （electrocardiograph）,and adverse reaction should be observed. Judge the efficacy after a course of 4-weekt reatment. [Results] In the treatment group, 7 cases were cured, 17 cases were markedly effective, 31 cases were effective, 5 cases were ineffective, the total effective rate. was 91.67%; in the control group, 2 cases were cured, 10 cases were markedly effective, 25cases were effective, 13 cases were ineffective, the total effective rate was 74.00%; the efficiency of the treatment group is superior to that of the control group （P 〈0.05）. Swallowing function scores were significantly improved in both groups （P〈0.01）, the improvement of the treatment group was better than that of the control group （P〈0.01）. [Conclusion] Acupuncture Aqiang acupoints combined with normal swallowing function training treatment of dysphagia after stroke has a satisfactory curative effect without severe bad reaction, worth popularizing.