针刺联合Vitalstim电刺激疗法治疗缺血性脑卒中后吞咽功能障碍的疗效观察

The clinical therapeutic effect of acupuncture combined with Vitalstim electric stimulation therapy on dysphagia after ischemic stroke

目的 观察针刺联合Vitalstim电刺激疗法对缺血性脑卒中后吞咽功能障碍的疗效.方法 选取2014年5月至2016年11月天津中医药大学第一附属医院针灸科收治的缺血性脑卒中后吞咽功能障碍患者92例,将患者按随机数字表法分为对照组和观察组,每组46例.两组在脑卒中常规药物治疗及摄食-吞咽康复训练基础上,对照组采用Vitalstim电刺激疗法,观察组采用针刺联合Vitalstim电刺激疗法.观察两组治疗前后吞咽能力评分、吞咽X线电视透视检查评分（VFSS）的变化及不良反应发生情况.结果 与治疗前比较,两组患者治疗后吞咽能力评分、VFSS评分均明显升高,且治疗后以观察组的变化程度较对照更显著 〔吞咽能力评分（分）：8.12±1.13比7.45±1.04,VFSS评分（分）：7.97±1.05比5.67±0.88〕;观察组总有效率明显高于对照组〔95.7%（44/46）比78.3%（36/46）〕,不良反应（误吸、肺感染）发生率明显低于对照组 〔10.9%（5/46）比28.3%（13/46）〕,两组比较差异均有统计学意义（均P〈0.05）.结论 针刺联合Vitalstim电刺激疗法能改善缺血性卒中后吞咽障碍患者的吞咽功能,且疗效较单纯Vitalstim电刺激疗法更为显著,不良反应较少.

Objective To investigate the therapeutic effect of acupuncture combined with Vitalstim electric stimulation therapy for treatment of patients with dysphagia after ischemic stroke.Methods Ninety-two patients with dysphagia after ischemic stroke in accord with the criteria of enrollment in this study were admitted to the Department of Acupuncture of the First Affiliated Hospital of Tianjin Traditional Chinese Medicine University from May 2014 to November 2016, and they were divided into a control group and an observation group by random number table, 46 cases in each group. Both groups were treated with stroke conventional drug therapy and feeding swallowing rehabilitation training, in addition, Vitalstim swallowing therapeutic electrical stimulation therapy was used in the control group, and acupuncture combined with Vitalstim stimulation were applied in observation group. The changes of swallowing ability score, video fluoroscopic swallowing study （VFSS） score and adverse reactions were observed before and after treatment in the two groups, and the curative effect of combined method was evaluated.Results Compared with those before treatment, the swallowing ability and VFSS score of two groups after treatment were obviously higher, and the degrees of changesin observation group were more significant than those in control group （swallowing score： 8.12±1.13 vs. 7.45±1.04, VFSS score： 7.97±1.05 vs. 5.67±0.88, allP 〈 0.05）; the total efficiency in the observation group was markedly higher than that in the control group [95.7% （44/46） vs. 78.3%（36/46）], the adverse reactions （wrong aspiration, pulmonary infection） in the observation group were significantly lower than those in the control group [10.9% （5/46） vs. 28.3% （13/46）], and there were statistically significant differences between the two groups （bothP 〈 0.05）.Conclusions Acupuncture combined with Vitalstim electric stimulation therapy can improve the swallowing ability in patients with dysphagia after ischemic stroke, and the therapy has less adverse reactions; compared with the simple Vitalstim electric stimulation therapy, in the aspect of improving swallowing ability, the therapeutic effect of combined therapy is more significant.