脑梗死后吞咽障碍的中医证候分布特点及针刺治疗

Observation on acupuncture therapeutic effects and TCM symptoms distribution characters of dysphagia after cerebral infarction

目的观察脑梗死后吞咽障碍的中医证候分布特点及"通关利窍"针刺法配合康复训练治疗该病的临床疗效。方法用SPSS 17.0软件进行数据整理,对337例多中心的患者中医症候分布特点进行分析;采用"通关利窍"针刺法配合康复训练治疗脑梗死后吞咽障碍,以洼田饮水试验为疗效指标,分别在治疗前、治疗1个月、5个月后随访3个时点进行观察。结果气虚血瘀型患者人数最多,其次依次为阴虚风动型、风痰阻络型、肝阳暴亢型、痰热腑实型;前四型患者治疗后、随访评分低于治疗前,差异有统计学意义;痰热腑实型患者在治疗后、随访评分也低于治疗前,但差异无统计学意义;治疗后和随访的各证型有效率相比存在差异,差异有统计学意义。其中,治疗后和随访患者有效率最高的证型分别为气虚血瘀型、阴虚风动型。结论 1)"通关利窍"针刺法配合康复训练既能短期又能长期改善肝阳暴亢、风痰阻络、气虚血瘀、阴虚风动型患者吞咽功能,但各证型之间的疗效存在差异。2)由于纳入痰热腑实型患者例数过少,尚不能对其疗效做出定论。3)通关利窍针法为通用法,但精准的治疗该病应以人为本,结合临床,分型、对证施治。

Objective To observe the distribution characters of TCM symptoms and the clinical effect of Tongguan Liqiaoacupuncture combined with rehabilitationon dysphagia after cerebral infarction.Methods By SPSS 17.0 software for data process,analyzing TCM symptoms of 337 cases from multicenter center.To treatdysphagia after cerebral infarction we use Tongguan Liqiao acupuncture combined with rehabilitation.The Watian drinking water test was used as outcome index.Patients were evaluated before and after treatment,follow-up 5 months after the treatment course.Results In the order of highest to lowestof all cases,there areqi deficiency and blood stasis type,yindeficiencyand wind act,wind-phlegm obstructing the channel,liver yang hyperactivity,phlegm-heat accumulation.After treatment and follow-up scores were lower than before treatment.But the difference was statistically significant for the top fourtypes.There is no statistically significant differencefor the phlegm-heat accumulationtype.There are differences between different types,the difference was statistically significant.Among them,the most efficient type after treatment and follow-up are yin deficiency and wind act,qi deficiency blood stasis respectively.Conclusion 1.Tongguan Liqiao acupuncture combined with rehabilitation can improve the swallowing functionof the first four types both in short-term and long-term.There are different effects between different types.2.Due to the case number of phlegm-heat accumulation type is too little,we can not make a conclusion on its efficacy still.3.Tongguan Liqiaoacupuncture therapy is the general method,it is necessary to be people-oriented,combined with clinical,syndrome differentiation and treatment in order to treat dysphagia after cerebral infarction accurately.