“咽四穴”治疗缺血性脑卒中后假性球麻痹吞咽障碍

Yansi Acupoints in Treatment of Pseudobulbar Paralysis Dysphagia After Ischemic Stroke

目的:探讨"咽四穴"治疗缺血性脑卒中后假性球麻痹吞咽障碍的临床疗效。方法:将60例缺血性脑卒中后假性球麻痹患者随机分为对照组与治疗组。治疗组以"咽四穴"为主穴,咽部正中线旁开2寸的左右两条直线,和甲状软骨最高点上下各1寸两条直线的4个交点为"咽四穴"。对照组以金津、玉液、咽后壁、水沟为主穴,两组均给予常规西医对症治疗及配穴。针灸每日1次,5 d为1个疗程,间隔2 d后行下1个疗程,治疗4周。比较两组患者临床疗效及治疗前后饮水试验(water swallowing test,WST)、标准吞咽功能评估(standardized swallowing assessment SSA)积分、不良反应等情况。结果:两组患者治疗前后WST分级、SSA积分比较,差异有统计学意义(P<0.05),且治疗组WST分级、SSA积分优于对照组,差异有统计学意义(P<0.05)。治疗组有效率96.7%,对照组有效率76.7%,两组比较,差异有统计学意义(P<0.05)。两组患者治疗过程中均未出现明显不良反应。结论:采用"咽四穴"治疗缺血性脑卒中后假性球麻痹吞咽障碍疗效显著优于常规针刺方法。

Objective：To explore the clinical efficacy of Yansi Acupoints in treatment of pseudobulbar paralysis dysphagia after ischemic stroke. Methods：60 patients were randomly divided into control group and treatment group. The treatment group took the main point of Yansi Acupoints,which are the four crossing points of the two straight lines along the midline of the pharynx and other two lines going along the top and bottom of the thyroid cartilage. In the control group,acupoints of Jinjin,Yuye,Yanhoubi and Shuigou were used as the main acupoints. Both groups were given routine western symptomatic treatment and acpoints matching. Acupuncture and moxibustion were made once a day,and 5 days was a course of treatment. 2 days later,the next course of treatment was carried out. The whole treatment lasted for 4 weeks. The clinical efficacy,water swallowing test（ WST）,standardized swallowing assessment（ SSA） score and adverse reaction before and after treatment was compared between the two groups. Results：There was a significant difference in WST grade and SSA score between the two groups before and after treatment（ P〈0. 05）. The WST grade and SSA score in the treatment group were significantly better than those in the control group（ P〈0. 05）. The effective rate in the treatment group was 96. 7% and that was 76. 7% in the control group. There was a statistically significant difference between the two groups（ P〈0. 05）. No obvious adverse reactions were found during the treatment of the two groups of patients. Conclusion：The effect of acupuncture and moxibustion on Yansi acupoint in treatment of pseudobulbar paralysis dysphagia after ischemic stroke is significantly better than conventional acupuncture.