眼针结合经颅直流电刺激治疗脑卒中后吞咽障碍临床效益研究

Clinical Efficacy of Eye Acupuncture Combined With tDCS in Treatment of Dysphagia after Stroke

目的：评价眼针结合经颅直流电刺激（t DCS）治疗脑卒中后吞咽障碍的临床效益。方法：选取2016年12月—2018年1月本院收治的脑卒中后吞咽障碍患者72例,采用简单随机化法将其随机分为两组,每组36例,t DCS组给予t DCS治疗,联合组在t DCS治疗基础上给予眼针治疗。评价并对比治疗前后洼田饮水试验分级、吞咽障碍严重程度（SSS）分级及治疗前后洼田饮水试验分级差值（Δ1）、治疗前后SSS分级差值（Δ2）,对比两组临床疗效（E）、总医疗成本（C）、成本效果比（C/E）、洼田饮水试验和SSS增量成本效果比。结果：两组治疗前洼田饮水试验分级、SSS分级比较差异无统计学意义（P〉0.05）,两组治疗后洼田饮水试验分级显著高于治疗前（P〈0.05）,联合组治疗后洼田饮水试验分级显著高于t DCS组（P〈0.05）,两组治疗后SSS分级均显著低于治疗前（P〈0.05）;联合组治疗后SSS分级显著低于t DCS组（P〈0.05）;联合组Δ1、Δ2均显著大于t DCS组（P〈0.05）;两组临床疗效等级分布比较差异显著（P〈0.05）,其中联合组总有效率显著高于t DCS组（P〈0.05）;联合组C较t DCS组高,但联合组C/E、洼田饮水试验和SSS增量成本效果比均低于t DCS组。结论：眼针结合t DCS能够显著改善脑卒中患者吞咽功能,疗效确切,且有较高的经济学价值,值得临床推广。

Objective：To evaluate the clinical efficacy of eye acupuncture combined with transcranial direct current stimulation（t DCS） to treat dysphagia after stroke. Methods：Seventy-two patients with dysphagia after stroke were selected in our hospital from September 2016 to June 2017 and randomly divided into 2 groups by simple randomization,36 cases in each group. The t DCS group was treated with t DCS,and the combined group was treated with eye acupuncture on the basis of t DCS treatment. The grades of Water swallow test,swallow severity scale（ SSS） before and after treatment,swallow test（ Δ1） and SSS（ Δ2） were compared.The clinical efficacy（ E）,the total medical costs（ C）,the cost effect ratios（ C/E）,incremental cost effect ratios of Water swallow test and SSS of the two groups were compared. Results：There were no differences in the grades of Water swallow test and SSS of the two groups before treatment（ P〈0. 05）. The grades of Water swallow test of the two groups after treatment were significantly higher than those before treatment（ P〈0. 05）. The grade of Water swallow test of the combined group after treatment was significantly higher than that of the t DCS group（ P〈0. 05）. The scores of SSS of the two groups after treatment were significantly lower than those before treatment（ P〈0. 05）. The grade of SSS of the combined group after treatment was significantly lower than that of the t DCS group（ P〈0. 05）. The Δ1 and Δ2 of the combined group were significantly higher than those of the t DCS group（P〈0. 05）. There were significant differences in the distribution of clinical efficacy of the two groups（P〈0. 05） and the total effective rate of the combined group was significantly higher than that of the t DCS group（ P〈0. 05）. The C of the combined group was higher than that of the t DCS group,while the C/E,incremental cost effect ratios of Water swallow test and SSS of the combined group were lower than those of the t DCS group. Conclusion：Eye acupuncture combined with t DCS can significantly improve the swallowing function of patients with dysphagia after stroke,and the curative effect is accurate and has higher economic value,which is worthy of clinical promotion.