化痰清瘀汤联合口咽部康复治疗缺血性脑卒中后阻塞性睡眠呼吸暂停并吞咽障碍(痰瘀阻窍)随机平行对照研究

Huatan Qingyu Decoction(化痰清瘀汤) combined with Oropharyngeal Rehabilitation Treatment of Obstructive Sleep Apnea and Dysphagia after Ischemic Stroke Randomized Parallel Control Study

[目的]观察化痰清瘀汤联合口咽部康复治疗缺血性脑卒中后阻塞性睡眠呼吸暂停并吞咽障碍(痰瘀阻窍)疗效。[方法]使用随机平行对照方法,将40例住院患者按就诊顺序号随机分为两组。对照组20例口咽部康复:口咽部肌肉功能性电刺激、基础训练(头颈、下颌、唇、舌、吞咽运动)、咽部冰感觉刺激、门德尔松手法、直接吞咽、摄食等。治疗组20例清瘀化痰汤(天麻、钩藤各15g,全蝎5g,僵蚕、川芎、丹皮、石菖蒲、郁金、半夏、陈皮各10g,甘草6g),水煎300mL,1剂/d,早晚分服;口咽部康复治疗同对照组。连续治疗30d为1疗程。观测洼田饮水试验评分、数字化吞咽造影检查(VFSS)评分、夜间最低血氧饱和度(LSaO_2)、低通气指数(AHI值)、不良反应。治疗1疗程(30d),判定疗效。[结果]治疗组显效11例,有效8例,无效1例,总有效率95.00%,对照组显效4例,有效10例,无效6例,总有效率70.00%,临床疗效治疗组优于对照组(P<0.05)。洼田饮水试验评分、数字化吞咽造影检查法(VFSS)评分、夜间最低血氧饱和度(LSaO_2),低通气指数(AHI值)两组均有改善(P<0.05),治疗组改善优于对照组(P<0.05)。[结论]化痰清瘀汤联合口咽部康复治疗脑卒中后阻塞性睡眠呼吸暂停并吞咽障碍(痰瘀阻窍)疗效满意,无严重不良反应,值得推广。

[Objective] To observe the effect of Huatan Qingyu decoction combined with comprehensive rehabilitation of oropharynx on obstructive sleep apnea combined with dysphagia after ischemic stroke. [Methods] Forty inpatients were randomly divided into two groups using randomized parallel control by order number. Control group 20 cases of oropharynx rehabilitation： throat muscles functional electrical stimulation, basic training （head and neck, jaw, lips, tongue, swallowing movements）, pharynx ministry ice sensory stimulation, mendelssohn gimmick, swallowing, such as feeding directly. Treatment group （20 cases of clear dampness and phlegm decoction （gastrodia elata, uncaria each 15g, 5g scorpion, batryticated silkworm, rhizoma ligustici wallichii, cortex moutan, stone calamus, turmeric, pinellia, each 10g dried tangerine or orange peel, liquorice 6g）, water frying, 300mL, 1 time/d, points in the morning and evening dress; Oral and pharyngeal rehabilitation treatment was the same as the control group. Continuous treatment for 30 days is 1 course of treatment. Observation of drinking water test score, Video Fluoroscopy Swallowing Study （VFSS） score, Lowest Oxygen Saturation at night （LSaO2） at night, apnea hypoventilation index （AHI） and adverse reactions in the depression. Continuous treatment for 1 course （30d） to determine the curative effect. [Results] Treatment group （11 cases had marked effect, 8 cases effectively, 1 had no effect, the total effective rate95.00%, control group 4 cases had marked effect, 10 cases were effective, 6 no effect, the total effective rate 70.00%, clinical curative effect of treatment group is better than that of control group （P〈0.05）.Tthe kubota drinking water test score, Video Fluoroscopy Swallowing Study （VFSS） score and swallowing, Lowest Oxygen Saturation at night （LSaO2）, apnea hypoventilation index （AI-II） values in the two groups were improved （P 〈0.05）, the treatment group is better than that of control group （P〈0.05）. [Conclusion] huatan qingyu decoction combined with oropharyngeal rehabilitation has satisfactory effect on obstructive sleep apnea and dysphagia （obstruction of phlegm and blood stasis） after stroke.