吞咽行为治疗结合针刺舌根部穴在假性延髓麻痹吞咽障碍中的应用

Clinical Effect of Swallowing Behavior Therapy Combined with Acupuncture at Tongue Root Points in Treatment of Dysphagia of Pseudobulbar Palsy

目的观察吞咽行为训练结合针刺舌根部穴对假性延髓麻痹吞咽障碍的临床疗效。方法选择114例假性延髓麻痹吞咽障碍患者,按照随机数字表将其分为行为组、针灸组及观察组,每组38例。行为组给予吞咽行为治疗,每日1次,每次30min;针灸组给予针刺舌根部穴治疗,每穴顺时针捻转3～4下,隔日1次;观察组给予吞咽行为训练和针刺舌根穴治疗。治疗20d后,采用洼田饮水试验、才藤吞咽障碍分级和摄食-吞咽功能分级评价3组临床疗效。结果 3组基于洼田饮水试验、才藤吞咽障碍分级和摄食-吞咽功能分级的疗效比较,差异均有统计学意义(P<0.05)。观察组基于洼田饮水试验、才藤吞咽障碍分级和摄食-吞咽功能分级的疗效均优于行为组和针灸组(P<0.05),而行为组与针灸组的疗效差异均无统计学意义(P>0.05)。结论吞咽行为训练结合针刺舌根部穴可明显改善假性延髓麻痹吞咽障碍患者的吞咽功能。

Objective To investigate the clinical effect of swallowing behavior therapy combined with acupuncture at tongue root points in the treatment of dysphagia of pseudobulbar palsy. Methods A total of 114 patients with dysphagia of pseudobulbar palsy were divided into behavior group, acupuncture group, and observation group using a random number table, with 38 patients in each group. The patients in the behavior group were given swallowing behavior therapy for 30 minutes each time once a day, those in the acupuncture group were given acupuncture at tongue root points with 3-4 times of clockwise twist at each point every other day, and those in the observation group were given swallowing behavior therapy combined with acupuncture at tongue root points. After 20 days of treatment, water swallow test, Caiteng 7 Rank for dysphagia, and feeding-swallowing functional grading were used to evaluate clinical outcome. Results After treatment, there was a significant difference between the three groups in the outcome based on water swallow test, Caiteng 7 Rank for dysphagia, and feeding-swallowing functional grading （P〈0.05） . The observation group had a significantly better clinical outcome based on water swallow test, Caiteng 7 Rank for dysphagia, and feeding-swallowing functional grading than the behavior group and the acupuncture group （P〈0.05）, while there was no significant difference between the behavior group and the acupuncture group （P〉0.05）. Conclusion Swallowing behavior therapy combined with acupuncture at tongue root points can significantly improve swallowing function in patients with dysphagia of pseudobulbar palsy.