针刺配合口腔感觉运动训练治疗帕金森病吞咽障碍疗效观察

Therapeutic Observation of Acupuncture Combined with Oral Sensorimotor Training for Dysphagia in Parkinson Disease

目的观察针刺配合口腔感觉运动训练治疗帕金森病(PD)合并吞咽障碍的疗效。方法将90例PD合并吞咽障碍患者随机分为对照组和治疗组,每组45例,对照组给予口腔感觉运动训练,治疗组在对照组治疗基础上加针刺治疗,观察两组吞咽障碍改善效果,对比两组治疗前及治疗后的吞咽功能、营养状况、脑血流动力学、日常生活能力和生活质量。结果治疗组摄食-吞咽功能治疗总有效率(95.6%)显著高于对照组(80.0%)(P<0.05);治疗后,两组洼田饮水试验评分、功能性经口摄食量表(FOIS)和咽动态透视录像造影检查(VFSS)评分显著提高(P<0.05),营养风险筛查2002(NRS2002)评分显著降低(P<0.05),两组脑血流动力学指标中双侧大脑动脉血流平均流速(Vm)、最大峰值流速(Vs)显著提高(P<0.05),血管阻力指数(RI)显著降低(P<0.05),两组改良Barthel指数(MBI)评分和吞咽障碍特异性生活质量量表(SWAL-QOL)评分显著提高(P<0.05),以上指标治疗组优于对照组(P<0.05)。结论针刺配合口腔感觉运动训练治疗PD合并吞咽障碍患者疗效确切,可明显提高患者摄食-吞咽功能,降低其营养不良风险,促进其脑血流动力学改善和日常生活活动能力提高,以达到改善患者生活质量的目的。

Objective To observe the therapeutic efficacy of acupuncture combined with oral sensorimotor training in treating Parkinson disease(PD)coupled with dysphagia.Method Ninety patients with PD coupled with dysphagia were randomized into a control group and a treatment group,with 45 cases in each group.The control group was given oral sensorimotor training,based on which the treatment group was intervened by acupuncture.The effect in improving dysphasia was observed in the two groups.The swallowing function,nutrition state,cerebral hemodynamics,activities of daily living and quality of life were compared between the two groups before and after treatment.Result The total effective rate regarding the intake-swallowing function was significantly higher in the treatment group(95.6%)than in the control group(80.0%)(P<0.05).After treatment,the Kubota’s water swallowing test score,Functional Oral Intake Scale(FOIS)score and video fluoroscopic swallowing study(VFSS)score all increased significantly(P<0.05)in both groups,the score of Nutrition Risk Screening(NRS)decreased significantly(P<0.05),the mean blood flow velocity(Vm)and peak systolic blood flow velocity(Vs)of bilateral cerebral arteries increased significantly(P<0.05),the resistance index(RI)dropped significantly(P<0.05),and the Modified Barthel Index(MBI)score and the Swallowing-related Quality of Life(SWAL-QOL)score increased significantly(P<0.05).The treatment group was superior to the control group comparing the above indexes(P<0.05).Conclusion Acupuncture combined with oral sensorimotor training is effective in treating patients with PD coupled with dysphagia.It can obviously improve the intake-swallowing function,reduce the malnutrition risk,and promote the improvement of cerebral hemodynamics and activities of daily life to improve patient’s quality of life.