不同深度针刺双侧风池、翳风穴治疗脑卒中后吞咽障碍的临床观察

Clinical Observation of Acupuncture at Fengchi and Yifeng Points at Different Depths on Dysphagia after Stroke

目的比较不同深度针刺双侧风池、翳风穴治疗脑卒中后吞咽障碍的临床疗效。方法收集2017年3月—2018年11月在辽宁中医药大学附属医院神经内科治疗的脑卒中后吞咽障碍患者90例,随机分为对照组和观察组,每组各45例。两组均给予康复训练、神经肌肉电刺激联合针刺治疗(两组取穴相同,针刺深度不同),治疗4周。观察两组临床疗效、吞咽功能、表面肌电图(sEMG)、血清IL-6和hs-CRP水平、不良反应、神经功能评分、中医症状评分和生活质量评分等。结果治疗后,对照组无不良反应发生,观察组出现1例瘀青,1例血肿;观察组治疗有效率明显高于对照组(P<0.05),且观察组更优(P<0.05);观察组口角歪斜程度、眼裂闭合程度等症状,WST、VFSS、NIHSS和SWAL-QOL评分,sEMG最大波幅值以及吞咽过程等改善情况均优于对照组(P<0.05);观察组血清IL-6、hs-CRP水平均显著低于对照组(P<0.05)。结论深刺双侧风池穴、翳风穴联合神经肌肉电刺激治疗脑卒中后吞咽障碍疗效显著。

OBJECTIVE The clinical effects of acupuncture at different depths on bilateral wind pools and acupuncture points on swallowing disorders after stroke were compared.METHODS A total of 90 patients with dysphagia after stroke who were treated in neurology in our hospital from March 2017 to November 2018 were collected and randomly divided into a control group and an observation group,with 45 cases in each group.Both groups were given rehabilitation training,neuromuscular electrical stimulation,and acupuncture(the two groups had the same acupoints,but the depth of acupuncture was different)for 4 weeks.The clinical efficacy,swallowing function,surface electromyogram(sEMG),serum IL-6 and hs-CRP,adverse reactions,neurological function score,TCM symptom score,and quality of life score were observed in both groups.RESULTS After treatment,there were no adverse reactions in the control group.One patient had bruises and one hematoma in the observation group.The treatment efficiency in the observation group was significantly higher than the control group(P<0.05).The observation group was better(P<0.05).The observation group’s symptoms such as mouth angle skew,degree of fissure closure,WST,VFSS,NIHSS,SWAL-QOL score,maximum sEMG amplitude,and swallowing process were all better than the control group(P<0.05);Serum IL-6 and hs-CRP levels in the observation group were significantly lower than those in the control group(P<0.05).CONCLUSION Deep puncture bilateral Fengchi and Qifeng points combined with neuromuscular electrical stimulation had significant effects in the treatment of swallowing disorders after stroke.