醒脑开窍针法联合神经肌肉电刺激对颅脑损伤吞咽障碍患者吞咽功能及血清蛋白水平的影响

Effects of Xing Nao Kai Qiao Needling Method Combined with Neuromuscular Electrical Stimulation on Swallowing Function and Serum Protein Levels in Patients with Dysphasia After Craniocerebral Trauma

目的观察醒脑开窍针法联合神经肌肉电刺激对颅脑损伤吞咽障碍患者吞咽功能及血清蛋白的影响。方法随机将69例颅脑损伤吞咽障碍患者分为两组,对照组(35例)采用常规吞咽功能康复训练治疗,观察组(34例)在对照组基础上给予醒脑开窍针法联合神经肌肉电刺激治疗。于治疗前后观察两组吞咽功能评估量表(GUSS)评级、洼田饮水试验(WST)评分及血清白蛋白(ALB)、血红蛋白(Hb)、前白蛋白(PA)、转铁蛋白(TRF)、缺氧诱导因子-1a(HIF-1a)、视锥蛋白样蛋白-1(VILIP-1)、神经元特异性烯醇化酶(NSE)、神经肽Y(NPY)、热休克蛋白70(HSP70)、脑源性神经营养因子(BDNF)、血管内皮生长因子(VEGF)、胰岛素样生长因子1(IGF-1)、髓鞘相关生长抑制因子(NogoA)水平,并观察两组的疗效。结果观察组总有效率为87.9%,对照组为69.7%,两组疗效比较差异有统计学意义(Z=2.351,P<0.05)。观察组治疗后GUSS评级较对照组更优(P<0.05),WST评分降低(P<0.05)。观察组治疗后HIF-1a、VILIP-1、NSE、NPY、Nogo-A水平低于对照组(P<0.05),而ALB、Hb、PA、TRF、HSP70、BDNF、VEGF、IGF-1水平高于对照组(P<0.05)。结论在常规吞咽功能康复训练基础上,醒脑开窍针法联合神经肌肉电刺激治疗颅脑损伤吞咽障碍患者的效果显著,能有效改善临床症状,促进吞咽障碍恢复,改善营养状态及神经营养状态,促进神经功能恢复,这可能与调节血清蛋白有关。

Objective To observe the effects of Xing Nao Kai Qiao(brain-awakening and orifice-opening)needling method plus neuromuscular electrical stimulation on swallowing function and serum proteins in patients with dysphasia after craniocerebral trauma.Method Sixty-nine patients with dysphasia after craniocerebral trauma were randomized into two groups.The control group(35 cases)was intervened by routine swallowing function rehabilitation training,while the observation group(34 cases)was additionally intervened by Xing Nao Kai Qiao needling method plus neuromuscular electrical stimulation.Before and after treatment,the Gugging Swallowing Screen(GUSS)grading,Kubota’s water swallowing test(WST)score,and serum levels of albumin(ALB),hemoglobin(Hb),prealbumin(PA),transferrin(TRF),hypoxia-inducible factor-1a(HIF-1a),vinisin-like protein-1(VILIP-1),neuron specific enolase(NSE),neuropeptide Y(NPY),heat shock protein 70(HSP70),brain-derived neurotrophic factor(BDNF),vascular endothelial growth factor(VEGF),insulin-like growth factor-1(IGF-1)and myelin-associated growth inhibitor(Nogo-A)were observed in the two groups.The therapeutic efficacy was also observed.Result The total effective rate was 89.7%in the observation group versus 69.7%in the control group,and the between-group difference in the therapeutic efficacy was statistically significant(Z=2.351,P<0.05).The improvement in GUSS grading was more significant in the observation group than in the control group(P<0.05),and the WST score decreased in the observation group(P<0.05).After treatment,the levels of HIF-1a,VILIP-1,NSE,NPY and Nogo-A were lower in the observation group than in the control group(P<0.05),and the levels of ALB,Hb,PA,TRF,HSP70,BDNF,VEGF and IGF-1 were higher in the observation group than in the control group(P<0.05).Conclusion Based on the routine swallowing function rehabilitation training,Xing Nao Kai Qiao needling method plus neuromuscular electrical stimulation can produce significant efficacy in treating dysphasia after craniocerebral trauma;it can effectively mitigate the clinical symptoms,promote the recovery of swallowing function,improve the nutritional state and neurotrophic state,and encourage the recovery of neural function,which are possibly associated with the regulation of serum proteins.