靶向针刺联合经颅磁刺激治疗脑卒中后吞咽障碍的疗效观察

Therapeutic effect of targeted acupuncture combined with transcranial magnetic stimulation for dysphagia after stroke

目的:观察靶向针刺联合高频重复经颅磁刺激(rTMS)对脑卒中后吞咽障碍的治疗效果。方法:脑卒中后吞咽障碍患者60例,随机分为常规组、针刺组、联合组,每组各20例。常规组采用改善脑供血、营养脑细胞等常规药物治疗,同时采用直接进食法、间接疗法等。针刺组在常规治疗的基础上,由资深针灸师进行靶向针刺,选穴风池、利咽穴等。联合组在针刺组基础上应用高性能磁刺激仪进行治疗。采用洼田饮水试验(WST)和吞咽功能评定量表(SSA)评价患者吞咽功能。结果:治疗4周后,3组WST及SSA评分与治疗前比较均有明显下降(均P<0.05),且联合组和针刺组均低于常规组(均P<0.05),联合组更低于针刺组(P<0.05)。联合组及针刺组痊愈率和总有效率均明显高于常规组(均P<0.05),且联合组痊愈率和总有效率均高于针刺组(均P<0.05)。结论:靶向针刺治疗及高频rTMS联合靶向针刺治疗均可有效改善卒中后吞咽障碍,且联合治疗效果更佳。

Objective:To observe the therapeutic effects of targeted acupuncture combined with high-frequency repetitive transcranial magnetic stimulation(rTMS)on dysphagia after stroke.Methods:Sixty patients with dysphagia after stroke were randomly divided into conventional group,acupuncture group and combined group,with 20 cases in each group.The conventional group was treated with conventional drugs such as improving cerebral blood supply and nourishing brain cells,while the direct feeding method and indirect therapy were used.On the basis of routine treatment,the acupuncture group was given targeted acupuncture by experienced acupuncturists,selecting points Fengchi and Liyan.The combined group was treated with high performance magnetic stimulator on the basis of acupuncture group.Swallowing function was evaluated by wa Tian drinking water test(WST)and swallowing function assessment scale(SSA).Results:After 4 weeks of treatment,the WST and SSA scores of the 3 groups were significantly lower than before treatment(all P<0.05),and those in the combined group and acupuncture group were lower than the conventional group(both P<0.05),and those in the combined group was lower than the acupuncture group(P<0.05).The cure rate and total effective rate of the combined group and acupuncture group were significantly higher than those of the conventional group(all P<0.05),and the cure rate and total effective rate of the combined group were higher than those of the acupuncture group(both P<0.05).Conclusion:Targeted acupuncture therapy combined with high-frequency rTMS can effectively improve dysphagia after stroke,and the combined therapy is more effective.