应用表面肌电图评价针刺风池穴对卒中吞咽障碍患者即刻影响研究

Immediate Effect Assessment of Needling GB20 on Post-Stroke Dysphagia by Using sEMG

目的:应用表面肌电图(sEMG)评定针刺风池穴对卒中患者吞咽障碍的即刻影响。方法:选择符合入选标准的96例卒中吞咽障碍患者,随机分为试验组48例、对照组48例。对照组行吞咽常规功能训练,试验组在对照组方案基础上施行项丛刺:风池(主穴),配以旁廉泉、廉泉、完骨及天柱,并结合金津、玉液舌下点刺放血,对比两组患者1个月治疗前后洼田饮水试验等级(WST)及标准吞咽功能评价量表评分(SSA),并首次利用sEMG探讨针刺项丛刺主穴风池穴对空吞咽及吞咽5 mL水的即刻影响,初探针刺风池穴治疗吞咽障碍的作用机制。结果:两组患者WST等级均较疗前改善(均P<0.05),SSA得分均较疗前减低(均P<0.05),且试验组均优于对照组(P<0.05)。sEMG示,针刺风池穴即刻与针刺前比较,在空吞咽及吞咽5 mL水模式下,颏下肌群及舌骨下肌群的吞咽时间均缩短,差异有统计学意义(均P<0.05);颏下肌群及舌骨下肌群吞咽平均振幅均增大,差异有统计学意义(均P<0.05)。结论:项丛刺疗法结合吞咽功能训练治疗吞咽障碍更有效,项丛刺风池穴可有效改善颏下肌群及舌骨下肌群吞咽时间、增加吞咽肌群的收缩能力及协调性。

Objective:To evaluate the immediate effect of needling Fengshi(GB20)on post-stroke dysphagia by using surface electromyography(sEMG).Methods:96 patients with post-stroke dysphagia were randomly divided into the control group(n=48)and the study group(n=48).The control group was treated with routine functional swallowing training;on which basis,the study group was also treated with nape cluster needling GB20,Panglianquan,Lianquan(CV20),Wangu(GB12)and Tianzhu(BL10)combined with Jinjin(EX-HN20 a)and Yuye(EX-HN20 b)blood-letting therapy.The scores of water swallowing test(WST)and the standardized swallowing assessment(SSA)were observed after one month of treatment;also,immediate effect of dry and wet swallowing(5ml water)after needling the main acupoint,GB20,of nape cluster needling was explored for the first time by using surface electromyography(sEMG).The action mechanism of needling GB20 in treating post-stroke dysphagia were preliminarily discussed.Results:Swallowing ability was significantly improved and SSA scores were significantly decreased after the treatment than those before the treatment in the two groups(P<0.05);of which the improvements and the decreases in the study group were more significant(P<0.05).sEMG showed immediate effect of needling GB20 could shorten swallowing time of both submental muscles and infrahyoid muscles(P<0.05),and could increase amplitude of the root mean square(RMS)(P<0.05)in terms of dry and wet swallowing test.Conclusion:The combination of nape cluster needling and functional swallowing training has better curative effect in the treatment of post-stroke dysphagia,and immediate effect of needling GB20 can shorten swallowing time and increase motion amplitude and improve the coordination of swallowing muscle group of the patients.