针刺和神经肌肉电刺激治疗中风后吞咽障碍研究进展

Research Progress of Acupuncture and Neuromuscular Electrical Stimulation for Dysphagia after Stroke

综述近5年来针刺和神经肌肉电刺激治疗中风后吞咽障碍的研究进展。通过计算机检索中国期刊全文数据库(CNKI)、维普、万方、pubmed数据库中2015年12月1日-2019年12月1日全部医学期刊,选取部分文献,对其研究方法、具体操作及结果进行分析。文献显示中风后吞咽障碍病机多为下元虚衰,虚阳上浮,痰浊与瘀血互结上泛舌本,阻塞喉舌之窍,以醒脑开窍、滋补肝肾为治则。现代医学普遍认为,吞咽障碍是指中风后的患者会损伤控制吞咽功能的相关肌肉或大脑皮质、脑干的支配功能,使得吞咽过程的一个或者多个阶段障碍。治疗手段中以针刺为主396篇,以神经肌肉电刺激为主46篇。总结得出近些年来关于以针刺和神经肌肉电刺激为主要手段的方法应用广泛,针刺方法和穴位的选择具有多样性,主要以头针、眼针、舌针、体针出现频次较高。神经肌肉电刺激目的是利用一定的频率和强度直接刺激咽部肌肉,诱发吞咽反射,增强吞咽肌肌力,重建大脑皮层控制功能,并改善局部组织血液循环,提高咽部肌肉的灵活性和协调性,防止肌肉废用性萎缩。该疗法在临床上促进中枢神经恢复效果明显,目前较多使用Vocastim-Master或Vitalstim神经肌肉电刺激治疗仪。在中风后吞咽障碍的临床研究中,针刺和神经肌肉电刺激均对于中风后吞咽功能障碍疗效确切,将两种疗法联合效果更突出,值得进一步临床探究。

To review the recent progress in acupuncture and neuromuscular electrical stimulation for Dysphagia after Stroke in Recent 5 Years. All the medical periodicals from December 1,2015 to December 1,2019 were retrieved from four databases of CNKI,Wan Fang,VIP and Pub Med,the research methods,specific operations and conclusions of some literatures were analyzed. The literature shows the pathogenesis of dysphagia after stroke is umbilicus lower Yin and Yang insufficiency,phlegm and blood stasis mutual knot on the extensive tongue,blocking the orifice of the mouthpiece,the treatment principle is to wake the brain and nourish the liver and kidney. Modern medicine generally believes that swallowing disorder refers to the patients after stroke will damage the control of swallowing function of the relevant muscles or cerebral cortex,brain stem of the dominant function,so that one or more stages of the process of swallowing disorders Among the treatment methods,396 were acupuncture and 46 were neuromuscular electrical stimulation. It is concluded that acupuncture and neuromuscular electrical stimulation have been widely used in recent years,and the selection of acupuncture methods and acupoints is diversified,mainly including head needle,eye needle,tongue needle and body needle. The purpose of neuromuscular electrical stimulation is to directly stimulate the pharyngeal muscles with a certain frequency and intensity,induce the swallowing reflex,enhance the swallowing muscle strength,rebuild the cerebral cortex control function,and improve the local tissue blood circulation,improve the flexibility and coordination of the pharyngeal muscles,and prevent muscle disuse atrophy. The therapy is effective in promoting the recovery of central nervous system,Vocastim-master or Vitalstim neuromuscular electrical stimulation therapy is widely used. In the clinical study of post-stroke dysphagia,acupuncture and neuromuscular electrical stimulation are both effective for post-stroke dysphagia,and the combined effect of the two therapies is more prominent,which is worthy of further clinical exploration.