项五针联合吞咽训练治疗缺血性脑卒中吞咽障碍老年患者的疗效及对脑血流动力学的影响

Efficacy of Nape Five-Needles Combined with Swallowing Training in Treating Elderly Ischemic Stroke Patients with Dysphagia and Its Influence to Cerebral Hemodynamics

目的:探讨项五针联合吞咽训练治疗缺血性脑卒中吞咽障碍老年患者的疗效及对脑血流动力学的影响。方法:选取武汉市第一医院收治的缺血性脑卒中伴吞咽功能障碍老年患者124例,按随机数字表法分成对照组和观察组,每组均有62例。两组参照指南给予缺血性脑卒中常规治疗措施,同时对照组给予吞咽训练,观察组在对照组治疗基础上给予项五针疗法。治疗4周后,比较两组标准吞咽功能评价量表(SSA)、电视透视吞咽功能检查(VFSS)、洼田饮水试验评分、国立卫生院神经功能缺损(NIHSS)评分、临床疗效以及脑动脉的血流平均流速(Vm)、最大峰值流速(Vs)和血管阻力指数(RI)。结果:与对照组比较,观察组患者治疗后SSA、洼田饮水试验和NIHSS评分降低更明显,VFSS评分升高更显著(P <0.01);观察组的总有效率为87.10%(54/62),对照组的总有效率为70.49%(43/61),观察组显著高于对照组(P <0.05);与对照组比较,观察组患者治疗后Vs、Vm增加更明显,RI下降更显著(P <0.01)。结论:项五针联合吞咽训练治疗缺血性脑卒中吞咽障碍老年患者的疗效明显,调节脑血流动力学可能是其疗效途径之一。

Objective: To observe the efficacy of nape five-needles combined with swallowing training in treating elderly ischemic stroke patients with dysphagia and its influence to cerebral hemodynamics. Methods: 124 ischemic stroke patients with dysphagia were randomly divided into the control group and the observation group,with 62 cases in each group. The two groups were received conventional treatment for ischemic stroke according to the guidelines. The control group was treated with swallowing training;on which basis,the observation group was also treated with nape five-needles. The scores of SSA,VFSS,water swallowing test and NIHSS,clinical efficacy,mean flow velocity( Vm),maximum peak flow velocity( Vs),and vascular resistance index( RI)were compared between the two groups after four weeks of the treatment. Results: The scores of SSA,water swallowing test and NIHSS were significantly decreased and the scores of VFSS were significantly increased in the observation group compared to those in the control group after the treatment( P < 0. 01). The total effective rate was 87. 10%( 54/62) in the observation group,which was significantly higher than 70. 49%( 43/61) in the control group( P < 0. 05). Compared to those in the control group,Vs and Vm were remarkably higher and RI was obviously lower in the observation group( P < 0. 01). Conclusion: The efficacy of nape five-needles combined with swallowing training is significant in treating elderly ischemic stroke patients with dysphagia,and regulating cerebral hemodynamics may be one of its action mechanism.