早期应用针刺配合康复训练对中风恢复期吞咽功能及肢体功能影响研究

Study on Effect of Early Application of Acupuncture Combined with Rehabilitation Training on Swallowing Function and Limb Function of Patients with Stroke in Convalescence Stage

目的探讨早期应用针刺配合康复训练对中风恢复期患者吞咽功能及肢体功能的影响。方法将2016年3月—2018年5月医院收治的中风恢复早期患者92例,随机分为对照组和观察组,各46例,对照组采用康复训练治疗,观察组采用早期应用针刺配合康复训练治疗,持续治疗4周为1个疗程。治疗前后分别评定标准吞咽功能评定量表(Standard swallowing function scale,SSA)、肢体Fugl-Meyer功能评分(Fugl-Meyer assessment scale,FMA)、Barthel指数、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白介素-6(Interleukin-6,IL-6)、高敏C反应蛋白(High-sensitivity C-reactive protein,hs-CRP)及大脑中动脉(Middle cerebral artery,MCA)、大脑前动脉(Anterior cerebral artery,ACA)、大脑后动脉(Posterior cerebral artery,PCA)血流速度,比较临床疗效及不良反应状况。结果治疗后对照组和观察组SSA评分(20.21±2.46)分、(18.37±2.19)分,FMA评分(76.34±9.13)分、(82.11±9.64)分,Barthel指数74.61±13.30、83.47±14.28,血hs-CRP(9.75±4.33)ng·mL^(-1)、(6.57±3.47)ng·mL^(-1),血IL-6(16.30±5.27)pg·mL^(-1)、(10.57±5.12)pg·mL^(-1),血TNF-α(59.82±21.07)pg·mL^(-1)、(42.13±20.54)pg·mL^(-1),MCA(63.51±6.20)cm/s、(69.17±6.34)cm/s,ACA(56.31±5.20)cm/s、(60.35±5.81)cm/s,PCA(47.29±6.41)cm/s、(52.81±6.53)cm/s,对照组和观察组上述指标比较,差异具有统计学意义(P<0.05)。对照组有效率82.61%(38/46)低于观察组95.65%(44/46),差异具有统计学意义(P<0.05)。结论早期应用针刺配合康复训练对中风恢复期患者的效果显著,可以改善吞咽功能及肢体功能,降低炎症因子,改善脑血流速度,值得推广。

Objective To explore the effect of early application of acupuncture combined with rehabilitation training on swallowing function and limb function of patients with stroke in convalescence stage.Methods Ninety-two patients with early recovery of stroke in our hospital from March 2016 to May 2018 were randomly divided into control group and observation group,46 cases in each group.The control group was treated with rehabilitation training.The observation group was treated with early acupuncture combined with rehabilitation training,and the treatment lasted for 4 weeks as a course of treatment.Standard swallow function scale(SSA),limb Fugl-Meyer function scale(FMA),Barthel index,tumor necrosis factor-alpha(TNF-alpha),interleukin-6(IL-6)and high sensitivity C-reactive protein(hs-CRP)were evaluated before and after treatment.The blood flow velocities of middle cerebral artery(MCA),anterior cerebral artery(ACA)and posterior cerebral artery(PCA)were compared.Results After treatment,the SSA scores of the control group and the observation group were(20.21±2.46)points and(18.37±2.19)points,respectively.The FMA scores of the control group and the observation group were(76.34±9.13)points and(82.11±9.64)points,respectively.The Barthel indexes of the control group and the observation group were 74.61±13.30 and 83.47±14.28,respectively.The serum levels of hs-CRP of the control group and the observation group were(9.75±4.33)ng·mL^(-1)and(6.57±3.47)ng·mL^(-1),respectively.Levels of IL-6 of the control group and the observation group were of the control group and the observation group were(16.30±5.27)pg·mL^(-1)and(10.57±5.12)pg·mL^(-1),respectively.The serum levels of TNF-alpha of the control group and the observation group were(59.82±21.07)pg·mL^(-1)and(42.13±20.54)pg·mL^(-1),respectively.The levels of MCA of the control group and the observation group were(63.51±6.20)cm/s and(69.17±6.34)cm/s,respectively.The levels of ACA of the control group and the observation group were(56.31±5.20)cm/s and(60.35±5.81)cm/s,respectively.The levels of PCA of the control group and the observation group were(47.29±6.41)cm/s and(52.8±6.53)cm/s,respectively.And all indexes above between the control group and the observation group were significantly different(P<0.05).The effective rate of the control group(82.61%,38/46)was lower than that of the observation group(95.65%,44/46)(P<0.05).Conclusion Early application of acupuncture combined with rehabilitation training has a significant effect on stroke patients in convalescent stage.It can improve swallowing function and limb function,reduce inflammatory factors and improve cerebral blood flow velocity.It is worthy of popularizing.