醒神通窍活血汤治疗脑卒中后环咽肌失弛缓所致吞咽障碍的临床疗效

Clinical Effects of Xingshen Tongqiao Huoxue Decoction in Treatment of Dysphagia Caused by Cricopharyngeal Achalasia After Stroke

目的:探讨醒神通窍活血汤治疗脑卒中后环咽肌失弛缓(CPA)所致吞咽障碍的临床疗效及对神经介质的影响。方法:按随机数字表法将114例患者分为对照组56例和观察组58例。两组均给予球囊导管扩张术和康复训练。对照组口服天丹通络胶囊,5粒/次,3次/d。观察组口服醒神通窍活血汤,1剂/d。两组疗程均为4周。进行治疗前后视频吞咽造影检查(VFSS)和洼田饮水试验(WST);进行治疗前后吞咽生命质量量表评分(SWAL-QOL),功能性经口摄食量表(FOIS)和美国国立卫生研究院卒中量表(NIHSS)评分;检测治疗前后血清脑源性神经营养因子(BDNF),P物质(SP),多巴胺(DA),5-羟色胺(5-HT)和神经生长因子(NGF)水平;记录并发症发生情况。结果:治疗后,观察组临床疗效高于对照组(Z=2.079,P<0.05);观察组VFSS检查情况低于对照组(Z=2.004,P<0.05);观察组WST检查情况低于对照组(Z=1.973,P<0.05);观察组VFSS,SWAL-QOL和FOIS评分均高于对照组,NIHSS评分低于对照组(P<0.01);观察组BDNF,DA,SP,5-HT和NGF水平均高于对照组(P<0.01);观察组并发症发生率为(8/58)13.79%,低于对照组的(17/56)30.36%,比较差异有统计学意义(χ2=4.565,P<0.05)。结论:在导管球囊扩张术和康复训练的基础上,醒神通窍活血汤治疗脑卒中后CPA所致吞咽障碍可调节神经介质,改善吞咽功能,提高生命质量,降低并发症,临床观察疗效显著。

Objective: To explore the clinical effects of Xingshen Tongqiao Huoxue decoction in the treatment of dysphagia caused by cricopharyngeal achalasia(CPA)after cerebral infarction and its influence on neurotransmitters. Method: One hundred and fourteen eligible patients were randomly divided into a control group(56 cases)and a treatment group(58 cases). Patients in both groups received balloon catheter dilatation and rehabilitation training. In the observation group,the Tiandan Tongluo capsules were further orally taken,five capsales per time,three times per day. In the control group,the Xingshen Tongqiao Huoxue decoction was provided,one dose per day. The treatment lasted for four weeks. Following the videofluoroscopic swallow study(VFSS) and water-swallowing test(WST) before and after treatment, the swallowing quality of life questionnaire(SWAL-QOL),functional oral intake scale(FOIS)and National Institutes of Health Stroke Scale(NIHSS)scores were calculated. The serum brain-derived neurotrophic factor(BDNF),substance P(SP),dopamine(DA),5-hydroxytryptamine(5-HT)and nerve growth factor(NGF)levels before and after treatment were detected,and the complications were recorded. Result: The clinical efficacy of the treatment group was superior to that of the control group(Z=2.079,P<0.05). Both VFSS and WST findings in the treatment group were milder than those in the control group(Z=2.004,P<0.05 and Z=1.973,P<0.05). The VFSS,SWAL-QOL,and FOIS scores and the BDNF,DA,SP,5-HT and NGF levels of the treatment group were elevated in contrast to those of the control group(P<0.01),whereas the NIHSS score declined(P<0.01). The complication rate in the treatment group was(8/58)13.79%,significantly lower than(17/56)30.36% in the control group(χ2=4.565, P<0.05). Conclusion: On the basis of balloon catheter dilatation and rehabilitation training, the Xingshen Tongqiao Huoxue decoction can significantly enhance the swallowing function,improve the quality of life,and reduce complications in patients with dysphagia caused by CPA after cerebral stroke.