揿针联合口部运动疗法治疗小儿脑瘫流涎:随机对照试验

Effect of intradermal needling combined with oral motor therapy for salivation in children with cerebral palsy: a randomized controlled trial

目的:比较揿针联合口部运动疗法与单纯口部运动疗法治疗小儿脑瘫流涎的临床疗效。方法:将60例脑瘫流涎患儿随机分为观察组和对照组,每组30例。观察组予揿针(取颊车、地仓、舌三针等,每次留针24 h)联合口部运动疗法,对照组仅予口部运动疗法,揿针每周治疗3次,口部运动疗法每周治疗5次,4周为一疗程,共治疗3个疗程。比较两组患儿治疗前及治疗4、8、12周后教师流涎(TDS)分级、流涎严重程度评级、洼田饮水试验分级及吞咽障碍调查评分,并评定临床疗效。结果:观察组患儿治疗8周后及两组患儿治疗12周后TDS分级、流涎严重程度评级较治疗前改善(P<0.05),且治疗12周后观察组优于对照组(P<0.05)。观察组患儿治疗8、12周后口腔期吞咽障碍调查评分较治疗前降低(P<0.05)。观察组总有效率为83.3%(25/30),高于对照组的53.3%(16/30,P<0.05)。结论:揿针联合口部运动疗法可改善脑瘫患儿的流涎症状和吞咽功能,疗效优于单纯口部运动疗法,且起效更早。

Objective To compare the effect of combination of intradermal needling with oral motor therapy and simple oral motor therapy on salivation in children with cerebral palsy. Methods A total of 60 children with salivation in cerebral palsy were randomized into an observation group and a control group, 30 cases in each group. The observation group was treated with intradermal needling(kept for 24 hours each time at Jiache [ST 6], Dicang [ST 4], tongue three needles, etc.) and oral motor therapy, while the control group was only given oral motor therapy. The intradermal needling was performed 3 times a week, and oral motor therapy was performed 5 times a week, 4 weeks as a course, totally 3 courses of treatment were required. The classification of teacher drooling scale(TDS), drooling severity and Kubota water swallow test, dysphagia disorders survey(DDS) score were compared before treatment and after 4, 8 and 12 weeks of treatment in both groups, and the clinical efficacy was evaluated. Results After 8 weeks of treatment in the observation group and after 12 weeks of treatment in the two groups, the classification of TDS and drooling severity were improved(P<0.05), and the observation group was better than the control group after 12 weeks of treatment(P<0.05). After 8 and 12 weeks of treatment, the DDS scores of oral period in the observation group were lower than those before treatment(P<0.05). The total effective rate in the observation group was 83.3%(25/30), which was higher than 53.3%(16/30) in the control group(P<0.05). Conclusion The combination of intradermal needling with oral motor therapy can improve salivation symptoms and swallowing function in children with cerebral palsy, the effect is better than oral motor therapy alone, and the effect is earlier.