针刺联合冰棉棒刺激治疗卒中后假性球麻痹吞咽障碍临床研究

Clinical effect of acupuncture combined with ice cotton swab stimulation for dysphagia due to post-stroke pseudobulbar paralysis

目的观察针刺联合冰棉棒刺激治疗卒中后假性球麻痹吞咽障碍的临床疗效。方法将220例卒中后假性球麻痹吞咽障碍患者按照随机数字表法分为3组。对照组72例予常规吞咽康复训练,针刺组74例在对照组治疗基础上加用针刺治疗,治疗组74例在针刺组基础上加用冰棉棒刺激治疗,3组疗程均为3个月。比较3组治疗前、治疗4周及治疗3个月临床疗效、洼田饮水试验分级、标准吞咽功能评定量表(SSA)评分变化。结果治疗4周,3组洼田饮水试验分级及SSA评分均较本组治疗前降低(P<0.05),但3组组间比较差异无统计学意义(P>0.05);治疗3个月,3组洼田饮水试验分级及SSA评分均较本组治疗前降低(P<0.05),且治疗组低于针刺组和对照组(P<0.05)。治疗4周治疗组总有效率60.81%(45/74),针刺组为58.11%(43/74),对照组为59.72%(43/72);治疗3个月3组总有效率分别为87.84%(65/74)、75.68%(56/74)、73.61%(53/72)。治疗4周3组总有效率比较差异无统计学意义(P>0.05),治疗3个月治疗组总有效率高于针刺组和对照组(P<0.05)。结论针刺联合冰棉棒刺激能够明显改善卒中后假性球麻痹吞咽障碍患者吞咽功能,提高临床疗效。

Objective To observe the clinical effect of acupuncture combined with ice cotton swab stimulation for dysphagia due to post-stroke pseudobulbar paralysis(PS-PBP).Methods A total of 220 PS-PBP patients with dysphagia were randomly assigned into the control group(n=72),the acupuncture group(n=74),and the treatment group(n=74).All patients were managed by routine swallowing rehabilitation training,the acupuncture group received acupuncture,and the treatment group received ice cotton swab stimulation based on the acupuncture group.Treated for 3 months,aiming to compare curative effect,the grade of water swallowing test(WST),standard swallowing assessment(SSA)on day 0,week 4,and month 3.Results The grade of WST,SSA scores on week 4 were decreased as compared with those before treatment in the three groups(P<0.05),the difference was not statistically significant among the three groups(P>0.05);the grade of WST,SSA scores on month 3 were decreased in the three groups(P<0.05),which were decreased in the treatment group compared with the acupuncture group and the control group(P<0.05).The overall effective rate on week 4 in the treatment group,the acupuncture group and the control group was 60.81%(45/74),58.11%(43/74)and 59.72%(43/72),respectively,the difference of the three groups being not significant(P>0.05).The overall effective rate on month 3 in the treatment group was higher than that in the acupuncture group and the control group(87.84%[65/74]vs 75.68%[56/74],73.61%[53/72],[P<0.05],respectively).Conclusion For PS-PBP patients with dysphagia,acupuncture combined with ice cotton swab stimulation can significantly improve swallowing function and improve clinical efficacy.