行气散瘀针刺法联合Vitalstim电刺激对脑卒中后吞咽障碍患者吞咽功能、表面肌电图的影响

Effect of Qi-Moving and Stasis-Dispersing Acupuncture Method Combined with Vitalstim Electrical Stimulation on Swallowing Function and Surface Electromyography in Patients with Post-Stroke Dysphagia

目的:观察行气散瘀针刺法联合Vitalstim电刺激治疗脑卒中后吞咽障碍(PSD)的疗效。方法:选取120例PSD患者,按随机数字表法分为对照组及观察组各60例,对照组采用Vitalstim电刺激,观察组在对照组基础上采用行气散瘀针刺法治疗。比较2组临床疗效,比较2组治疗前后吞咽功能[洼田饮水试验评分、标准吞咽功能评定量表(SAA)评分]、表面肌电图(sEMG)、血液流变学指标值的变化。结果:观察组临床疗效总有效率为91.67%,对照组为78.33%,2组比较,差异有统计学意义(P<0.05)。治疗后,2组SAA评分、洼田饮水试验评分均较治疗前下降,观察组上述2项评分均低于对照组,差异均有统计学意义(P<0.05)。治疗后,2组sEMG最大波幅均较治疗前升高,吞咽时间均较治疗前缩短,差异均有统计学意义(P<0.05)。治疗后,观察组sEMG最大波幅高于对照组,吞咽时间短于对照组,差异均有统计学意义(P<0.05)。治疗后,2组纤维蛋白原、全血黏度、红细胞压积均较治疗前降低,观察组上述3项指标值均低于对照组,差异均有统计学意义(P<0.05)。结论:行气散瘀针刺法联合Vitalstim电刺激能有效促进PSD患者吞咽功能恢复,改善表面肌电图,调节血液流变学指标,临床疗效确切。

Objective : To observe the effect of the therapy of qi-moving and stasis-dispersing acupuncture method combined with Vitalstim electrical stimulation on swallowing function and surface electromyography in patients with post-stroke dysphagia(PSD). Methods:A total of 120 patients with PSD were selected and divided into the control group and the observation group according to the random number table method, with 60 cases in each group. The control group was treated with Vitalstim electrical stimulation, and the observation group was additionally treated with qi-moving and stasis-dispersing acupuncture method on this basis. The clinical effects were compared between the two groups,and the changes of swallowing function through drinking water test and Standard Swallowing Assessment(SSA),surface electromyography(EMG) and hemorheology indexes before and after treatment were compared between the two groups. Results: The total effective rate was 91.67% in the observation group, and 78.33% in the control group,the difference being significant(P<0.05). After treatment,the scores of SSA and drinking water test in the two groups were decreased when compared with those before treatment,and the above two scores in the observation group were lower than those in the control group,differences being significant(P<0.05). After treatment, the maximum amplitude of sEMG was increased and the swallowing time was decreased in both groups when respectively compared with that before treatment,differences being significant(P<0.05). After treatment, the maximum amplitude of sEMG in the observation group was higher than that in the control group,and the swallowing time was shorter than that in the control group, differences being significant(P<0.05). After treatment, the levels of fibrinogen,whole blood viscosity and hematocrit in the two groups were decreased when compared with those before treatment,and the above three levels in the observation group were lower than those in the control group,differences being significant(P < 0.05). Conclusion : The therapy of qi-moving and stasis-dispersing acupuncture method combined with Vitalstim electrical stimulation can effectively promote the recovery of swallowing function in PSD patients, improve surface electromyography, regulate hemorheology indexes,and have a precise clinical effect.