辨证取穴利咽针刺联合呼吸-吞咽协调训练治疗脑梗死后吞咽功能障碍的疗效分析

Analysis of Curative Effect of Liyan Acupuncture Based on Syndrome Differentiation Combined with Breathing-Swallowing Coordination Training in Treatment of Dysphagia after Cerebral Infarction

目的:探讨辨证取穴利咽针刺联合呼吸-吞咽协调训练治疗脑梗死后吞咽功能障碍的疗效以及对舌肌力、舌骨喉复合体动度以及营养状态的影响。方法:根据随机数字表法将80例脑梗死后吞咽功能障碍患者分为两组,对照组(40例)采用呼吸-吞咽协调训练治疗,观察组(40例)采用辨证取穴利咽针刺联合呼吸-吞咽协调训练治疗,两组均治疗4周。观察两组治疗疗效,吞咽功能、舌肌力、舌骨喉复合体动度以及营养状态。结果:观察组总有效率高于对照组,差异具有统计学意义(P<0.05)。两组治疗后标准吞咽功能评定(SSA)、吞咽造影检查(VFSS)误吸评分与VFSS吞咽障碍评分均较治疗前明显降低,差异具有统计学意义(P<0.05),舌压峰值、舌压平均值、舌压持续时间、舌骨上移、舌骨前移、甲状软骨上移、甲状软骨前移、血清白蛋白(ALB)与前白蛋白(PA)水平均较治疗前明显增高,差异具有统计学意义(P<0.05)。观察组治疗后SSA、VFSS误吸评分与VFSS吞咽障碍评分低于对照组,差异具有统计学意义(P<0.05),舌压峰值、舌压平均值、舌压持续时间、舌骨上移、舌骨前移、甲状软骨上移、甲状软骨前移及血清ALB、PA水平高于对照组,差异具有统计学意义(P<0.05)。结论:辨证取穴利咽针刺联合呼吸-吞咽协调训练可改善脑梗死后吞咽功能障碍患者吞咽功能,提高舌肌力与舌骨喉复合体动度,改善营养状态。

Objective:To explore the curative effect of Liyan acupuncture based on syndrome differentiation combined with breathing-swallowing coordination training in treatment of dysphagia after cerebral infarction and to observe its influence to lingual muscle strength,hyoid bone-laryngeal complex mobility and nutritional status.Methods:80 patients with dyspahgia after cerebral infarction were randomly divided into the control group(n=40)and the observation group(n=40).The control group was treated with breathing-swallowing coordination training;on which basis,the observation group was also treated with Liyan acupuncture based on syndrome differentiation.Both groups were treated for 4 weeks.Therapeutic effect,swallowing function,lingual muscle strength,hyoid bone-laryngeal complex mobility and nutritional status were observed after the treatment in the two groups.Results:The total effective rate of the observation group was higher than that of the control group(P<0.05).Standard swallowing assessment(SSA)score,aspiration score of video fluoroscopic swallowing study(VFSS)and swallowing disorder score of VFSS were significantly lower after the treatment than those before the treatment in the two groups(P<0.05);the peak tongue pressure,average tongue pressure,duration of tongue pressure,hyoid bone ascendancy,hyoid bone antedisplacement,thyroid cartilage ascendancy and thyroid cartilage antedisplacement,as well as the serum levels of albumin(ALB)and prealbumin(PA)were significantly increased after the treatment than those before the treatment in the two groups(P<0.05).SSA score,VFSS aspiration score and VFSS swallowing disorder score were lower(P<0.05);whereas the peak tongue pressure,average tongue pressure,duration of tongue pressure,hyoid bone ascendancy,hyoid bone antedisplacement,thyroid cartilage ascendancy and thyroid cartilage antedisplacement,as well as the serum levels of ALB and PA were higher after the treatment in the observation group than those in the control group(P<0.05).Conclusion:Liyan acupuncture based on syndrome differentiation combined with breathing-swallowing coordination training can improve swallowing function,improve lingual muscle strength and hyoid bone-laryngeal complex mobility,and improve nutritional status of patients with dysphagia after cerebral infarction.