针灸联合吞咽训练治疗脑卒中后吞咽功能障碍临床研究

Clinical Study on Acupuncture and Moxibustion Combined with Swallowing Training for Dysphagia After Stroke

目的:观察针灸联合吞咽训练治疗脑卒中患者吞咽功能障碍的康复效果。方法:选择脑卒中后吞咽功能障碍患者90例,按数字奇偶法分为对照组和治疗组各45例。对照组行吞咽功能训练,治疗组在对照组的基础上给予针灸治疗。治疗4周后评估2组临床疗效、中医证候积分、美国国立卫生院卒中量表(NIHSS)评分、吞咽功能评价量表(SSA)评分及血浆一氧化氮(NO)、超氧化物歧化酶(SOD)水平。结果:治疗组总有效率为95.56%,对照组为80.00%,2组比较,差异有统计学意义(P<0.05)。治疗前,2组中医证候积分比较,差异无统计学意义(P>0.05);治疗后,2组中医证候积分均较治疗前降低(P<0.05),且治疗组中医证候积分低于对照组(P<0.05)。治疗前,2组NIHSS、SSA评分比较,差异无统计学意义(P>0.05);治疗后,2组NIHSS、SSA评分均较治疗前降低(P<0.05),且治疗组NIHSS、SSA评分均低于对照组(P<0.05)。治疗前,2组血浆NO、SOD水平比较,差异无统计学意义(P>0.05);治疗后,2组NO水平较治疗前降低(P<0.05),SOD水平较治疗前升高(P<0.05);且治疗组NO、SOD水平改善较对照组更显著(P<0.05)。结论:针灸联合吞咽训练治疗脑卒中后吞咽功能障碍效果良好,可有效调节血浆NO、SOD水平,显著改善患者神经功能及吞咽功能。

Objective: To observe the rehabilitation effect of the therapy of acupuncture and moxibustion combined with swallowing training on patients with dysphagia after stroke. Methods:A total of90 patients with dysphagia after stroke were divided into the control group and the treatment group,with45 cases in each group. The control group received swallowing training, and the treatment group additionally received acupuncture and moxibustion based on the treatment of the control group. After 4 weeks of treatment, the clinical effects, scores of traditional Chinese medicine(TCM) syndrome, National Institute of Health Stroke Scale(NIHSS) and Standardized Swallowing Assessment(SSA),and the levels of plasma nitric oxide(NO) and superoxide dismutase(SOD) in both groups were evaluated. Results:The total effective rate was 95.56% in the treatment group and 80.00% in the control group,the difference being significant(P<0.05). Before treatment,there was no significant difference in the comparison of the TCM syndrome scores between the two groups(P>0.05);after treatment,the TCM syndrome scores in both groups were decreased when compared with those before treatment(P<0.05),and the TCM syndrome score in the treatment group was lower than that in the control group(P<0.05). Before treatment,there was no significant difference being found in the comparison of scores of NIHSS and SSA between the two groups(P>0.05);after treatment, the NIHSS and SSA scores in both groups were decreased when compared with those before treatment(P<0.05),and the NIHSS and SSA scores in the treatment group were lower than those in the control group(P<0.05). Before treatment,there was no significant difference being found in the comparison of levels of plasma NO and SOD between the two groups(P>0.05);after treatment, the levels of plasma NO in both groups were decreased when compared with those before treatment(P<0.05),and the SOD level was increased(P<0.05). The improvement of levels of plasma NO and SOD in the treatment group was more significant than that in the control group(P<0.05). Conclusion:The therapy of acupuncture and moxibustion combined with swallowing training has a good effect on the treatment of dysphagia after stroke,which can effectively regulate the levels of NO and SOD in plasma,and significantly improve the nerve function and swallowing function of patients.