不同频率电针廉泉穴联合吞咽康复训练对脑卒中吞咽障碍患者疗效及血清BDNF、SP水平的影响

Clinical Effects of Different Frequency Electroacupuncture at Lianquan Points and Swallowing Rehabilitation Training in the Treatment of Dysphagia after Stroke and the Influence on the Levels of Serum BDNF and SP

目的:探讨不同频率电针廉泉穴联合吞咽康复训练对脑卒中吞咽障碍患者疗效及血清脑源性神经营养因子(brain-derived neurotrophic factor,BDNF)、P物质(substance P,SP)水平的影响。方法:将144例脑卒中吞咽障碍患者采用随机数字表法分为参照组、低频组、高频组各48例,参照组患者给予吞咽康复训练,低频组在参照组基础上给予1 Hz电针廉泉穴,高频组在参照组基础上给予5 Hz电针廉泉穴。观察3组患者临床疗效、吞咽功能、脑血流、血清BDNF与SP水平及不良反应发生率。结果:总有效率低频组为95.83%(46/48),高频组为81.25%(39/48),均高于参照组的68.75%(33/48)(P<0.05),低频组高于高频组(P<0.05)。治疗后低、高频组患者大脑动脉收缩期峰值流速(spectral atlas systolic peak velocity,Vs)、平均流速(mean velocity,Vm)高于参照组,搏动指数(pulsatility index,PI)、标准吞咽功能评价量表评分(standardized swallowing assessment,SSA)评分低于参照组(P<0.05);低频组Vs、Vm高于高频组,PI、SSA低于高频组(P<0.05)。治疗后低、高频组BDNF、胰岛素样生长因子1(insulin-like growth factor-1,IGF-1)及SP水平高于参照组(P<0.05),低频组高于高频组(P<0.05)。3组患者治疗期间不良反应发生率比较差异无统计学意义(χ^(2)=0.447,P=0.800)。结论:低频率电针廉泉穴联合吞咽康复训练可提高脑卒中吞咽障碍患者BDNF、SP水平,改善其吞咽功能,疗效优于单纯吞咽康复训练及高频率电针廉泉穴联合吞咽康复训练。

Objective:To explore clinical effects of different frequency electroacupuncture at Lianquan(RN23)points and swallowing rehabilitation training in the treatment of dysphagia after stroke,and the influence of BDNF and SP.Methods:All 144 patients were allocated to reference group,low frequency group and high frequency group using random number table method with 48 cases in each group,the patients in the reference group accepted swallowing rehabilitation training,low frequency group received 1 Hz electroacupuncture at Lianquan points on the foundation of the therapy the reference group accepted,high frequency group 5 Hz electroacupuncture at Lianquan points based on swallowing rehabilitation training.To observe clinical effects,swallowing function,cerebral blood flow,the levels of serum BDNF and SP and the incidence of adverse reaction in three groups.Results:Total effective rates of low frequency group and high frequency group were 95.83%(46/48)and 81.25%(39/48),higher than 68.75%(33/48)of the reference group(P<0.05),low frequency group was higher than high frequency group(P<0.05).After the treatment,Vs and Vm of low frequency group and high frequency group were higher than these of the reference group,PI and SSA lower than these of the reference group(P<0.05);Vs and Vm of low frequency group were higher than these of high frequency group,PI and SSA were lower than these of high frequency group(P<0.05).After the treatment,the levels of BDNF,IGF-1 and SP of low frequency group and high frequency group were higher than these of the reference group(P<0.05),low frequency group was higher than high frequency group(P<0.05).The difference had no statistical meaning in the incidence of adverse reaction between three groups during therapeutic period(χ^(2)=0.447,P=0.800).Conclusion:Low frequency electroacupuncture at Lianquan(RN23)points combined with swallowing rehabilitation training could raise the levels of BDNF and SP in the treatment of dysphagia after stroke,improve the patients'swallowing function,and its clinical effects better than these of single swallowing rehabilitation training,as well as high frequency electroacupuncture in combination with swallowing rehabilitation training.