循经取穴针刺联合中医康复对卒中后吞咽困难的临床疗效研究

Clinical effects of meridian acupuncture plus TCM rehabilitation on dysphagia after stroke

目的:探讨循经取穴针刺联合中医康复对卒中后吞咽困难的临床疗效,以期提高吞咽功能,恢复神经功能及生活质量。方法:将2019年1月-2020年12月在广州市第一人民医院南沙医院治疗的54例卒中后吞咽困难患者按随机数字表法分为两组,对照组使用中医康复训练,在此基础上,观察组使用循经取穴针刺治疗,共治疗6周,对比两组的临床疗效、吞咽功能、生活质量。结果:观察组痊愈9例、显效11例、有效6例、无效1例,治疗总有效率为96.30%(26/27),对照组痊愈2例、显效10例、有效8例、无效7例,治疗有效率为74.07%(20/27),前者明显更高(P<0.05);两组治疗前标准吞咽功能评价量表(Standardized Swallowing Assessment,SSA)评分、洼田饮水试验结果差异无统计学意义(P>0.05),观察组治疗后SSA评分、洼田饮水试验明显低于对照组,组间差异有统计学意义(P<0.05);两组治疗前改良Barthel指数(Modified Barthel Index,MBI)评分、吞咽障碍生活质量量表(Swallowing Disorder Quality of Life Score,SWAL-QOL)评分差异无统计学意义(P>0.05),观察组治疗后MBI评分、SWAL-QOL评分明显高于对照组,组间差异有统计学意义(P<0.05)。结论:循经取穴针刺联合中医康复对卒中后吞咽困难的临床疗效显著,能针对性训练患者的吞咽能力,辨证选取头面部穴位可刺激经络,改善神经传导功能,从而有效改善吞咽功能,增强自主进食能力,降低误吸风险,提高日常生活能力及生活质量,具有积极的临床意义。

Objective:To investigate the clinical effects of meridian acupuncture plus TCM rehabilitation on dysphagia after stroke in order to improve swallowing function,restore nerve function and quality of life.Methods:A total of 54 patients with dysphagia after stroke treated in Nansha Hospital,Guangzhou First People’s Hospital from January 2019 to December 2020 were divided into two groups according to the random number table method.The control group received traditional Chinese medicine rehabilitation training.On the basis of the treatment in the control group,the observation group received meridian acupuncture treatment.After 6 weeks of treatment,the clinical efficacy,swallowing function and quality of life in the two groups were compared.Results:In the observation group,9 cases were cured,11 cases were significantly effective,6 cases were effective,1 case was ineffective,and the effective rate was 96.30%(26/27).In the control group,2 cases were cured,10 cases were significantly effective,8 cases were effective,7 cases were ineffective,and the effective rate was 74.07%(20/27).The effective rate of the former was significantly higher(P<0.05).There was no significant difference between the two groups before treatment in SSA score and swale drinking water test(P>0.05).After treatment,SSA score and swale drinking water test in the observation group were significantly lower than those in the control group,and there were statistical differences between the groups(P<0.05).There was no significant difference in MBI score and SWAL-QOL score between the two groups before treatment(P>0.05),while MBI score and SWAL-QOL score in the observation group were significantly higher than those in the control group after treatment,and there were statistical differences between the groups(P<0.05).Conclusion:Meridian acupuncture combined with traditional Chinese medicine rehabilitation has a significant clinical effects on dysphagia after stroke.It can train patients’swallowing ability,stimulatate meridians by head and facial acupoints based on syndrome differentiation,and improve nerve conduction function,so as to effectively improve swallowing function,enhance autonomous eating ability,reduce aspiration risk,improve daily living ability and quality of life,which has positive clinical significance.