针灸联合吞咽康复训练治疗脑卒中后吞咽障碍临床研究

Clinical Study of Acupuncture and Moxibustion Combined with Swallowing Rehabilitation Training in the Treatment of Dysphagia after Stroke

目的探讨针灸联合吞咽康复训练用于脑卒中后吞咽障碍患者治疗中的临床价值。方法选择本院2021年9月-2022年12月收治的36例脑卒中后吞咽障碍患者,按照随机数字表法分为对照组与观察组;对照组实施吞咽康复训练,观察组在对照组基础上辅助针灸治疗,每组18例;比较洼田饮水试验(WST)评分、标准吞咽功能量表(SSA)评分、脑血流动力学指标、血清脑源性神经营养因子(BDNF)水平、表面肌电图(sEMG)。结果评估吞咽功能,相比治疗前,两组治疗后SSA、WST评分差异明显(P<0.05),且相比对照组,观察组以上评分更低(P<0.05);治疗前,两组脑血流动力学指标比较(P>0.05);治疗后,观察组Vp、Vm、RI值均优于对照组(P<0.05);治疗前,两组BDNF水平比较(P>0.05);治疗后,观察组BDNF水平高于对照组(P<0.05);治疗前,两组sEMG比较(P>0.05);治疗后,观察组吞咽5mL水时颏下肌群、舌骨下肌群的AEMG、持续时间较对照组显著低(P<0.05)。结论脑卒中后吞咽障碍开展针灸联合吞咽功能,可取得确切疗效,有效改善脑血流动力学,调节血清BDNF水平,提高患者吞咽功能,实现良好预后结果。

Objective To explore the clinical value of acupuncture combined with swallowing rehabilitation training in the treatment of patients with swallowing disorders after stroke.Methods 36 patients with dysphagia after stroke admitted to our hospital from September 2021 to December 2022 were selected and divided into control group and observation group according to random number table method.The control group received swallowing rehabilitation training,and the observation group received acupuncture treatment on the basis of the control group,with 18 cases in each group.The scores of lowland drinking water test(WST),standard Swallowing Function Scale(SSA),cerebral hemodynamic indexes,serum brain-derived neurotrophic factor(BDNF)levels and surface electromyography(sEMG)were compared.Results Compared with before treatment,SSA and WST scores of the two groups were significantly different after treatment(P<0.05),and the above scores of the observation group were lower than those of the control group(P<0.05).Before treatment,cerebral hemodynamics indexes were compared between the two groups(P>0.05).After treatment,Vp,Vm and RI values in observation group were better than those in control group(P<0.05).Before treatment,BDNF level was compared between the two groups(P>0.05);After treatment,BDNF level in observation group was higher than that in control group(P<0.05).Before treatment,sEMG was compared between the two groups(P>0.05).After treatment,the AEMG and duration of submental and hyoid muscles in the observation group were significantly lower than those in the control group when swallowing 5mL water(P<0.05).Conclusion Acupuncture and moxibustion combined with swallowing function can achieve exact curative effect,effectively improve cerebral hemodynamics,adjust serum BDNF level,improve swallowing function and achieve good prognosis in patients with dysphagia after stroke.