揿针联合中药治疗卒中后吞咽障碍的疗效观察及对吞咽肌群表面肌电信号的影响

Therapeutic observation of thumbtack needles plus Chinese medication for post-stroke dysphagia and the effect on surface electromyographic signals of the swallowing muscle group

目的 观察揿针联合通窍利咽方治疗卒中后吞咽障碍的临床疗效及其对患者吞咽肌群表面肌电信号的影响。方法 将90例卒中后吞咽障碍的患者用随机数字表法平均分为常规组与观察组,每组45例。常规组予常规康复训练及饮食护理,观察组在常规组治疗基础上予揿针联合口服通窍利咽方治疗。比较两组临床疗效,观察两组治疗前后美国国立卫生研究院卒中量表(National Institutes of Health stroke scale,NIHSS)、标准吞咽功能评价量表(standardized swallowing assessment,SSA)、改良曼恩吞咽能力评估量表(Mann assessment of swallowing ability,MASA)和吞咽生活质量量表(swallowing-quality of life,SWAL-QOL)的评分变化,观察两组治疗前后舌骨喉活动度检测指标和吞咽肌群表面肌电信号指标的变化,观察两组治疗前后脑血流动力学指标的变化。比较两组不良反应发生情况。结果 观察组总有效率优于常规组(P<0.05)。治疗后,两组NIHSS和SSA评分均较治疗前下降(P<0.05),MASA和SWAL-QOL评分均较治疗前升高(P<0.05);观察组NIHSS、SSA、MASA和SWAL-QOL评分均优于常规组(P<0.05)。治疗后,观察组舌骨上移、舌骨前移、甲状软骨上移和甲状软骨前移距离均大于治疗前(P<0.05),且舌骨上移和舌骨前移距离均大于常规组(P<0.05)。治疗后,两组空吞与吞咽5 mL温水时吞咽肌群表面肌电信号最大振幅、平均振幅和吞咽时间均较治疗前降低(P<0.05),且观察组上述吞咽肌群表面肌电信号指标均低于常规组(P<0.05)。治疗后,两组患者大脑血管平均血流量、平均血流速度、脉搏波速度、血管特性阻抗和外周阻力均较治疗前改善(P<0.05),且观察组上述脑血流动力学指标均优于常规组(P<0.05)。观察组不良反应发生率低于常规组(P<0.05)。结论 在常规康复训练基础上,揿针联合通窍利咽方治疗卒中后吞咽障碍的临床疗效优于单一中药治疗,可促进神经功能恢复,改善患者吞咽功能和吞咽肌群表面肌电信号,提高脑血流动力学指标,且不良反应发生风险较低。

Objective To observe the clinical efficacy of thumbtack needles plus Tong Qiao Li Yan prescription in treating post-stroke dysphagia and its effect on surface electromyographic(s EMG) signals of the swallowing muscle group.Method Ninety patients with post-stroke dysphagia were allocated to a conventional group and an observation group using the random number table method,with 45 cases in each group.The conventional group received regular rehabilitation training and diet care,and the observation group was treated with thumbtack needles plus oral administration of Tong Qiao Li Yan prescription based on the intervention given to the conventional group.The clinical efficacy was compared between the two groups.The National Institutes of Health stroke scale(NIHSS),standardized swallowing assessment(SSA),modified Mann assessment of swallowing ability(MASA),and swallowing-quality of life(SWAL-QOL) scores were observed before and after the treatment,as well as the hyoid-laryngeal movement,sEMG signals of the swallowing muscle group,and cerebral hemodynamic indicators.The adverse reaction incidence was also compared between the two groups.Result The observation group was superior to the conventional group in comparing the total effective rate(P<0.05).After the treatment,the NIHSS and SSA scores dropped(P<0.05),and the MASA and SWAL-QOL scores increased in both groups(P < 0.05);the observation group outperformed the conventional group in comparing the NIHSS,SSA,MASA,and SWAL-QOL scores(P<0.05).The upward and forward displacements of the hyoid bone and thyroid cartilage were enlarged after the intervention in the observation group(P<0.05),and the upward and forward displacements of the hyoid were greater than those in the conventional group(P<0.05).After the treatment,the maximum and mean sEMG amplitudes and swallowing duration at swallowing 5 m L warm water or without water decreased in the two groups(P<0.05) and were smaller in the observation group than in the conventional group(P<0.05).The mean cerebral blood flow volume,mean blood flow velocity,pulse wave velocity,vascular characteristic impedance,and peripheral resistance improved after the treatment in both groups(P<0.05) and were better in the observation group than in the conventional group(P<0.05).The observation group had a lower adverse reaction incidence than the conventional group(P<0.05).Conclusion Based on the regular rehabilitation training,thumbtack needles plus Tong Qiao Li Yan prescription can produce more significant clinical efficacy in treating post-stroke dysphagia than Chinese medication alone;this method can boost neurological recovery,improve the patient's swallowing function and sEMG of the swallowing muscle group,and enhance cerebral hemodynamics,with a low adverse reaction incidence.