通督益脑化痰法针药并用治疗缺血性脑卒中假性球麻痹吞咽障碍临床研究

Clinical Study on Acupuncture Combined with Dredging Governor Meridian and Benefiting Brain and Resolving Phlegm Method in Treatment of Pseudobulbar Paralysis Dysphagia of Ischemic Stroke

目的观察用通督益脑化痰法针药并用治疗缺血性脑卒中假性球麻痹吞咽障碍的临床效果。方法将医院2020年1月—2022年1月收治的108例缺血性脑卒中假性球麻痹吞咽障碍患者按照随机数字表法分为对照组和治疗组各54例。对照组患者给予咽部肌肉电刺激的康复治疗,治疗组在对照组基础上给予针刺“督脉、舌三针”联合通督益脑化痰汤治疗,连续治疗4周。通过两组患者治疗前后洼田饮水试验评分、吞咽功能评价量表(SSA)评分变化评估临床效果,比较患者吞咽障碍特异性生活质量量表(SWAL-QOL)评分、卒中相关肺炎的发生率、副反应量表(TESS)评分。结果对照组治疗的有效率78.00%,明显低于治疗组的有效率94.12%(P<0.05);治疗后与对照组相比,观察组饮水试验中吞咽等级更优(P<0.05);治疗2周、治疗4周治疗组的SSA评分均较对照组明显降低(P<0.05),SWAL-QOL评分均明显高于对照组(P<0.05);与对照组患者的卒中相关肺炎的发生率20.00%相比;治疗组卒中相关肺炎的发生率9.80%相对较低,但差异无统计学意义(χ^(2)=2.076,P>0.05);治疗组的副反应量表TESS评分(2.76±0.73)分与对照组的TESS评分(2.39±0.81)分比较,差异无统计学意义(t=0.401,P=0.646>0.05)。结论通督益脑化痰法针药并用治疗缺血性脑卒中假性球麻痹吞咽障碍疗效确切,能显著改善患者的吞咽功能,提高生活质量,降低卒中相关肺炎的发生率,且不增加不良反应。

Objective To observe the clinical effect of acupuncture combined with dredging governor meridian and benefiting brain and resolving phlegm method in treating swallowing disorders caused by pseudobulbar palsy in ischemic stroke.Methods A total of 108 ischemic stroke patients with pseudobulbar paralysis dysphagia from January 2020 to January 2022 were divided into control group(54 cases)and treatment group(54 cases)according to random number table method.The control group was given pharyngeal muscle electrical stimulation rehabilitation treatment.On the basis,the treatment group was given acupuncture at governor meridian and tongue three-needle combined with dredging governor meridian and benefiting brain and resolving phlegm Decoction(通督益脑化痰汤).The treatment lasted for 4 weeks.The clinical effect was evaluated by the changes of the score of the Depression drinking water test and swallowing function evaluation scale(SSA)before and after treatment.The specific quality of life scale(SWAL-QOL)score of swallowing disorders,the incidence of stroke-related pneumonia and the treatment emergent symptom scale(TESS)score were compared.Results The effective rate of the control group was 78.00%,which was significantly lower than that of treatment group(94.12%)(P<0.05).The improvement of swallowing grade in the observation group was significantly better than that in the control group(P<0.05).The SSA score of the treatment group was significantly lower than that of the control group after 2 and 4 weeks of treatment(P<0.05).The SWAL-QOL score in the treatment group was significantly higher than that of control group(P<0.05).The incidence of stroke-related pneumonia was 20.00%in the control group and that of the treatment group was 9.80%,but there was no significant difference(χ^(2)=2.076,P>0.05).There was no significant difference between treatment group and control group in TESS score[(2.76±0.73)points and(2.39±0.81)points](t=0.401,P=0.646>0.05).Conclusion The combination of acupuncture and medicine in the treatment of pseudobulbar paralysis dysphagia of ischemic stroke is effective,which can significantly improve the swallowing function and the quality of life of patients and reduce the incidence of stroke-related pneumonia,and do not increase the adverse reactions.