分期针刺结合中药治疗中风后吞咽功能障碍的临床研究

Clinical Study on Staged Acupuncture Combined with Traditional Chinese Medicine for the Treatment of Swallowing Dysfunction after Stroke

目的 探讨辨证分期针刺结合中药治疗用于卒中后吞咽功能障碍中的临床效果。方法 选取2021年12月—2023年6月丰县中医医院住院治疗的80例中风后吞咽功能障碍患者为研究对象。采用随机数表法分为观察组和对照组,对照组(40例)予以普通针刺联合中药进行治疗,观察组(40例)予以辨证分期针联合中药进行治疗。比较两组患者电视透视吞咽功能检查、口期传递时间、咽启动延迟时间、咽期时长、喉向前和向上距离(%C2-4)、食管入口的最大开放程度、误吸情况。结果 相较于对照组,观察组治疗后的电视透视吞咽功能评分更高,口期传递时间更长,咽启动延迟时间、咽期时长更短,喉向前和向上距离(%C2-4)更大,差异有统计学意义(t=2.222、2.781、2.554、2.304、2.303、3.381,P均<0.05)。两组误吸情况相对比,观察组误吸发生率低于对照组,差异有统计学意义(χ^(2)=6.135,P<0.05)。结论 应用辨证分期针刺结合中药治疗脑卒中后发生吞咽功能障碍的临床治疗效果明显,可以改善吞咽功能,且能提高吞咽时喉上抬及喉前移的距离,减少误吸发生率和梨状窝滞留。

Objective To explore the clinical effect of staged acupuncture combined with traditional Chinese medicine treatment for post-stroke swallowing dysfunction.Methods 80 patients with post-stroke swallowing dysfunction hospitalized in Fengxian Hospital of Traditional Chinese Medicine from December 2021 to June 2023 were selected as the study objects.They were divided into observation group and control group according to random number table method,40 cases in the control group were treated with ordinary acupuncture combined with traditional Chinese medicine,and 40 cases in the observation group were treated with identification staged acupuncture combined with traditional Chinese medicine.TV fluoroscopic swallowing function examination,oral phase transmission time,pharyngeal initiation delay time,pharyngeal phase duration,laryngeal forward and upward distance(%C2-4),maximum opening degree of esophageal inlet,and aspiration were compared between the two groups.Results Compared with the control group,the observation group after treatment had higher swallowing function score by fluoroscopy,longer oral period transmission time,shorter pharyngeal initiation delay time,shorter pharyngeal period duration,and greater laryngeal forward and upward distance(% C2-4),and the differences were statistically significant(t=2.222,2.781,2.554,2.304,2.303,3.381,all P<0.05).Compared with the aspiration between the two groups,the incidence of aspiration in the observation group was lower than that of the control group,and the difference was statistically significant(χ^(2)=6.135,P<0.05).Conclusion The clinical therapeutic effect of the application of identification staged acupuncture combined with traditional Chinese medicine for the treatment of swallowing dysfunction occurring after stroke is obvious,which can improve the swallowing function,and can improve the distance of laryngeal elevation and laryngeal anterior displacement during swallowing,and reduce the incidence of aspiration and pyriform fossa retention.