通督益脑针法联合化痰通络方治疗缺血性脑卒中假性球麻痹吞咽障碍患者的疗效及对其血清脑源性神经营养因子、类胰岛素一号生长因子含量的影响

Efficacy of Tongdu Yinao Acupuncture Combined with Huatan Tongluo Formula in Treatment of Dysphagia Caused by Pseudobulbar Paralysis after Ischemic Stroke and Effect on Serum BDNF and IGF-1

目的观察通督益脑针法联合化痰通络方治疗缺血性脑卒中假性球麻痹吞咽障碍患者的疗效及对其血清脑源性神经营养因子(Brain-derived neurotrophic factor,BDNF)及类胰岛素一号生长因子(Insulin-like growth factor I,IGF-1)含量的影响。方法选取2020年12月—2021年12月期间北京中医医院顺义医院神经内科收治的110例缺血性脑卒中假性球麻痹吞咽障碍患者为研究对象,按随机数字表法分为对照组和观察组,每组各55例。对照组采用常规治疗及康复锻炼,观察组在对照组基础上予以通督益脑针法联合化痰通络方治疗,均治疗4周。观察比较两组患者临床疗效,治疗前后中医症状积分、吞咽功能[吞咽功能评定量表(Standardizedswallowing assessment,SSA)及洼田吞咽能力评定量表]、吞咽困难特异性生活质量量表(Swallowquality-of-life questionnaire,SWAL-QOL)、BDNF及IGF-1含量。结果治疗后观察组总有效率92.73%(51/55)明显高于对照组80.00%(44/55),差异有统计学意义(P<0.05)。治疗后两组患者SSA、洼田饮水评分均较治疗前降低,SWAL-QOL评分均较治疗前升高,差异有统计学意义(P<0.05);且观察组SSA、洼田饮水评分均明显低于对照组,SWAL-QOL评分明显高于对照组,差异有统计学意义(P<0.05)。治疗后两组患者中医证候积分均较治疗前下降,差异有统计学意义(P<0.05);且观察组中医证候积分明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者血清BDNF及IGF-1含量均较治疗前明显升高,差异有统计学意义(P<0.05);且观察组血清BDNF及IGF-1含量均明显高于对照组,差异有统计学意义(P<0.05)。结论通督益脑针法联合化痰通络方能够显著改善缺血性脑卒中假性球麻痹吞咽障碍患者神经功能,上调神经因子水平,减轻吞咽困难症状,改善其生活水平,疗效显著,值得临床推广。

Objective To observe the efficacy of the Tongdu Yinao acupuncture combined with Huatan Tongluo Formula in treating dysphagia in patients caused by pseudobulbar paralysis after ischemic stroke and its effect on serum levels of brain-derived neurotrophic factor(BDNF)and insulin-like growth factor I(IGF-1).Methods A total of 110 patients with pseudobulbar palsy-induced dysphagia after ischemic stroke treated in the Department of Neurology at Shunyi Hospital of Beijing Hospital of Traditional Chinese Medicine from December 2020 to December 2021,were selected and randomly divided into a control group and an observation group according to a random number table,with 55 patients in each group.The control group received routine treatment and rehabilitation exercises,while the observation group received Tongdu Yinao acupuncture combined with Huatan Tongluo Formula based on the treatment in the control group.Both groups were treated for 4 weeks.Clinical efficacy,traditional Chinese medicine(TCM)symptom scores,swallowing function[Standardized Swallowing Assessment(SSA)and Kubota Drinking Test],swallowing-related quality of life(Swallow Quality-of-Life Questionnaire,SWAL-QOL),and levels of BDNF and IGF-1 were observed and compared before and after treatment.Results After treatment,the total effective rate in the observation group was 92.73%(51/55),significantly higher than 80.00%(44/55)in the control group(P<0.05).After treatment,both groups showed significant decreases in SSA and Kubota Drinking Test scores and significant increases in SWAL-QOL scores compared to those before treatment(P<0.05).The SSA and Kubota Drinking Test scores in the observation group were significantly lower,and SWAL-QOL scores significantly higher than those in the control group(P<0.05).Both groups showed significant decreases in TCM symptom scores compared to those before treatment,with the observation group being significantly lower than the control group(P<0.05).After treatment,serum levels of BDNF and IGF-1 in both groups were significantly higher than those before treatment,with the observation group being significantly higher than the control group(P<0.05).Conclusion The Tongdu Yinao acupuncture combined with Huatan Tongluo Formula significantly improves facial muscle electrical activity and neurological function in patients with pseudobulbar palsy-induced dysphagia after ischemic stroke,which upregulates neurotrophic factors,alleviates dysphagia symptoms,and improves quality of life,demonstrating significant efficacy and clinical value for widespread application.