穴位按摩结合神经肌肉电刺激治疗脑卒中吞咽障碍的临床研究

Clinical study on acupoint massage combined with neuromuscular electrical stimulation in the treatment of dysphagia after stroke

目的探讨穴位按摩结合神经肌肉电刺激治疗脑卒中吞咽障碍的临床效果。方法选取2022年4月至2023年3月在佛山市第一人民医院康复医学科接受治疗的92例脑卒中吞咽障碍患者作为研究对象。根据不同的治疗方式将患者分为结合组(53例)和电刺激组(39例),电刺激组接受神经肌肉电刺激治疗,结合组在电刺激组的基础上增加穴位按摩。治疗后比较两组患者临床疗效、吞咽功能、渗漏-误吸(PAS)分级、舌压及口部肌肉运动评分等。结果结合组总有效率为92.45%,高于电刺激组的74.36%,差异有统计学意义(P<0.05);治疗后,结合组平均波幅及舌压高于电刺激组,且吞咽时限低于电刺激组,差异有统计学意义;结合组PAS及容积-黏度吞咽测试(V-VST)分级优于电刺激组,且安全性及有效性受损率低于电刺激组,差异有统计学意义(P<0.05);结合组标准化吞咽功能评定量表(SSA)评分低于电刺激组,差异有统计学意义(P<0.05);吞咽相关生活质量量表(SWAL-QOL)评分及口部肌肉运动评分高于电刺激组,差异有统计学意义(P<0.05)。结论穴位按摩结合神经肌肉电刺激治疗脑卒中吞咽障碍效果显著,能够有效提升患者口部运动及吞咽功能,缓解其吞咽障碍。

Objective To explore the clinical efficacy of acupoint massage combined with neuromuscular electrical stimulation in the treatment of dysphagia after stroke.Methods From April 2022 to March 2023,a total of 92 patients with dysphagia after stroke who were treated in the Department of Rehabilitation Medicine,The First People’s Hospital of Foshan were selected as the study objects.According to different treatment methods,patients were divided into combination group(53 cases)and electrical stimulation group(39 cases).The electrical stimulation group received neuromuscular electrical stimulation treatment,and on the basis of electrical stimulation group,the combination group added acupoint massage to patients.After treatment,the clinical efficacy,swallowing function,penetration-aspiration scale(PAS)grading,tongue pressure and oral muscle movement score were compared between the two groups.Results The total effective rate of 92.45%in the combination group was higher than that of 74.36%in the electrical stimulation group,and the difference was statistically significant(P<0.05).After treatment,the average wave amplitude and tongue pressure in the combination group were higher than those in the electrical stimulation group,and the swallowing time was lower than that in the electrical stimulation group,and the difference was statistically significant(P<0.05).After treatment,the PAS and volume-viscosity swallow test(V-VST)grading of the combination group were significantly better than those of the electrical stimulation group,and the safety and effectiveness damage rate was lower than that of the electrical stimulation group,and the difference was statistically significant(P<0.05).After treatment,the standardized swallowing assessment(SSA)score in the combination group was lower than that in the electrical stimulation group,and the difference was statistically significant(P<0.05).The swallowing quality-of-life questionaire(SWAL-QOL)score and oral muscle movement score were higher than those in the electrical stimulation group,and the difference was statistically significant(P<0.05).Conclusion Acupoint massage combined with neuromuscular electrical stimulation is effective in treating dysphagia after stroke,which can effectively improve the oral-motor and swallowing function of patients and relieve their dysphagia.