电针联合通督益脑化痰汤治疗脑卒中后口咽期吞咽障碍临床研究

Clinical study of electro-acupuncture combined with Tongdu Yinao Huatan decoction in the treatment of dysphagia in oropharyngeal stage after stroke

目的:探讨电针联合通督益脑化痰汤治疗脑卒中后口咽期吞咽障碍的影响。方法:选择痰瘀阻络型脑卒中后口咽期吞咽障碍患者102例为研究对象,采用随机数字表法将其分为电针组和联合组各51例。电针组采用电针夹廉泉穴、风府穴治疗,联合组在此基础上给予通督益脑化痰汤治疗。观察两组患者的临床疗效、中医证候积分、神经功能缺损评分(NIHSS)、日常生活活动能力(ADL)评分、吞咽功能评价量表(SSA)评分、血管内皮功能、神经功能因子、不良反应发生情况。结果:治疗后,联合组治疗总有效率高于电针组(P<0.05);治疗后联合组中医证候积分、NIHSS与SSA评分、可溶性血管细胞黏附分子-1(sVCAM-1)、神经元特异性烯醇化酶(NSE)、神经生长相关蛋白-43(GAP-43)水平均低于电针组(P<0.05);治疗后联合组ADL、内皮源性超极化因子(EDHF)、脑源性神经营养因子(BDNF)水平均高于电针组(P<0.05);两组不良反应总发生率差异无统计学意义(P>0.05)。结论:电针夹廉泉穴、风府穴联合通督益脑化痰汤治疗脑卒中后口咽期吞咽障碍可改善患者血管内皮功能指标及神经功能因子水平,提高患者神经功能、日常生活能力及吞咽功能,提高临床疗效。

Objective:To investigate the effect of electro-acupuncture combined with Tongdu Yinao Huatan decoction in the treatment of dysphagia in oropharyngeal period after stroke.Methods:A total of 102 patients with oropharyngeal dysphagia after stroke with phlegm and blood stasis were selected as the study objects,and were divided into electro-acupuncture group(n=51)and combined group(n=51)by random number table method.The electro-acupunctur group was treated with Jialianquan point and Fengfu point,and the combined group was treated with Tongdu Yinao Huatan decoction on this basis.Clinical efficacy,TCM syndrome score,Neurological function deficit score(NIHSS),activity of daily living(ADL)score,swallowing function Evaluation Scale(SSA)score,vascular endothelial function,neurological function factors,and adverse reactions were observed in 2 groups.Results:After treatment,the total effective rate of combined group was higher than that of electro-acupunctur group(P<0.05).TCM syndrome score,NIHSS and SSA scores,soluble vascular cell adhesion molecule-1(sVCAM-1),specific enolase(NSE)and nerve growth associated protein-43(GAP-43)levels in combination group were lower than those in electro-acupunctur group(P<0.05).The levels of ADL,endodermal hyperpolarization factor(EDHF)and brain-derived neurotrophic factor(BDNF)in combination group were higher than those in electro-acupunctur group(P<0.05).There was no significant difference in the total incidence of adverse reactions between the two groups(P>0.05).Conclusion:Electro-acupunctur combined with Tongdu Yinao Huatan decoction in the treatment of swallowing disorder in oropharyngeal stage after stroke can improve the level of vascular endothelial function indicators and nerve function factors,improve the nerve function,daily living ability and swallowing function of patients.