基于弥散张量成像技术探讨针刺对脑梗死后吞咽障碍患者神经重塑的研究

ObjectiveTo investigate the clinical effect of acupuncture among patients with dysphagia after cerebral infarction, and the nerve remodeling of acupuncture using diffusion tensor imaging.MethodsOne hundred and twenty patients with dysphagia after cerebral infarction were randomly assigned to either acupuncture group or sham-acupuncture group with a 1:1 ratio. All patients received usual care and swallowing function training of neurology department. Additionally, acupuncture was applied at Sìshéncōng (四神聪EX-HN1), Băihuì (百会GV20), Tàiyáng (太阳EX-HN5), Fēngchí (风池GB20) and Shésānzhēn (舌三针three-tongue needling points, Extra) in acupuncture group. The needles were retained for 30 min each time, and five times a week for three weeks as a course of treatment. Two courses of treatments were required in total. In sham-acupuncture group, the blunt needles were put into the needle sleeve, and the top of needle was fixed on the skin. During treatment the blunt needle tip only had slight contact with the skin without any penetration. The blunt needle tips were placed on EX-HN1, GV20, EX-HN5, GB20 and three-tongue needling points, respectively. The duration of treatment in sham-acupuncture group was the same as that in acupuncture group. Before and after treatment, all patients underwent Kubota water swallowing test to evaluate the clinical effect. Using diffusion tensor image (DTI), the nerve remodeling was detected.ResultsClinical effect: After treatment and assessed by water swallowing test, there were 38 cases of normal swallowing function in acupuncture group, higher than 15 cases in sham-acupuncture group (P < 0.05). Nerve remodeling: (1) apparent diffusion coefficient (ADC): before treatment, ADC in acupuncture group and sham acupuncture group were 1.76 ± 0.45 mm/s and 1.68 ± 0.51 mm/s, respectively. After treatment, ADC were 0.66 ± 0.15 mm/s and 0.74 ± 0.11 mm/s, respectively. The difference in ADC had no statistical significance between two groups after treatment (P > 0.05);(2) fractional anisotropy (FA): after treatment, FA of acupuncture group was 0.57 ± 0.06, which was significantly higher than that of sham-acupuncture group (P < 0.05);(3) observation of different infarct lesions: after treatment, ADC of temporal lobe infarction in acupuncture group was (0.57 ± 0.11) mm/s, lower than 0.82 ± 0.24 mm/s of sham acupuncture group, while FA in acupuncture group was 0.61 ± 0.07, higher than 0.45 ± 0.10 in sham-acupuncture group, both with statistical significance (both P < 0.05). Regarding the changes of FA maps for temporal lobe infarction before and after treatment, the transverse bundles of the white matter fibers increased remarkably in infarct lesions and on the healthy side of temporal lobe.ConclusionAcupuncture could improve the swallowing function of patients with dysphagia after cerebral infarction. It reduced ADC and increased FA, especially among patients with temporal lobe infarction after treatment. Acupuncture may have a remodeling effect on transverse cortical fibers after temporal lobe infarction.

Relieving throat and opening orifice acupuncture therapy for the post-stroke dysphagia

Objectives: To observe the effectiveness of acupuncture therapy for relieving throat and opening orifice on dysphagia due to different brain infarct sites.Methods: According to the random number table, 128 patients with post-stroke dysphagia were divided into group A(63 cases, intervention with deglutition training and acupuncture) and group B(65 cases,intervention with simple deglutition training). The conventional treatment and deglutition rehabilitation training in neurology department were used in the two groups. In group B, according to patient's condition, the rehabilitation trainings, such as respiration and neck movement range were used selectively.In group A, on the base of deglutition training, acupuncture therapy for relieving throat and opening orifice was supplemented. The acupoints included Sìshéncōng(四神聪EX HN 1),Bāihuì(百会GV 20), Tàiyang(太阳EX-HN5) bilateral, Fēngchi(风池GB 20) bilateral and Shésānzhēn(舌三针).Electrostimulator was attached on EX-HN 1, bilateral GB 20 and Shesanzhen(舌三针). Needles were retained for 30 min in each treatment. The treatment was given once a day, 5 treatments a week and the treatment for 3 weeks as 1 course. After 6 weeks of treatment, the deglutition ability scale developed by Fujishima Ichiro was adopted to determine the therapeutic effects and observe the score increase for dysphagia related to brain infarct sites before and after treatment.Results: In assessment after 6-week treatment, the improvements of deglutition ability were different corresponding to different brain infarct sites in group A. Specially, the improvements in the patients with dysphagia related to cerebral hemisphere infarction in group A were better than group B(8.68 ±1.12 vs7.32 ±0.91, P<0.05), followed by the improvements in the patients with dysphagia related to internal capsule/basal ganglia/diencephalon infarction(6.53 ±0.65 vs 6.36 ±0.84, P>0.05). Regarding the therapeutic effects in comparison of the two groups, the total effective rates in dysphagia related to cerebral hemisphere infarction were different between the two groups significantly(96.67% vs 82.75%, P< 0.05), as well as in the patients related to internal capsule/basal ganglia/diencephalon infarction(88.89% vs 66.67%,P<0.05). The therapeutic effects were not different in the patients related to cerebral stem and cerebella infarction between the two groups(P>0.05).Conclusion: The acupuncture therapy for relieving throat and opening orifice combined with deglutition training achieves the satisfactory therapeutic effects on dysphagia induced by cortical infarction in stroke.However, a large sample and multicentral clinical trial with this therapy is needed for a further argument so that this therapy is likely promoted in clinical practice in future.