辣椒素在神经源性吞咽障碍患者中的应用进展

吞咽是呼吸道、口咽及食管结构的一项重要神经肌肉功能,在保护气道的同时,将物质从口腔运输到胃[1]。吞咽障碍是由于下颌、双唇、舌、软腭、咽喉、食管等器官结构和(或)功能受损,不能安全有效地把食物经口送到胃内,可表现为饮水呛咳、吞咽粘滞感、咽下困难、吞咽乏力等症状[2]。由神经性统疾病导致的吞咽障碍称为神经源性吞咽障碍(neurogenic dysphagia, ND),以卒中后吞咽障碍最为常见[3]。研究表明,卒中后吞咽功能障碍发生率高达37.0%~78.0%[4],吞咽障碍易诱发吸入性肺炎、窒息、脱水和营养不良等,严重影响患者生活质量,甚至危及生命,给家庭和社会带来沉重负担。

吞咽功能训练和针灸及神经肌肉电刺激在脑卒中吞咽功能障碍恢复中的效应

吞咽功能障碍是脑卒中患者的常见并发症。有报道大约30％-50％的患者有吞咽困难，脑干卒中的发生率约40％～70％，单侧半球卒中的发生率为35％。目前脑卒中后吞咽功能恢复主要采用吞咽功能训练、针灸、神经肌肉电刺激等方法。本次探讨此三种方法联合使用治疗脑卒中所致的吞咽功能障碍的临床效果。

CLINICAL RESEARCH ON TREATMENT OF DYSPHAGIA WITH NECK ACUPUNCTURE

Objective To observe the clinical therapeutic effects on dysphagia induced by pseudobulbar palsy chiefly treated with neck acupuncture and probe into the mechanism on the effects. Methods The 86 cases that had been diagnosed definitely were randomized into two groups, the treatment group and control group. The treatment group （acupuncture＋western medication） （44 cases） was treated with acupuncture on Fēngfǔ（风府 GV16）, Fēngchí （风池GB20）, Gòngxě（供血 Extra）, Yīmíng （翳明 EX-HN14）, Zhìqiāng （治呛 Extra）, Tūnyàn （吞咽 Extra）, Fāyīn （发音 Extra）, Liánquán （廉泉CV23）, etc., and the intravenous injection with Shuxuetong （疏血通） 6- 10 mL and 0.9%, NaCl 250 mL. The control group （western medication） （42 cases） was treated with the intravenous injection with Shuxuetong （疏血通） 6- 10 mL and 0.9%, NaCl 250 mL. Results The total effective rate was 97.73 % and 80.95 % in the treatment group and control group respectively, indicating very significant difference （P 〈 0.01 ）. Conclusion The therapeutic effects mainly with neck acupuncture are better on dysphagia induced by psudalbulbar palsy, which is superior to that with simple western medication and worth to be promoted. Concerning to the mechanism on the therapeutic results, it is viewed that acupuncture on neck points improves the excitability of cerebral neurocytes, resuscitates the reversible neurocytes or awakens the inhibited neurocytes.

长针联合电刺激治疗外伤性后组颅神经损伤

后组颅神经损伤后常表现为吞咽困难、构音障碍、软腭不能上提及患侧舌肌萎缩等。目前，关于这方面的研究仍相对较少，治疗效果不甚理想。我们采用长针联合神经肌肉电刺激治疗外伤性后组颅神经损伤l例，取得了满意的效果，现将病例治验介绍如下。

Association of swallowing problems with frailty in Chinese hospitalized older patients

Objective:To estimate the prevalence of dysphagia and frailty among hospitalized older patients and to analyze the relationship between dysphagia and frailty in these people.Methods:Data were collected on 386 participants aged 65 and older in a general hospital from April to December 2017.Patients were asked to complete a self-designed demographic questionnaire.Frailty and swallowing function assessments were performed using the Fried frailty phenotype and the 30-ml water swallowing test,respectively.Multiple stepwise logistic regression analyses were used to identify the association between frailty and dysphagia.Results:Dysphagia developed in 31.1%of older people,and 24.4%developed frailty.Frailty was statistically significantly related with dysphagia.Dysphagia was more prevalent in frail and pre-frail patients(48.9%and 32.4%,respectively)than those who were non-frail(13.6%).In multivariate analyses,frail(OR,5.420;95%CI,2.684±10.944;P<0.001)and history of choking/coughing while drinking(OR,2.954;95%CI,1.844±4.733;P<0.001)were associated with dysphagia.result.Conclusions:Frailty is associated with dysphagia.More attention should be paid to frailty and dysphagia of the elderly and further studies are needed to evaluate the correlated mechanism and develop targeted nursing interventions.

Implementation strategies to improve evidence-based practice for post-stroke dysphagia identification and management:A before-andafter study

Objectives Even though guidelines are available to guide dysphagia identification and management practice,there is still a gap between evidence and practice,which requires improvement.The purpose of this study was to determine the effect of using tailored,multifaceted strategies to improve evidence-based post-stroke dysphagia identification and management practice in a community hospital.Methods Guided by the Knowledge to Action framework,the tailored,multifaceted strategies were developed and implemented for 5 months in a community hospital using a before-and-after study design.These strategies consisted of training intervention,policy intervention,and audit and feedback intervention.Nurses’level of knowledge and adherence,were collected in March 2019 and again in January 2020.Patients’quality of life and satisfaction were evaluated during the pre-intervention period(between February 2019 and April 2019)and the post-intervention period(between November 2019 and January 2020).Results A total of 55 patients with post-stroke dysphagia(28 in the pre-intervention period and 27 in the post-intervention period)and 17 registered nurses were recruited.Following implementation,there were statistically significant improvements in patients’outcomes(quality of life and satisfaction)and nurses’outcomes(level of knowledge and adherence).Conclusions This study assists in closing the research-practice gap by using tailored,multifaceted strategies to increase the use of evidence-based nursing care for dysphagia identification and management practices.

“Tong Guan Li Qiao” Acupuncture Therapy on Post-Stroke Dysphagia

The differences between the“Tong Guan Li Qiao”acupuncture therapy and the conventional and current other acupuncture methods for poststroke dysphagia are as follows:first,it adheres to the basic idea of "Xing Nao Kai Qiao"acupuncture therapy in selecting and combining acupoints,centers on the brain,and combines the dysphagia symptoms of the mouth,tongue,and throat-related orifices with the root cause of"brain";second,thereare strictand standard requirements intheacupuncture operation,that is,manipulation quantification.In addition to standardized twirling,lifting,and thrusting,the techniques of deep needling on the acupoints in the neck region,blood-letting puncturing at the posterior wallof the pharynx,and theneedling sensation of"like a fishbone getting stuck in the throat"are all unique.

脑梗死合并吞咽功能障碍的护理研究进展

脑梗死合并吞咽功能障碍是一种常见且严重的疾病。本文综述了目前针对该病症的护理研究进展,包括食管镜检查、营养支持、吞咽康复训练和管饲等方面。其中,食管镜检查可以评估患者的吞咽能力,指导治疗方案;营养支持可以确保患者的营养需求;吞咽康复训练可以帮助患者恢复吞咽能力;管饲可以减少呼吸道感染和肺炎等并发症的风险。这些护理方法和治疗方案在实践中已经得到了广泛应用,并取得了显著的疗效。我们认为,这些研究成果有望为相关领域的医学工作者提供宝贵的参考资料,促进该领域的进一步发展和探索。

Therapeutic efficacy of swallowing neuromuscular electrical stimulation combined with acupuncture for post-stroke dysphagia

Objective To seek a better therapy for treating post-stroke dysphagia. Methods Patients with stroke and swallowing disorders were randomly divided into ordinary acupuncture group （group A, 58 cases） and swallowing neuromuscular electrical stimulation combined with acupuncture group （group B, 62 cases）. Two-group patients were given the same basic internal medical treatment. In addition, group A was given normal acupuncture treatment with the choice of local points： Junjin （金津 EX-HN 12）, Yuye（玉液 EX-HN 23）, Fengchi （风池 GB 20）, Yifeng （翳风 TE 17）, Lianquan （廉泉 CV 23）, Wangu （完骨 GB 12）. Group B was given swallowing neuromuscular electrical stimulation combined with acupuncture： GB 20, Fengfu （风夜 GV 16）, TE 17, Yiming （翳明 EX-HN 14）, Yamen （哑门 GV 15）, Tianrong（天容 SI 17）, Tianchuang （天窗 SI 16）, CV 23, the uniform reinforcing-reducing manipulation was used; EX- HN 12, EX-HN 13, the piercing and blood-letting method （1-2 mL blood） was used; at the same time, the swallowing neuromuscular electrical stimulation therapy device was used to electrically stimulate the nerves and muscles in the throat and neck at specific output pulse current （50-100 Hz）. Treatment was made twice a day, 30 minutes each time. Two weeks after the treatment, the patients were assessed in symptoms improvement and clinical efficacy. Results The total effective rate in group B was 91.4% and 75.8% in group A; in the total efficiency comparison in both groups, χ^2=5.232, P〈0.05. The difference in improvement of symptoms with post-stroke dysphagia treated with above mentioned combination treatment was statistically significant between both groups （P〈0.05）. Conclusion The above mentioned swallowing neuromuscular electrical stimulation combined with acupuncture treatment has a better clinical effect when compared with ordinary acupuncture.

Treatment of 85 patients with dysphagia after stroke with deep needling at local glossopharyngeum

Objective To observe the clinical efficacy of deep needling at local glossopharyngeum in treatment of dysphagia after stroke. Methods Deep needling at local glossopharyngeum was applied in 85 patients with dysphagia after stroke. Firstly, quick prick was conducted on lingual surface（mainly at the side of paralysis lingualis）, Jīnjīn（金津 EX-HN 12） and Yùyè（玉液 EX-HN 13） under the tongue; secondly, filiform needle with the length of 75 mm was used to perform quick prick at posterior wall of pharynx at the affected side about three or four times, and then the needle was removed rapidly. Filiform needle with the length of 75 mm was inserted perpendicularly at Liánquán（廉泉 CV 23） towards root of tongue; after deqi, the needle was pushed towards root of tongue in the depth of 60–70 mm, and the needle was retained for 30 min. Meanwhile, the patient was asked to swallow, and the feeling of abnormal deglutition without pain was considered as most appropriate. During needle retention, twirling for reinforcement was applied for two times. The manipulation was conducted once daily, and six days was considered as one course of treatment. Between two courses, one day was free of treatment; and there were four courses in total. Kubota＇s drinking water test evaluation scale was applied to assess the efficacy after the treatment for two weeks and four weeks. Results The score of Kubota＇s drinking water test at the early stage of treatment was 5.08 ± 2.28, the score of evaluation of treatment with deep needling at local glossopharyngeum after treatment for two weeks was 4.56 ± 2.32, and the total effective rate was 89.4%; the score of evaluation after treatment for four weeks was 2.80 ± 2.12, and the total effective rate was 95.3%. Compare before the treatment, the score of Kubota＇s drinking water test was reduced after treatment for two and four weeks（P〈0.05, P〈0.01）. Conclusion Deep needling at local glossopharyngeum in treatment of dysphagia after stroke has good effect.

Therapeutic observation of Gao's nape acupuncture plus swallowing training for pharyngeal deglutition disorder after stroke

Objective: To observe the clinical efficacy of Gao's nape acupuncture plus swallowing training in treating pharyngeal deglutition disorder after stroke. Methods: One hundred patients with post-stroke pharyngeal deglutition disorder were randomized into a treatment group and a control group, with 50 cases in each group. The two groups both received routine neurological intervention. In addition, the treatment group was given Gao's nape acupuncture plus swallowing training, while the control group was intervened by swallowing training alone. After eight-week treatment, the two groups were observed in terms of the changes in repetitive saliva swallowing test (RSST), modified water swallowing test (MWST), standardized swallowing assessment (SSA) and swallowing-related quality of life (SWAL-QOL). The clinical efficacies of the two groups were also compared. Results: After treatment, the RSST grading, and scores of MWST, SSA and SWAL-QOL changed significantly in both groups (P<0.05 or P<0.01). The RSST grading, and scores of MWSX SSA and SWAL-QOL in the treatment group were significantly different from those in the control group after treatment (P<0.05 or P<0.01). The total effective rate and markedly effective rate were respectively 100.0% and 72.3% in the treatment group, versus 97.9% and 34.0% in the control group. There was a significant differenee in the markedly effective rate between the two groups (P<0.01). The differenee in the clinical efficacy between the two groups was statistically significant (P<0.01). Con elusion: Gao's n ape acupu ncture plus swallowi ng training is an effective approach for post-stroke phary ngeal deglutiti on disorder. Its therapeutic efficacy is more significant than that of swallowing training alone.

Treatment of Swallowing Dysfunction after Cerebral Apoplexy by Acupuncture:A Report of 56 Cases

Fifty-six patients with swallowing dysfunction after cerebral apoplexy were treated by acupuncture and swallowing function training. The curative effect is satisfactory and the total effective rate was 96.4%.

Treatment of 40 Cases of Post-apoplectic Dysphagia by Acupuncture plus Rehabilitation Exercise

Objective： To investigate the efficacy of acupuncture plus rehabilitation exercise in treating post-apoplectic dysphagia. Methods： The patients were randomly allocated into treatment and control groups. The treatment group was treated by acupuncturing points Fengchi（GB 20）, Tianzhu（BL 10）, Tongli（HT 5） and Lianquan（CV 23） plus rehabilitation exercises and the control group only by rehabilitation exercise. Results： The total effective rate was 95.0% in the treatment group and 71.9% in the control group. There was a significant difference between the two groups （P〈0.01）. Conclusion： Acupuncture plus rehabilitation exercise can improve the curative effect on postapoplectic dysphagia.

Observation on mind-refreshing and orifice-opening needling method plus swallowing disorder therapeutic apparatus for deglutition disorder of stroke patients in the convalescent stage

Objective： To observe the clinical effect of mind-refreshing and orifice-opening needling method plus swallowing disorder therapeutic apparatus for deglutition disorder of stroke patients in convalescence stage. Methods： A total of 136 patients conforming to the inclusion criteria were randomized into three groups by the random number table, including group A of 46 cases, group B of 44 cases and group C of 46 cases. Patients in group A received swallowing disorder therapeutic apparatus treatment, patients in group B received mind-refreshing and orifice-opening needling method treatment, and patients in group C received mind-refreshing and orifice-opening needling method plus swallowing disorder therapeutic apparatus treatment. The treatment was given once a day for 10 d as a course, the whole treatment lasted for 4 courses. Therapeutic evaluation items including water-swallowing test （WST）, standardized swallowing assessment （SSA） and modified Barthel index （MBI） were measured before treatment, after treatment and at follow-up visit （2 months after treatment）. Results： After treatment, scores of WST and MBI in all three groups increased significantly （all P〈0.05）, while the SSA score dropped significantly （all P〈0.05）. After treatment and during follow-up visit period, score of WST in group C was significantly higher than that in group A and group B （both P〈0.05）, while the difference between group A and group B showed no statistical significance （P〉0.05）; the SSA score in group C was substantially lower than that in group A and group B （all P〈0.05）, the difference between group A and group B showed no statistical significance （P〉0.05）; the MBI scores in group B and group C were substantially higher than that in group A （all P〈0.05）, the difference between group B and group C showed no statistical significance （P〉0.05）. After treatment and during follow-up visit period, the differences in overall therapeutic effect between group A and group B showed no statistical significance （P〉0.05）, while the overall therapeutic effect in group C was substantially better than that in group A and group B （all P〈0.05）. Conclusion： Both mind-refreshing and orifice-opening needling method and swallowing disorder therapeutic apparatus can alleviate symptoms of deglutition disorder of stroke patients respectively, and the combination of two methods can improve the therapeutic effect.

Clinical Observations on Acupuncture Treatment of Post-Stroke Dysphagia

To seek a treatment that can improve the effect on dysphagia following post-stroke pseudobulbar palsy. Methods： Sixty patients were randomly allocated into observation and control groups, 30 cases each. The observation group was treated with Western drugs plus acupuncture at Tiantu （CV 22） and other three acupoints around Lianquan （CV 23） and the control group with simple Western drugs. Results： The effective rate was 86.7% in the observation group and 30.0% in the control group. Conclusion： Acupuncture can improve the curative effect of Western drugs on dysphagia following post-stroke pseudobulbar palsy.

Fire-needle therapy for deglutition disorders in post-stroke pseudobulbar palsy:a randomized controlled trial

Objective:To observe the clinical efficacy of fire-needle therapy in treating deglutition disorders due to pseudobulbar palsy in the remission stage of stroke.Methods:Sixty-two eligible subjects were divided into a fire-needle group and a rehabilitation group by a simple randomization method at a ratio of 1:1.The two groups received same basic intervention;in addition,the fire-needle group received fire-needle treatment,while the rehabilitation group received rehabilitation training.The two groups of subjects all received a 3-week treatment and were evaluated by the dysphagia severity rating scale (DSRS),modified Mann assessment of swallow ability (MMASA) and Kubota Toshio swallow test (KTST) before and after the intervention.The complications and adverse events occurred during the trial were recorded.The data were statistically analyzed.Results:At the third week,the DSRS,MMASA and KTST scores changed significantly compared with the baseline in both groups (P<0.05),and the changes in the fire-needle group were more significant than those in the rehabilitation group (P<0.05).The between-group comparison at the third week showed that the therapeutic efficacy in the fire-needle group was superior to that in the rehabilitation group (P<0.05).Conclusion:Fire-needle therapy can obviously change the DSRS,MMASA and KTST scores in pseudobulbar palsy in the remission stage of stroke,and significantly enhance the therapeutic efficacy of the treatment of deglutition disorders in this stage.

Clinical observation on acupoint massage plus Vitalstim electrical stimulation for deglutition disorder after stroke

Objective:To observe the effect of acupoint massage plus Vitalstim electrical stimulation on deglutition function and surface electromyography(SEMG)of deglutition muscle groups.Methods:A total of 60 patients with deglutition disorder after stroke were selected and divided into an electrical stimulation group,a massage group and an integrated group according to the random number table method,with 20 cases in each group.Patients in these three groups were given the same routine rehabilitation training for deglutition.In addition,patients in the electrical stimulation group were given extra Vitalstim electrical stimulation,patients in the massage group were given extra acupoint massage on the head,face and neck,and patients in the integrated group were given extra acupoint massage plus Vitalstim electrical stimulation.Fujishima Ichiro food intake level scale(FILS)was scored before and after treatment.The swallowing duration and maximal amplitude of masseter muscle in SEMG were evaluated before and after treatment.Results:After treatment,the FILS score and the maximal amplitude of recruitment potential generated by muscular contraction of masseter muscle group in the three groups were higher than those before treatment(all P<0.05),and the swallowing duration of masseter muscle group was shortened compared with that in the same group before treatment(all P<0.05).After treatment,the FILS score in the integrated group was higher than that in the electrical stimulation group and the massage group(both P<0.05).The swallowing duration of masseter muscle group measured by SEMG was lower than that in the electrical stimulation group and the massage group(both P<0.05),while the maximal amplitude was higher than that of the electrical stimulation group and the massage group(P<0.05).After treatment,there were no significant differences in the FILS score,swallowing duration and maximal amplitude of masseter muscle group between the electrical stimulation group and the massage group(all P>0.05).Conclusion:Both acupoint massage and electrical stimulation can improve the deglutition function in patients with deglutition disorder after stroke,and improve the coordination and flexibility of masseter muscle.The integration of the two is more effective.

Clinical Study on Puncturing Renying （ST 9） to Treat Poststroke Dysphagia

Objective： To observe the clinical efficacy of puncturing Renying （ST 9） in the treatment of poststroke dysphagia. Methods： Sixty cases of poststroke dysphagia were randomized into two groups, a control group in which 30 cases were given rehabilitation training, and a treatment group in which 30 cases were treated by puncturing Renying （ST 9） and rehabilitation training, with a course of four weeks. Results： The total effective rate for dysphagia was higher in the treatment group than in the control group （P〈0.05）. Conclusion： Puncturing Renying （ST 9） is quite effective for poststroke dysphagia.

Influence of acupoint-injection on TXB_2 and 6-keto-PGF_(1a) in patients with pseudobulbar palsy: a randomized controlled trial

Objective： To prove the feasibility and validity of Xing Nao Jing acupoint-injection （XNJ-AI） at Fengchi （GB 20） for pseudobulbar palsy caused by ischemic stroke （PBP-IS）. Methods： An assessor-blinded, two-parallel-group, randomized controlled trial was conducted, and the patients with PBP-IS were recruited and randomly divided into two groups. Patients in the control group received oral aspirin （100 mg per day for 2 weeks）. In addition to oral aspirin; patients in the treatment group received XNJ-AI at Fengchi （GB 20）, once a day, for two weeks. The primary outcome was assessed by the water-swallowing test （WST）. Thromboxane B2 （TXB2） and 6-keto-prostaglandin F1α （6-keto-PGF1α） in plasma were measured before and after the treatment. Results： In the treatment group, the percentage of swallowing function no less than grade 3 before and after the treatment was 32% and 88%, respectively; in the control group, it was 28% and 76% before and after the treatment, respectively; the difference after the treatment between the two groups was statistically significant （P〈0.05）. There were statistical differences between pre- and post-treatment levels of plasma TXB2 and 6-keto-PGF1α in the two groups （both P〈0.05）. After the treatment, there were significant differences in the levels of plasma TXB2 and 6-keto-PGF1α between the two groups （both P〈0.05）. Conclusion： XNJ-AI at Fengchi （GB 20） can improve the patients＇ swallowing function and balance the levels of TXB2 and 6-keto-PGF1α in plasma.

Efficacy evaluation of acupuncture plus rehabilitation training for post-stroke deglutition disorders of qi-deficiency blood stasis pattern

Objective:To observe the clinical efficacy of acupuncture plus rehabilitation training in treating post-stroke deglutition disorders of qi-deficiency blood stasis pattern.Methods:Sixty-six patients with post-stroke deglutition disorders of qi-deficiency blood stasis patter were divided into an observation group and a rehabilitation group using the random number table method.The two groups both received conventional medications and supportive treatment for stroke.In addition,the observation group received acupuncture plus rehabilitation training while the rehabilitation group only received the same rehabilitation training.The interventions were conducted 3 times a week for a total of 4 weeks in both groups.They were evaluated using Kubota water swallowing test(KWST),Fujishima Ichiro food intake level scale(FILS)and symptoms score of traditional Chinese medicine(TCM)before and after treatment,and at the 1-month follow-up.The therapeutic efficacy was assessed at the 1-month follow-up.Results:The KWST grading and FILS result after treatment and at the follow-up were significantly different from those before treatment in both groups(all P<0.001);the results of these two items at the follow-up were not significantly different from those after treatment in the two groups(all P>0.05).There were significant differences in the KWST grading and FILS result between the two groups after treatment and at the follow-up(all P<0.05).The TCM symptoms score changed significantly after treatment and at the follow-up compared with that before treatment in both groups(all P<0.001).The TCM symptoms grading efficacy at the follow-up was significantly different from that after treatment in the observation group(P<0.05),while the difference was statistically insignificant in the rehabilitation group(P>0.05).The TCM symptoms grading efficacy in the observation group was significantly different from that in the rehabilitation group after treatment and at the follow-up(both P<0.05).Conclusion:Based on the conventional treatment for stroke,acupuncture plus rehabilitation training or use of rehabilitation training alone both can improve the clinical symptoms in post-stroke deglutition disorders of qi-deficiency blood stasis pattern,but acupuncture plus rehabilitation training can produce more significant efficacy and better long-term efficacy in improving TCM symptoms.