缺血性脑卒中所致假性延髓麻痹患者短期预后的相关影响因素

目的:回顾性分析缺血性脑卒中所致假性延髓麻痹短期预后的相关影响因素,筛选出预测指标,以指导早期干预措施和治疗方案。方法:选择2004-05/2005-04在哈尔滨医科大学附属第二医院神经科住院的急性缺血性脑卒中患者中发生假性延髓麻痹的患者126例,均自愿参加观察。选择患者的性别、年龄、既往史(高血压史、糖尿病史、冠状动脉粥样硬化性心脏病史、脑卒中次数、吸烟史、饮酒史)、入院时检查(血压、血糖、胆固醇、三酰甘油、纤维蛋白原)、假性延髓麻痹类型、偏瘫程度、合并感染、合并电解质紊乱、头CT或MRI病灶数18个因素进行单因素分析;应用Logistic模型分析影响疾病短期预后的相关因素和预测因素。入院后正规治疗20d,第21天评价短期预后。显效为假性延髓麻痹症状基本消失,能顺利进食流质食物;好转为能顺利进食固体食物,但进食流质食物仍有呛咳。短期预后好为显效和好转的患者,短期预后差为无变化、恶化和死亡的患者。结果:患者126例全部进入结果分析,无脱落。①单因素分析结果:短期预后好组患者84例,短期预后差组患者42例,单因素分析结果显示两组患者有7个因素差异具有显著性意义(P<0.05),包括年龄、脑卒中次数、假性延髓麻痹类型、偏瘫程度、合并感染、合并电解质紊乱、CT或MRI病灶数。②Logistic模型分析结果:合并感染、完全性假性延髓麻痹、年龄大、CT或MRI病灶数多、合并电解质紊乱是短期预后差的具有预测意义的影响因素。结论:患者的年龄、假性延髓麻痹类型、合并感染、合并电解质紊乱、CT或MRI病灶数在一定程度上能够预测缺血性脑卒中所致假性延髓麻痹短期预后的发展趋势。对有此趋势的患者应早期干预、充分救治。

风府穴对针刺治疗假性球麻痹效果的影响

目的 观察风府穴是否能增加治疗假性球麻痹的效果。方法 60例脑卒中合并假性球麻痹患者被随机均匀分成两组。对照组治以风池、廉泉、通里,治疗组则在上方基础上加针风府。结果 治疗组 30例,治愈 13例 ( 43. 3% ),总有效率93. 3%;对照组 30例,治愈 7例(23. 3% ),总有效率73. 3%。治疗组疗效明显优于对照组 (P<0. 05)。结论 加用风府穴对针刺治疗假性球麻痹可明显增加疗效。

针刺治疗中风假性球麻痹30例临床观察

目的探讨影响针刺治疗中风假性球麻痹(PBP)患者疗效的因素。方法将60例风痰阻络型中风假性球麻痹住院患者随机分为治疗组和对照组,对疗效进行观察。结果与结论针刺对PBP是有效的,治疗组效果优于对照组(P<0.05)。研究中发现随着脑卒中发生次数的增多,发生重度吞咽困难的机率有增高的趋势,发生吞咽困难的时间相继提前,提示对脑卒中进行早期治疗和预防的重要性。

针刺对中风假性球麻痹患者血液粘稠度的影响

目的 探讨针刺治疗中假性球麻痹的可能机理。方法与结果 将 75例中风假性球麻痹患者随机分为针刺组、西药组、针刺加西药组,分别于治疗前及治疗后检测患者的血液流变学。将结果进行组间及治疗前后比较。3组患者治疗前后血浆粘度、红细胞压积(% )、血沉、全血高切还原粘度的比较均有统计学差异(P<0. 01)。治疗后针刺组与针刺加西药组的血浆粘度和血沉方程K比较,经统计学处理具有显著性差异(P<0. 05)。西药组与针刺加西药组间血浆粘度、红细胞聚集指数、血沉、全血高切还原粘度、全血低切还原粘度、血沉方程K值的比较均有显著性差异(P<0. 05)。结论 针刺能明显降低患者血液的浓稠性和粘滞性,可能是治疗中风假性球麻痹的机理之一。

Clinical Observation on Acupuncture Treatment of 30 Cases with Apoplectic Pseudobulbar Palsy

Objective： To investigate the factors influencing the therapeutic effect in acupuncture treatment of apoplectic pseudobulbar palsy （PBP）. Methods： Sixty patients with apoplectic pseudobulbar palsy in pattern of obstruction of wind and phlegm in the meridians were randomly divided into the treatment group and control group, to observe the therapeutic effect. Results and Conclusion： The therapeutic effect was significantly better in the treatment group than in the control group （P〈0.05）. It has been found in the study that with increase in the occurrence of cerebral apoplexy, the incidence rate of severe dysphagia increased and dysphagia took place progressively earlier, indicating the importance of early treatment and prevention of cerebral apoplexy.

Clinical Observation of Acupuncture in Treating Pseudobulbar Palsy

Objective： To observe the clinical efficacy of needling nape acupoints in the treatment of pseudobulbar palsy. Methods： One hundred and twenty cases of pseudobulbar palsy were randomized into two groups, a treatment group in which 60 cases were treated by needling nape acupoints and a control group in which 60 cases were treated by needling tongue acupoints; after one-month treatment, the clinical symptoms and signs were observed. Results： The cure rate and total effective rate were respectively 41.7% and 90.0% in the treatment group, and respectively 26.7% and 81.7% in the control group, with differences in the cure rate and total effective rate between the two groups （P〈0.01）. Conclusion： Needling nape acupoints is quite effective to treat pseudobulbar palsy in the relief of clinical symptoms and signs.

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.

Observations on the Efficacy of Combined Acupuncture and Medicine in Treating 50 Cases of Pseudobulbar Paralysis

Objective： To investigate the curative effect of combined acupuncture and medicine on pseudobulbar paralysis. Method：The patients were allocated into an acupuncture group of 50 cases and a control group of 48 cases by completely random sampling, The acupuncture group received western medicine combined with acupuncture and the control group received simple Western medicine. Results： The effective rate was 92,0% in the acupuncture group and 62.5% in the control group, There was a very significant difference in curative effect between the two groups（P〈 0.01）. Conclusion：The curative effect of combined acupuncture and medicine on pseudobulbar paralysis is significantly better than that of simple Western medicine.

Clinical Observations on the Treatment of Pseudobulbar Paralysis by Combined Scalp and Body Acupuncture

Objective： To investigate the efficacy of scalp acupuncture in combination with body acupuncture for treating pseudobulbar paralysis. Methods： Eighty patients were randomly divided into treatment and control groups, 40 cases each. The control group was treated by the routine method of Western medicine and the treatment group by combined scalp and body acupuncture on the basis of the former. The curative effect was evaluated after treatment in both groups. The influence of the treatment on mean blood velocity（MBV） in anterior, middle and posterior cerebral arteries was observed by transcranial Doppler（TCD） in both groups. Results： The total efficacy rate was 97.5% in the treatment group and 12.5% in the control group. The recovery rate was 75% in the treatment group and 0% in the control group. There was a significant difference between the two groups（P〈 0.01）. TCD showed that blood velocity in cerebral arteries was significantly increased and the unbalanced stasis of the right and left cerebral blood flow changed in the treatment group. A comparison of MBV between pretreatment and posttreatment showed P 〈 0.01. Conclusion： Scalp acupuncture in combination with body acupuncture has a good effect on pseudobulbar paralysis.

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.

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 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.

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.

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.

Influence of Acupuncture on Remodeling of Swallowing Functions for Patients with Pseudobulbar Palsy after Cerebral Infarction

Objective： To explore the interfering effect of acupuncture treatment in remodeling the swallowing functions for the patients with pseudobulbar palsy after cerebral infarction. Methods： Seventy-two cases with pseudobulbar palsy after cerebral infarction were randomly allocated into an observation group and a control group, 36 cases in each group. The treatment neurological therapies, once a day, with one day rest group was treated with acupuncture based upon routine after continuous treatment for six days, and therapeutic effects were assessed after six courses of the treatments. The control group was treated with routine neurological therapies, with the therapeutic effects observed after the treatment for 42 d. Results： The total effective rate was 80.6% in the observation group and 58.3% in the control group, with statistical significance in comparison of difference between the two groups （P〈0.05）, and with statistical significance in comparison of the score of deglutition disorder between the observation group and control group （P〈0.01）. Conclusion： Nape acupuncture can obviously improve the clinical symptoms and signs for the patients with pseudobulbar palsy, with affirmative therapeutic effects, and is worthy of popularization.

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.