中华中医药学刊

目的:探讨颈项针联合电刺激对脑卒中患者吞咽障碍临床效果和脑血流的影响。方法:选择2017年1月—2017年7月医院进行治疗的脑卒中后吞咽障碍患者共150例,按照随机数字的方法分为两组,对照组和实验组,每组75例患者,所有患者给予常规对症治疗,对照组患者在基础药物及康复训练治疗的基础上给予传统针刺治疗,实验组患者在基础药物及康复训练治疗的基础上给予颈项针电刺激法治疗,对治疗的效果进行分析。结果:经过治疗后,对照组患者的洼田氏饮水试验结果评级,标准吞咽功能评价量表评分分别从(3.28±0.92)级,(31.57±5.41)分降低到(2.31±0.57)级,(24.21±4.25)分,藤岛一郎疗效评分从(4.37±1.02)分升高到(6.01±1.07)分。实验组患者的洼田氏饮水试验结果评级,标准吞咽功能评价量表评分分别从(3.27±0.87)级,(32.07±4.98)分降低到(1.08±0.41)级,(15.07±3.71)分,藤岛一郎疗效评分从(4.42±1.13)分升高到(8.31±1.68)分。经过治疗后,对照组患者的左椎动脉,右椎动脉,基底动脉的平均血流速度,收缩期血流速度分别从(18.43±3.86)cm/s,(28.41±3.71)cm/s,(18.61±2.81)cm/s,(27.41±3.82)cm/s,(18.49±2.88)cm/s,(29.01±2.91)cm/s升高到(22.07±2.00)cm/s,(32.54±5.55)cm/s,(22.54±2.07)cm/s,(31.89±3.55)cm/s,(23.01±2.25)cm/s,(32.14±2.71)cm/s,搏动指数分别从(1.31±0.27),(1.28±0.28),(1.49±0.51)降低到(1.17±0.21),(1.16±0.22),(1.12±0.25)。实验组患者的左椎动脉,右椎动脉,基底动脉的平均血流速度,收缩期血流速度分别从(18.51±4.01)cm/s,(29.01±3.47)cm/s,(18.34±2.99)cm/s,(28.09±3.87)cm/s,(17.61±3.07)cm/s,(29.81±2.76)cm/s升高到(28.43±3.66)cm/s,(38.91±3.68)cm/s,(28.91±3.04)cm/s,(37.89±3.77)cm/s,(28.43±2.91)cm/s,(38.49±2.68)cm/s,搏动指数分别从(1.32±0.28),(1.32±0.29),(1.44±0.26)降低到(0.94±0.19),(0.95±0.21),(0.89±0.21)。实验组患者在各个项目的改善幅度均大于对照组患者,数据差异均具有统计学意义(t=15.171,-10.000,14.031,-13.206,-8.284,7.033,-15.000,-10.034,5.980,-12.761,-14.429,6.101,P<0.05)。实验组的治疗效果优于对照组,治疗总有效率高于对照组,数据差异具有统计学意义(z=-5.654,χ²=5.769,P<0.05)。在治疗过程中,两组患者的各项不良反应发生率的数据差异均不具有统计学意义(χ²=1.027,0.362,0.315,0.432,P>0.05)。结论:利用颈项针联合电刺激治疗脑卒中后吞咽障碍的患者,可以明显改善患者的吞咽困难与脑部血流情况,提升治疗效果,值得在临床工作中推广。

Objective:To investigate the effect of cervical needle combined with electrical stimulation on the clinical effect and cerebral blood flow of dysphagia in patients with stroke.Methods:A total of 150 patients with dysphagia after stroke in our hospital from January 2017 to July 2017 were selected. According to the random number method, the patients were divided into the control group and the experimental group, with 75 patients in each group. All patients were given routine symptomatic treatment. The patients in the control group were treated with traditional acupuncture on the basis of basic drugs and rehabilitation training. The patients in the experimental group were treated with neck acupuncture stimulation on the basis of basic drugs and rehabilitation training, and the effect of the treatment was analyzed. Results:After treatment, the score of the drinking water test in the control group and the standard swallowing function rating scale were from 3.28±0.92 and 31.57±5.41 to 2.31±0.57 and 24.21±4.25. Toshima Ichiro's curative effect score increased from 4.37±1.02 to 6.01 ±1.07. In the experimental group, the rating of the results of the drinking water test and the standard swallowing function rating scale were from 3.27±0.87 and 32.07±4.98 to 1.08 ±0.41 and 15.07±3.71. Toshima Ichiro's curative effect score increased from 4.42±1.13 to 8.31±1.68. After treatment, the mean blood flow velocity of the left vertebral artery, right vertebral artery and basilar artery in the control group was from(18.43±3.86)cm/s,(28.41±3.71)cm/s,(18.61±2.81)cm/s,(27.41±3.82)cm/s,(18.49±2.88)cm/s and(29.01±2.91)cm/s increased to(22.07±2.00)cm/s,(32.54±5.55)cm/s,(22.54±2.07)cm/s,(31.89±3.55)cm/s,(23.01±2.25)cm/s and(32.14±2.71)cm/s. The pulsatility index decreased from 1.31±0.27, 1.28±0.28 and 1.49±0.51 to 1.17±0.21, 1.16±0.22 and 1.12±0.25. The mean blood flow velocity of the left vertebral artery, right vertebral artery and basilar artery in the experimental group and the velocity of systolic blood flow were from(18.51±4.01)cm/s,(29.01±3.47)cm/s,(18.34±2.99)cm/s,(28.09±3.87)cm/s,(17.61±3.07)cm/s and(29.81±2.76)cm/s increased to(28.43±3.66) cm/s,(38.91±3.68)cm/s,(28.91±3.04)cm/s,(37.89±3.77)cm/s,(28.43±2.91)cm/s and(38.49±38.49)cm/s. The pulsatility index decreased from 1.32±0.28, 1.32±0.29 and 1.44±0.26 to 0.94 ± 0.19, 0.95±0.21 and 0.89 ±0.21. The improvement of the patients in the experimental group was greater than that of the control group, and the difference of the data was statistically significant(t=15.171,-10.000, 14.031,-13.206,-8.284, 7.033,-15.000,-10.034, 5.980,-12.761,-14.429, 6.101, P<0.05). The therapeutic effect of the experimental group was better than that of the control group, and the total effective rate of the treatment group was higher than that of the control group, and the difference was statistically significant(z=-5.654, χ²=5.769, P<0.05). In the course of treatment, the difference of the incidence of adverse reactions between the two groups was not statistically significant(χ²=1.027, 0.362, 0.315, 0.432, P>0.05). Conclusion:The patients with dysphagia after stroke can obviously improve the dysphagia and brain blood flow in patients with cerebral apoplexy, and improve the therapeutic effect. It is worthy of promoting in clinic.