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[吞咽障碍电刺激联合吞咽康复训练治疗脑卒中患者的临床试验]

[Clinical Trials for Treatment of Stroke Patients with Dysphagia by Vitalstim Electroacupuncture Combined with Swallowing Rehabilitation Training].

作者信息

Zhang Sheng-Yu, Liu Shao-Bing, Wu Wei, Chen Yi-Min, Liao Kang-Lin, Xiang Yong, Pan Dun

机构信息

Department of Rehabilitation, Minda Hospital of Hubei University for Nationalities, Hubei Province, Enshi 445000, China.

The Second Affiliated Hospital of Nanchang University, Nanchang 330006.

出版信息

Zhen Ci Yan Jiu. 2017 Apr 25;42(2):168-72.

Abstract

OBJECTIVE

To observe the clinical effect of vitalstim electroacupuncture (EA) combined with swallowing rehabilitation training in the treatment of stroke patients with dysphagia.

METHODS

A total of 80 stroke patients with dysphagia were randomized into treatment and control groups (=40 in each group). Patients of the control group were treated by regular medication for anti-platelet aggregation and anti-coagulation, lipid-lowering, neuroprotection, blood glucose control and blood pressure control, etc. and swallowing function rehabilitation training, and those of the treatment group treated by EA stimulation of Fengchi (GB 20), Jinjin (EX-HN 12) and Yuye (EX-HN 13) with a Vitalstim Electrostimulator and manual acupuncture stimulation of Lianquan (CV 23), Tiantu (CV 22) in combination with regular medication plus swallowing function training as those mentioned in the control group. The EA and manual acupuncture stimulation treatment was conducted once daily, 6 times a week and 4 weeks altogether. The therapeutic effect was assessed by using Kubota swallowing ability test (6 levels), dysphagia subscale (0-6 scores) of the neurological deficit degrees, videofluorography (VFG) assessment (markedly effective, effective and invalid, for evaluating the function and symmetry state of the swallowing movements), and the MOS Item Short Form Health Survey (SF-36, 8 minor items of two major aspects in physiological function, mental health, emotional function, social function and overall health) for assessing the patients' daily-life quality.

RESULTS

After the treatment, the dysphagia score of the treatment group was signi-ficantly lower than that of the control group (<0.05). VFG outcomes showed that, of the two 40 patients in the control and treatment groups, 16 and 23 experienced a marked improvement, 20 and 15 were effective, 4 and 2 were ineffective, with the markedly effective rate being 40.0% and 57.5%, respectively. The daily-life quality scores for physiological function, mental health, emotional function, social function and overall health were all notably increased after the treatment in both groups, particularly in the treatment group (<0.05). The therapeutic effects of the treatment group were remarkably superior to those of the control group in improving dysphagia (showed by dysphagia score and VFG outcomes) and life quality.

CONCLUSIONS

EA treatment combined with swallowing function rehabilitation training is effective in improving swallowing ability and daily-life quality in stroke patients with dysphagia.

摘要

目的

观察吞咽障碍治疗仪电针(EA)结合吞咽康复训练治疗脑卒中吞咽障碍患者的临床疗效。

方法

将80例脑卒中吞咽障碍患者随机分为治疗组和对照组,每组40例。对照组患者采用常规药物进行抗血小板聚集、抗凝、降脂、神经保护、控制血糖和血压等治疗,并进行吞咽功能康复训练;治疗组患者采用吞咽障碍治疗仪电刺激风池(GB 20)、金津(EX-HN 12)、玉液(EX-HN 13),手动针刺廉泉(CV 23)、天突(CV 22),结合常规药物治疗及与对照组相同的吞咽功能训练。电针及手动针刺治疗每日1次,每周6次,共4周。采用洼田吞咽能力评定(6级)、神经功能缺损程度吞咽障碍亚量表(0~6分)、电视透视吞咽功能检查(VFG)评估(显效、有效、无效,用于评估吞咽运动的功能及对称状态)及医学结局研究简明健康调查量表(SF-36,生理功能、心理健康、情感职能、社会功能及总体健康2个主要方面的8个小项)评估患者日常生活质量。

结果

治疗后,治疗组吞咽障碍评分明显低于对照组(P<0.05)。VFG结果显示,对照组和治疗组的40例患者中,显效分别为16例和23例,有效分别为20例和15例,无效分别为4例和2例,显效率分别为40.0%和57.5%。两组治疗后生理功能、心理健康、情感职能、社会功能及总体健康的日常生活质量评分均明显提高,治疗组尤其明显(P<0.05)。治疗组在改善吞咽障碍(吞咽障碍评分及VFG结果显示)及生活质量方面的疗效明显优于对照组。

结论

电针治疗结合吞咽功能康复训练可有效提高脑卒中吞咽障碍患者的吞咽能力及日常生活质量。

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