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近端与远端穴位针刺联合神经肌肉电刺激对脑瘫患儿流涎的影响

[Effect of acupuncture at proximal and distal acupoints combined with neuromuscular electrical stimulation on children with cerebral palsy salivation].

作者信息

Gao Shan, Gao Dan, Su Na, Zeng Chao, Zhou Quan, Lin Jun

机构信息

Department of TCM Rehabilitation, Guangdong Provincial Corps Hospital of Chinese People's Armed Police Forces, Guangzhou Medical University, Guangzhou 510507, China.

Department of Rehabilitation, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology.

出版信息

Zhongguo Zhen Jiu. 2018 Aug 12;38(8):825-30. doi: 10.13703/j.0255-2930.2018.08.008.

Abstract

OBJECTIVE

To explore the effect of acupuncture at the proximal and distal acupoints combined with neuromuscular electrical stimulation (NMES) for the children with cerebral palsy salivation on the basis of oral function training.

METHODS

A total of 124 children were randomized into an observation group and a control group, 62 cases in each one. Oral function training (30 min a time) and NMES (20 min a time) were used in the two groups. Acupuncture was applied after NMES in the observation group. The main acupoints were Baihui (GV 20), Sishencong (EX-HN 1), Speech AreaⅠ, Dicang (ST 4), Jiache (ST 6), Hegu (LI 4), Zusanli (ST 36), etc. Scalp acupuncture was for 1 h, and body acupuncture was for 30 min. Pricking blood was used at Jinjin (EX-HN 12) and Yuye (EX-HN 13) for the patients of Ⅴ in teacher salivation grading (TDS). All the treatment was given for 3 courses, 30 days as a course, 5 times a week, once a day. TDS, safety, dysphagia and Gesell development scale were assessed before and after treatment.

RESULTS

After treatment, the total effective rate of TDS in the observation group was 83.9% (52/62), which was better than 58.1% (36/62) in the control group (<0.05). The total effective rate of dysphasia in the observation group was 88.7% (55/62), which was better than 69.4% (43/62) in the control group (<0.05). The lip and tongue movement, chewing and swallowing after treatment in the observation group were superior to those in the control group (all <0.05). After treatment, the Gesell development scale of adaptability, language behavior and personal social development quotient were better compared with those before treatment in the observation group (all <0.05); the language behavior improved after treatment in the control group (<0.05). The adaptability, language behavior and personal social development quotient after treatment in the observation group were superior to those in the control group (<0.05,<0.01). The adverse reactions in the observation group were less than those in the control group.

CONCLUSION

Acupuncture at the proximal and distal acupoints combined with NMES are better than simple NMES for children with cerebral palsy salivation. The methods could not only improve children's behavior cognitive ability, but also improve the sensation and motor coordination of the lip, tongue, pharynx, etc. As a result, the salivation and swallowing function improve.

摘要

目的

探讨在口腔功能训练基础上,针刺远近端穴位联合神经肌肉电刺激(NMES)对脑瘫流涎患儿的影响。

方法

将124例患儿随机分为观察组和对照组,每组62例。两组均采用口腔功能训练(每次30分钟)和NMES(每次20分钟)。观察组在NMES后进行针刺。主要穴位有百会(GV 20)、四神聪(EX-HN 1)、言语一区、地仓(ST 4)、颊车(ST 6)、合谷(LI 4)、足三里(ST 36)等。头皮针治疗1小时,体针治疗30分钟。流涎程度分级为Ⅴ级(TDS)的患儿在金津(EX-HN 12)、玉液(EX-HN 13)点刺放血。所有治疗均进行3个疗程,30天为1个疗程,每周5次,每天1次。治疗前后评估TDS、安全性、吞咽困难及盖塞尔发育量表。

结果

治疗后,观察组TDS总有效率为83.9%(52/62),优于对照组的58.1%(36/62)(P<0.05)。观察组吞咽困难总有效率为88.7%(55/62),优于对照组的69.4%(43/62)(P<0.05)。观察组治疗后唇舌运动、咀嚼及吞咽功能均优于对照组(均P<0.05)。治疗后,观察组盖塞尔发育量表适应性、语言行为及个人社交发展商较治疗前均改善(均P<0.05);对照组治疗后语言行为改善(P<0.05)。观察组治疗后适应性、语言行为及个人社交发展商均优于对照组(P<0.05,P<0.01)。观察组不良反应少于对照组。

结论

针刺远近端穴位联合NMES治疗脑瘫流涎患儿效果优于单纯NMES。该方法不仅可提高患儿行为认知能力,还可改善唇、舌、咽等感觉及运动协调性,从而使流涎及吞咽功能得到改善。

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