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针刺对脑卒中后吞咽障碍患者长期结局的影响。

Effect of acupuncture on long-term outcomes in patients with post-stroke dysphagia.

机构信息

Department of Traditional Chinese Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China.

Department of Acupuncture and Moxibustion, Beijing Hospital of Traditional Chinese Medicine, Beijing, China.

出版信息

NeuroRehabilitation. 2022;51(3):433-441. doi: 10.3233/NRE-220113.

Abstract

BACKGROUND

Acupuncture has been used to treat patients with post-stroke neurological dysfunction.

OBJECTIVE

The purpose of our observational study was to observe the long-term efficacy of acupuncture and investigate whether the acupuncture treatment could short the recovery time of patients with post-stroke dysphagia.

METHODS

Medical records were reviewed to select patients who met the inclusion criteria for post-stroke dysphagia. Exposure factor was defined as received acupuncture during inpatient. Clinical data were obtained at the 6-month follow-up. The primary outcome was the time to improve the score of Food Intake Level Scale (FILS, 0-10) by 3 grades. Cox regression models were used to assess the relationship between acupuncture and recovery of dysphagia.

RESULTS

In acupuncture group, the median time to achieve clinical improvement of dysphagia was 97 days (95% CI, 93-124) compared with 119 days (95% CI, 108-145) in control group, with a statistically significant difference between the two groups (HR = 1.48; 95% CI 1.14-1.92; P = 0.003). At 6 months, 78 patients (60.5%) in acupuncture group reached excellent function and 61 patients (47.3%) in control group (RR = 1.28; 95% CI, 1.02-1.62; P = 0.045). 106 patients (82.2%) in acupuncture group achieved favorable function and 91 patients (70.5%) in control group (RR = 1.17; 95% CI, 1.02-1.35; P = 0.039). The outcome of adjusted multivariable Cox regression models showed that there was a difference in the recovery time of dysphagia between groups, HR = 1.79, 95% CI 1.34-2.39. The rates of adverse events were similar in both groups.

CONCLUSIONS

Acupuncture can promote the recovery of post-stroke dysphagia, and has a better long-term efficacy. Besides, it can reduce the degree of disability and improve the quality of life.

摘要

背景

针刺已被用于治疗脑卒中后神经功能障碍的患者。

目的

我们的观察性研究旨在观察针刺的长期疗效,并探讨针刺治疗是否能缩短脑卒中后吞咽困难患者的康复时间。

方法

回顾性病历选择符合脑卒中后吞咽困难纳入标准的患者。暴露因素定义为住院期间接受针刺治疗。在 6 个月的随访时获取临床数据。主要结局为通过食物摄入水平量表(Food Intake Level Scale,FILS)评分提高 3 级的时间。Cox 回归模型用于评估针刺与吞咽困难恢复之间的关系。

结果

在针刺组中,达到吞咽困难临床改善的中位数时间为 97 天(95%CI:93-124),而对照组为 119 天(95%CI:108-145),两组间有统计学差异(HR=1.48;95%CI:1.14-1.92;P=0.003)。在 6 个月时,针刺组 78 例(60.5%)患者达到了良好的功能,而对照组 61 例(47.3%)(RR=1.28;95%CI:1.02-1.62;P=0.045)。针刺组 106 例(82.2%)患者达到了良好的功能,而对照组 91 例(70.5%)(RR=1.17;95%CI:1.02-1.35;P=0.039)。多变量 Cox 回归模型的调整结果显示,两组之间的吞咽困难恢复时间存在差异,HR=1.79,95%CI 1.34-2.39。两组不良事件发生率相似。

结论

针刺可促进脑卒中后吞咽困难的恢复,且具有更好的长期疗效。此外,它还可以降低残疾程度,提高生活质量。

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