Shao Xiangzhi, Chen Bing, Zhu Lielie, Zhu Lili, Zheng Jinyihui, Pu Xinyu, Chen Jiajun, Xia Jianning, Wu Xinming, Zhang Jiacheng, Wu Dengchong
Department of Rehabilitation, Wenzhou Hospital of Traditional Chinese Medicine, Wenzhou 325000, China.
Evid Based Complement Alternat Med. 2022 Dec 8;2022:2011597. doi: 10.1155/2022/2011597. eCollection 2022.
To evaluate the effect of adding Di-tan decoction (DTD) and/or electroacupuncture (EA) to standard swallowing rehabilitation training (SRT) on improving PSD.
In total, 80 PSD patients were enrolled and randomly assigned to the DTD, EA, DTD + EA or control group at a 1 : 1 : 1 : 1 ratio. All patients received basic treatment and standard SRT. The DTD group received DTD orally, the EA group received EA, the DTD + EA group received both DTD and EA simultaneously, and the control group received only basic treatment and standard SRT. The interventions lasted for 4 weeks. The outcome measurements included the Standardized Swallowing Assessment (SSA) and Swallowing-Quality of Life (SWAL-QOL), performed and scored from baseline to 2, 4, and 6 weeks after intervention, and the Videofluoroscopic Dysphagia Scale (VDS), scored at baseline and 4 weeks after intervention. Scores were compared over time by repeated-measures analysis of variance (ANOVA) among all groups. Interactions between interventions were explored using factorial design analysis.
(1) The effective rates (ERs) for PSD treatment were higher in the DTD, EA and DTD + EA groups than in the control group (all < 0.05). The ER was higher in the DTD + EA group than in the DTD or EA group (both < 0.05). (2) There were significant group effects, time effects and interactions for the SSA and SWAL-QOL scores (all < 0.05). All groups showed decreasing trends in SSA scores and increasing trends in SWAL-QOL scores over time from baseline to 6 weeks after intervention (all < 0.01). (3) Factorial design analysis for ΔVDS showed that there was a significant main effect for DTD intervention ( = 11.877, < 0.01) and for EA intervention ( = 29.357, < 0.01). However, there was no significant interaction effect between DTD and EA ( = 0.133, = 0.717). Multiple comparisons showed that the DTD, EA and DTD + EA groups all had higher ΔVDS values than the control group ( < 0.05). The DTD + EA group had a higher ΔVDS than the DTD or EA group (both < 0.05). (4) Most adverse reactions were mild and transient.
Adding DTD or EA to SRT can better improve PSD than applying SRT alone. Adding DTD and EA simultaneously can accelerate and amplify the recovery of swallowing function versus DTD or EA alone, and both are effective and safe treatments, alone or jointly, for PSD and are a powerful supplement to routine treatments.
评估在标准吞咽康复训练（SRT）基础上加用涤痰汤（DTD）和/或电针（EA）对改善帕金森病吞咽障碍（PSD）的效果。
共纳入80例PSD患者，按1∶1∶1∶1的比例随机分为DTD组、EA组、DTD+EA组和对照组。所有患者均接受基础治疗和标准SRT。DTD组口服DTD，EA组接受电针治疗，DTD+EA组同时接受DTD口服和电针治疗，对照组仅接受基础治疗和标准SRT。干预持续4周。结局指标包括标准化吞咽评估（SSA）和吞咽生活质量量表（SWAL-QOL），在干预前及干预后2、4、6周进行测评并评分，以及电视透视吞咽障碍量表（VDS），在干预前及干预后4周进行评分。通过重复测量方差分析（ANOVA）比较各组不同时间点的评分。采用析因设计分析探索干预措施之间的交互作用。
（1）DTD组、EA组和DTD+EA组PSD治疗的有效率高于对照组（均P<0.05）。DTD+EA组的有效率高于DTD组或EA组（均P<0.05）。（2）SSA和SWAL-QOL评分存在显著的组效应、时间效应及交互作用（均P<0.05）。从基线到干预后6周，所有组的SSA评分均呈下降趋势，SWAL-QOL评分均呈上升趋势（均P<0.01）。（3）ΔVDS的析因设计分析显示，DTD干预有显著主效应（F=11.877，P<0.01），EA干预也有显著主效应（F=29.357，P<0.01）。然而，DTD与EA之间无显著交互效应（F=0.133，P=0.717）。多重比较显示，DTD组、EA组和DTD+EA组的ΔVDS值均高于对照组（P<0.05）。DTD+EA组的ΔVDS高于DTD组或EA组（均P<0.05）。（4）多数不良反应轻微且短暂。
在SRT基础上加用DTD或EA比单纯应用SRT能更好地改善PSD。与单独使用DTD或EA相比，同时加用DTD和EA可加速并增强吞咽功能的恢复，二者单独或联合应用对PSD均有效且安全，是常规治疗的有力补充。
