Clinical Efficacy Study on the Treatment of Post-Stroke Dysphagia Using Acupuncture Combined with Swallowing Therapy Based on the “Central-Peripheral-Central” Closed-Loop Rehabilitation Theory
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摘要:
目的 观察“中枢-外周-中枢”闭环康复理论指导下运用头针联合吞咽治疗仪治疗脑卒中后吞咽困难的临床疗效。 方法 60例脑卒中后遗留吞咽困难的患者被随机分为治疗组（n = 30）和对照组（n = 30）。治疗组与对照组均给予脑血管二级预防和吞咽功能康复训练，此外，对照组接受吞咽治疗仪治疗，治疗组接受头针联合吞咽治疗仪治疗。每次治疗持续20 min，1次/d，5次/周，共3周。分别在治疗前后对患者进行标准吞咽评定量表（SSA）、吞咽生活质量量表（SWAL-QOL）评估统计2组拔除胃管例数。 结果 治疗后，2组患者SAA分值较治疗前均下降（P < 0.01），SWAL-QOL分值较治疗前升高（P < 0.01）；经过治疗，治疗组的SSA分值小于对照组（P < 0.05），SWAL-QOL分值大于对照组（P < 0.01），治疗组拔除胃管例数多于对照组，比较具有统计学意义（P < 0.05）。 结论 在“中枢-外周-中枢”闭环康复理论指导下，头针联合吞咽治疗仪可改善脑卒中患者吞咽功能和生活质量。 -
关键词:
- 脑卒中 /
- 吞咽困难 /
- 头针 /
- 吞咽治疗仪 /
- “中枢-外周-中枢”闭环康复理论
Abstract:Objective To observe the clinical efficacy of using acupuncture combined with swallowing therapy device guided by the “central-peripheral-central” closed-loop rehabilitation theory in the treatment of post-stroke dysphagia. Methods 60 patients with post-stroke dysphagia were randomly divided into treatment group （n = 30） and control group （n = 30）. Both groups received secondary prevention of cerebrovascular disease and swallowing rehabilitation training. In addition, the control group received treatment with a swallowing therapy device, while the treatment group received treatment with acupuncture combined with the swallowing therapy device. Each treatment session lasted for 20 minutes, once a day, 5 times per week, for a total of 3 weeks. The patients were evaluated using the Standard Swallowing Assessment （SSA） and the Swallowing Quality of Life Questionnaire （SWAL-QOL） before and after the treatment. the cases in both groups whose gastric tubes were removed were calculated. Results After treatment, SAA score in 2 groups significantly decreased （P < 0.01）, and SWAL-QOL scores significantly increased （P < 0.05）. After treatment, the SSA score of the treatment group was significantly lower than that of the control group （P < 0.05）, and the SWAL-QOL score was significantly higher than that of the control group （P < 0.01）. There were more patients whose gastric tubes were removed in treatment group than that of control group （P < 0.05）. Conclusion Under the guidance of “central-peripheral-central” closed-loop rehabilitation theory, head acupuncture combined with swallowing apparatus can improve the swallowing function and quality of life of stroke patients. -
表 1 患者基本资料对比（
$\bar x \pm s $ ）Table 1. Comparison of patients’ basic data （
$\bar x \pm s $ ）组别 n 性别（n） 年龄（岁） 病程（d） 病变性质（n） 延髓麻痹分类（n） 男 女 脑梗死 脑出血 真性 假性 治疗组 30 18 12 65.70 ± 13.99 33.86 ± 27.13 18 12 1 29 对照组 30 19 11 63.43 ± 12.68 41.43 ± 36.45 20 10 4 26 t/χ2 0.071 0.657 −0.912 0.287 1.964 p 0.791 0.514 0.366 0.592 0.161 
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表 2 治疗前后SSA评分对比（
$\bar x \pm s $ ）Table 2. Comparison of SSA scores before and after treatment （
$\bar x \pm s $ ）组别 n 治疗前 治疗后 t P 治疗组 30 35.13 ± 6.42 23.63 ± 5.03 7.875 0.000* 对照组 30 34.10 ± 5.65 26.46 ± 5.75 7.638 0.000* t 0.661 −2.029 P 0.511 0.047* *P < 0.05。
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表 3 治疗前后SWAL-QOL评分对比（
$\bar x \pm s $ ）Table 3. Comparison of SWAL-QOL scores before and after treatment （
$\bar x \pm s $ ）组别 n 治疗前 治疗后 t P 治疗组 30 98.46 ± 25.43 155.36 ± 23.64 −13.464 0.000* 对照组 30 106.50 ± 29.01 124.76 ± 34.09 −7.688 0.000* t −1.140 4.039 P 0.259 0.000* *P < 0.01。
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表 4 治疗前后留置胃管的情况比较（n）
Table 4. Comparison of indwelling gastric tube before and after treatment （n）
组别 n 治疗前留置胃管 治疗后留置胃管 有 无 有 无 治疗组 30 18 12 4 26 对照组 30 15 15 12 18 χ2 0.606 5.455 P 0.436 0.020* *P < 0.05。
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[1] Lakshminarayan K,Tsai A W,Tong X,et al. Utility of dysphagia screening results in predicting poststroke pneumonia[J]. Stroke,2010,41(12):2849-2854. doi: 10.1161/STROKEAHA.110.597039 [2] Gandolfo C,Sukkar S,Ceravolo M G,et al. The predictive dysphagia score (PreDyScore) in the short- and medium-term post-stroke: a putative tool in PEG indication.[J]. Neurol Sci,2019,40(8):1619-1626. doi: 10.1007/s10072-019-03896-2 [3] Souza J T,Ribeiro P W,de Paiva S A R,et al. Dysphagia and tube feeding after stroke are associated with poorer functional and mortality outcomes[J]. Clin Nutr,2020,39(9):2786-2792. doi: 10.1016/j.clnu.2019.11.042 [4] Abubakar S A,Jamoh B Y. Dysphagia following acute stroke and its effect on short-term outcome[J]. Niger Postgrad Med J,2017,24(3):182-186. doi: 10.4103/npmj.npmj_96_17 [5] Jones C A,Colletti C M,Ding M C. Post-stroke Dysphagia: Recent Insights and Unanswered Questions[J]. Curr Neurol Neurosci Rep,2020,20(12):61. doi: 10.1007/s11910-020-01081-z [6] 贾杰. “中枢-外周-中枢”闭环康复——脑卒中后手功能康复新理念[J]. 中国康复医学杂志,2016,31(11):1180-1182. [7] 李冲,涂舒婷,林嘉滢等. 基于闭环理论的脑卒中后上肢感觉障碍康复研究进展[J]. 中国脑卒中杂志,2022,17(10):1058-1064. [8] 姚路路,杜鑫,付渊博,张帆,张涛,黄凤,李彬,刘桂林. 针灸调控神经可塑性作用机制初探[J]. 针灸临床杂志,2022,38(10):1-5. [9] 金海鹏,李相良,叶清景等. 双侧头针电刺激对皮质型脑卒中后吞咽困难患者吞咽造影时间学参数和皮质兴奋性的影响[J]. 针刺研究,2020,45(6):473-479. [10] 桂美琳,肖洪波,陈瑞全等. 腕踝针结合Vocastim-Master吞咽治疗仪治疗缺血性脑卒中后吞咽困难临床研究[J]. 湖北中医杂志,2021,43(4):34-37. [11] Powers W J,Rabinstein A A,Ackerson T,et al. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association[J]. Stroke,2019,50(12):e344-e418. [12] Greenberg S M,Ziai W C,Cordonnier C,et al. 2022 Guideline for the Management of Patients With Spontaneous Intracerebral Hemorrhage: A Guideline From the American Heart Association/American Stroke Associationa[J]. Stroke,2022,53(7):e282-e361. [13] Dziewas R,Michou E,Trapl-Grundschober M,et al. European Stroke Organisation and European Society for Swallowing Disorders guideline for the diagnosis and treatment of post-stroke dysphagia[J]. Eur Stroke J,2021,6(3):LXXXIX-CXV. doi: 10.1177/23969873211039721 [14] 廖喜琳,钟美容,蔡超群. 标准吞咽功能评估及预见性护理对老年脑卒中吞咽困难患者康复的影响[J]. 中国老年学杂志,2015,35(8):2036-2038. [15] McHorney C A,Robbins J,Lomax K,et al. The SWAL-QOLand SWAL -CARE outcomes tool for oropharyngeal dysphagia in adults. III. Documentation of reliability and validity[J]. Dysphagia,2002,17(2):97. doi: 10.1007/s00455-001-0109-1 [16] 何思锦,陈奇刚,罗凯旋,和智娟,陈小霞,司林阁,顾力华. 基于“中枢-外周-中枢”闭环理论治疗听神经瘤术后吞咽困难1例[J]. 四川医学,2021,42(7):754-756. [17] 时烨. 电针头穴刺激对健康人大脑各功能区变化的fMRI 研究[D]. 南京: 南京中医药大学, 2016. [18] 余祉欣. 中日头皮针理论在大脑皮层定位与周围神经的配对研究[D]. 广州中医药大学, 2017. [19] 袁英,汪洁,黄小波,吴东宇. 吞咽功能的中枢及周围神经调控机制[J]. 中国康复医学杂志,2018,33(12):1479-1482. [20] 达婷,张茜娟,于慧金,杨小霞,牛见升,何涛,陈丹,赵腾蛟,孙军弟,张艳. 经颅直流电刺激治疗脑卒中后吞咽困难的研究进展[J]. 兰州大学学报(医学版),2022,48(3):77-82. [21] 闫莹莹,郭钢花,郭君,李哲,梁英姿. 不同频率高频重复经颅磁刺激治疗单侧脑卒中患者吞咽困难的疗效观察[J]. 中国康复,2022,37(8):486-488. [22] 凌水桥,王静. 头针联合吞咽训练治疗脑卒中后吞咽困难的临床疗效及对患者脑皮层血流量和吞咽功能的影响[J]. 河北中医,2019,41(3):448-451+455. [23] 储瑾,唐军,姚红霞,王燕平. 中风复元方联合针灸治疗脑卒中吞咽障碍的临床观察[J]. 湖北中医药大学学报,2016,18(5):85-87. [24] 王鹏,王学新,王亚楠等. 吞咽治疗仪在脑卒中吞咽困难治疗中的研究进展[J]. 中国康复,2019,34(8):441-444. [25] Cosentino G,Todisco M,Giudice C,Tassorelli C,Alfonsi E. Assessment and treatment of neurogenic dysphagia in stroke and Parkinson's disease[J]. Curr Opin Neurol,2022,35(6):741-752. doi: 10.1097/WCO.0000000000001117 [26] Wang P,Ma X,Huang J,et al. Effect of acupuncture treatment on dysphagia caused by pseudobulbar paralysis after stroke: a systematic review and meta-analysis[J]. Ann Palliat Med,2022,11(7):2257-2264. doi: 10.21037/apm-21-3551 -
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