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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