针刺联合卒中单元康复治疗老年卒中后吞咽障碍临床观察

针刺联合卒中单元康复治疗老年卒中后吞咽障碍临床观察
常 娥 孙 婧 江玉娟 王炯妹
沧州市中心医院，河北 沧州 061000
通信作者：常娥
【摘要】 目的 探讨针刺联合卒中单元康复治疗对卒中后吞咽障碍患者吞咽造影及表面肌电检查结果的影响。方法 纳入 2019-02—2020-12 在沧州市中心医院就诊的卒中后吞咽障碍患者 106 例进行前瞻性研究。采用双色球法将患者分为 2 组，每组 53 例。对照组行常规卒中单元康复治疗，观察组在此基础上加以针刺治疗。比较 2 组患者临床疗效、吞咽造影、表面肌电检查结果、生活质量、误吸性肺炎发生情况及不良反应发生情况。结果 观察组患者总有效率为 90.57%，高于对照组的 75.47%（P<0.05）。治疗后观察组进食清流质［（39.51±9.88）% vs （30.16±8.72）%］、浓流质［（42.05±9.38）% vs （34.86±8.33）% 及糊状物［（42.18±12.08）% vs （36.35±11.37）%］，咽腔收缩率均低于对照组（P<0.05）。治疗后观察组最大波幅大于对照组［（528.17±102.74）μV vs （715.88±149.56）μV］，治疗后观察组吞咽时程低于对照组［（1.38±0.36）s vs （1.02±0.27）s］，观察组生活质量得分高于对照组［（68.25±13.82）分 vs（74.88±16.91） 分，P<0.05］。观察组未出现误吸性肺炎，对照组出现 4 例（7.55%），差异有统计学意义（P<0.05）。对照组未出现明显的不良反应，观察组出现 1 例（1.89%）晕针，2 组比较差异无统计学意义（P>0.05）。结论 针刺联合卒中单元康复可提高卒中后吞咽障碍临床疗效，改善吞咽造影、表面肌电检查结果，提高生活质量，降低误吸性肺炎发生率且具有较高的安全性。
【关键词】 脑卒中；针刺；卒中单元康复治疗；卒中后吞咽障碍；吞咽造影；表面肌电
【中图分类号】 R743 【文献标识码】 A 【文章编号】 1673-5110 （2022） 08-0964-05

Clinical observation of acupuncture combined with stroke unit rehabilitation in the treatment of patients with dysphagia after stroke
CHANG E，SUN Jing，JIANG Yujuan，WANG Jiongmei
Cangzhou Central Hospital，Cangzhou 061000，China
Corresponding author：CHANG E
【Abstract】 Objective To explore the effect of acupuncture combined with stroke unit rehabilitation on the results of swallowing angiography and surface electromyography in patients with dysphagia after stroke. Methods A prospective study was conducted on 106 patients with post-stroke dysphagia who were treated in Cangzhou Central Hospital from February 2019 to December 2020. The patients were divided into two groups by the two-color ball method，with 53 cases in each group. The control group received conventional stroke unit rehabilitation treatment，and the observation group received acupuncture treatment on this basis. The clinical efficacy，swallowing contrast，surface lectromyography，quality of life，occurrence of aspiration pneumonia，and adverse reactions were compared between the two groups. Results The total effective rate of patients in the observation group was 90.57%，which was higher than 75.47% in the control group（P<0.05）.After treatment，the observation group ate clear liquid（（39.51±9.88）% vs （30.16±8.72）%），thick liquid（（42.05±9.38）% vs （34.86± 8.33）%）and paste（（42.18±12.08）% vs （36.35±11.37）%），and the pharyngeal cavity contraction rate were all lower than the control group（P<0.05）. After treatment，the maximum amplitude of the observation group was greater than that of the control group（（528.17±102.74）μV vs 715.88±149.56）μV），the swallowing time course of the observation group after treatment was lower than that of the control group（（1.38±0.36）s vs 1.02±0.27）s）， and the quality of life score of the observation group was higher than that of the control group（（68.25±13.82） points vs （74.88±16.91）points，P<0.05）. There was no aspiration pneumonia in the observation group，4 cases （7.55%）in the control group，the difference was statistically significant（P<0.05）. There was no obvious adverse reaction in the control group，and 1 case（1.89%）in the observation group had fainting. There was no statistically significant difference between the two groups（P>0.05）. Conclusion Acupuncture ombined with stroke unit rehabilitation can improve the clinical efficacy of post-stroke dysphagia，improve the results of swallowing radiography and surface electromyography，improve the quality of life，reduce the incidence of aspiration pneumonia，and has high safety.
【Key words】 Stroke；Acupuncture；Stroke unit rehabilitation treatment；Dysphagia after stroke；Angiography of swallowing；Surface electromyography