摘要
目的通过超声测量吞咽障碍患者舌骨-甲状软骨的运动相关参数,定量评估脑梗死后吞咽困难患者的针刺疗效。方法将脑梗死后吞咽障碍患者60例随机分为经穴组(n=30)和非经非穴组(n=30),经穴组为经穴针刺法联合吞咽障碍的常规治疗,经穴组取穴方案:舌三针、风池、翳风、完骨、金津、玉液、双侧咽后壁,采用得气加电针的真针刺干预模式;非经非穴组在常规治疗的基础上,加用非穴位、不得气、针刺加电的假针刺模式。两组患者均治疗1次/d,每周治疗5次,共治疗4周。所有患者采用吞咽造影(VFSS)进行吞咽障碍诊断,结合标准吞咽功能评估量表(SSA)、VFSS进行临床评估,并利用超声测量两组患者治疗前、治疗4周舌骨-甲状软骨的运动相关参数。结果两组患者组内SSA评分比较,治疗4周后评分均低于治疗前,差异均有统计学意义(P<0.05);且治疗4周后,经穴组SSA评分低于非经非穴组,差异有统计学意义(P<0.05)。两组患者治疗前后组内VFSS评分比较,治疗4周后评分均高于治疗前,差异均有统计学意义(P<0.05);治疗4周后,两组患者组间VFSS评分比较:经穴组评分均大于非经非穴组,且差异有统计学意义(P<0.05)。两组患者治疗前后比较,最短距离、运动时间变小,最大距离、缩短距离、缩短率、运动速度增大,差异均有统计学意义(P<0.05);两组患者治疗4周后进行组间比较,缩短距离、缩短率、运动时间、运动速度比较差异有统计学意义(P<0.05);最大距离、最短距离比较差异无统计学意义(P>0.05)。超声检查的吞咽相关运动参数与临床评估指标SSA、VFSS、PAS做Pearson相关分析:治疗4周后,舌骨-甲状软骨的缩短距离、缩短率、运动速度与VFSS呈正的直线相关(P<0.05),而与SSA、PAS呈负的直线相关(P<0.05)。结论针刺可能通过改善舌骨-甲状软骨的运动功能,从而改善吞咽功能,为针刺疗效提供一定的临床证据。
Objective To quantitatively evaluate the clinical efficacy of acupuncture treatment of dysphagia after cerebral infarction by measuring the motion-related parameters of the hyoid and thyroid cartilage in patients with dysphagia by ultrasound.Methods Sixty-three patients with post-stroke dysphagia were randomly divided into an acupuncture group and a non-acupuncture control group.The acupuncture group received acupuncture treatment at specific acupoints in addition to conventional dysphagia therapy.The acupoint selection for the acupuncture group included Tongue Three Needles,Fengchi,Yifeng,Wangu,Jinjin,Yuye,and bilateral posterior pharyngeal wall.Real acupuncture with electric stimulation was applied in the acupuncture group.The non-acupuncture control group received sham acupuncture with non-acupoints,no stimulation,and no electric stimulation,in addition to conventional therapy.Both groups received one treatment session per day,five times a week,for a total of four weeks.All patients underwent swallowing imaging for dysphagia diagnosis and clinical assessment using the Swallowing Severity Assessment(SSA)and Videofluoroscopic Swallowing Study(VFSS).The motion-related parameters of the hyoid bone-thyroid cartilage were measured using ultrasound before and after the four-week treatment in both groups.Results The SSA scores decreased significantly in both groups after four weeks of treatment compared to before treatment(P<0.05).Moreover,the acupuncture group had lower SSA scores than the non-acupuncture control group after four weeks of treatment(P<0.05).The VFSS scores increased significantly in both groups after treatment compared to before treatment(P<0.05).After four weeks of treatment,the acupuncture group had higher VFSS scores than the non-acupuncture control group(P<0.05).Comparison of ultrasound measurements:After treatment,the shortest distance and motion time decreased gradually,while the shortened distance,shortened rate,and motion speed increased gradually in both groups,and the differences were statistically significant(P<0.05).After four weeks of treatment,the acupuncture group showed significant improvements compared to the non-acupuncture control group in terms of shortened distance,shortened rate,motion time,and motion speed(P<0.05).There were no statistically significant differences in the maximum distance and shortest distance comparison(P>0.05).Pearson correlation analysis of swallowing related motion parameters and clinical evaluation indicators SSA,VFSS,and PAS in ultrasound examination:After 4 weeks of treatment,the shortening distance,shortening rate,and movement speed of the hyoid thyroid cartilage showed a positive linear correlation with VFSS(P<0.05),while a negative linear correlation with SSA and PAS(P<0.05).Conclusion Acupuncture may improve the motion function of the hyoid bone-thyroid cartilage and thereby improve swallowing function,providing certain clinical evidence for the efficacy of acupuncture treatment.
作者
李眺
金小千
张白雪
董媛
邓玲
蔺丽娟
冼婷婷
曾小香
LI Tiao;JIN Xiao-qian;ZHANG Bai-xue;DONG Yuan;DENG Ling;LIN Li-juan;XIAN Ting-ting;ZENG Xiao-xiang(Department of Rehabilitation Medicine,Zhuhai People's Hospital,Zhuhai 519000,Guangdong Province,China;不详)
出处
《广东医学》
CAS
2023年第6期766-772,共7页
Guangdong Medical Journal
基金
广东省中医药局科研项目(20201327)。
关键词
超声检查
针刺
脑梗死
吞咽障碍
舌骨、甲状软骨
ultrasound examination
acupuncture
cerebral infarction
dysphagia
hyoid bone,thyroid cartilage
