Abstract:

Objective　To explore the influence of modified Huiyan Zhuyu decoction on the swallowing function and cerebral blood flow of patients with post-stroke dysphagia. Methods　A total of 160 patients with post-stroke dysphagia who were admitted to Weihai Central Hospital from January 2020 to December 2023 were selected as the research subjects. According to the treatment methods, the patients were divided into the control group and the observation group, with 80 cases in each group. There were 41 males and 39 females in the control group, aged (51.69±3.31) years, course of the disease (6.33±0.19) days, classification of dysphagia: 53 cases at grades Ⅰ and Ⅱ, 27 cases at grades Ⅲ and Ⅳ. There were 37 males and 43 females in the observation group, aged (50.83±3.10) years, course of the disease (6.50±0.21) days, classification of dysphagia: 51 cases at grades Ⅰ and Ⅱ, 29 cases at grades Ⅲ and Ⅳ. The control group received conventional treatment and swallowing training. The observation group, in addition to the treatment of the control group, was treated with neuromuscular electrical stimulation combined with the modified Huiyan Zhuyu decoction. Both groups received continuous treatment for 6 weeks. The clinical efficacy, the occurrence of complications, and the swallowing disorders (functional swallowing disorder staging assessment form), swallowing-eating function (standard swallowing function evaluation scale), swallowing imaging, cerebral blood flow status (average blood flow velocity of bilateral vertebral arteries and basilar arteries, systolic blood flow velocity and pulsatility index) were compared between the two groups before and after treatment. Independent sample t test, paired t test, and χ² test were used for statistical analysis. Results　The total effective rate of treatment in the observation group was higher than that in the control group [91.25% (73/80) vs. 65.00% (52/80)] (P<0.05). After treatment, the scores of the functional swallowing disorder staging assessment form and the standard swallowing function evaluation scale in the observation group were lower than those in the control group [(20.30±7.93) points vs. (34.56±8.89) points, (20.13±4.33) points vs. (26.53±5.80) points], and the swallowing imaging score was higher than that of the control group [(9.46±1.25) points vs. (8.65±1.98) points] (all P<0.05); the average blood flow velocity and systolic blood flow velocity of the bilateral vertebral arteries and basilar arteries in the observation group were higher than those in the control group, and the pulsatility index were lower than that of the control group (all P<0.05). The total incidence of complications in the observation group was lower than that in the control group [6.25% (5/80) vs. 21.25% (17/80)] (P<0.05). Conclusion　The neuromuscular electrical stimulation combined with the modified Huiyan Zhuyu decoction has a better therapeutic effect on patients with post-stroke dysphagia. It can improve the swallowing function, the cerebral blood flow status, and reduce complications.

Key words: Post-stroke dysphagia,  , Neuromuscular electrical stimulation,  , Huiyan Zhuyu , decoction,  , Swallowing function,  , Clinical value

摘要：

目的　探讨会厌逐瘀汤加减对脑卒中后吞咽障碍患者吞咽功能和脑部血流的影响。方法　选取2020年1月至2023年12月威海市中心医院收治的160例脑卒中后吞咽障碍患者作为研究对象。根据治疗方式，将患者分为对照组和观察组，每组80例。对照组男41例，女39例；年龄（51.69±3.31）岁，病程（6.33±0.19）d，吞咽障碍分级：Ⅰ～Ⅱ级53例，Ⅲ～Ⅳ级27例。观察组男37例，女43例；年龄（50.83±3.10）岁；病程（6.50±0.21）d；吞咽障碍分级：Ⅰ～Ⅱ级51例，Ⅲ～Ⅳ级29例。对照组采用常规治疗和吞咽训练，观察组在对照组基础上采用神经肌肉电刺激联合会厌逐瘀汤加减治疗。两组均持续治疗6周。比较两组临床疗效，治疗前后吞咽障碍（功能性吞咽障碍分期评估表）、吞咽-摄食功能（标准吞咽功能评价量表）、吞咽造影、脑部血流状况（双侧椎动脉与基底动脉平均血流速度、收缩期血流速度与搏动指数），并发症发生情况。采用独立样本t检验、配对t检验和χ²检验进行统计学分析。结果　观察组治疗总有效率高于对照组［91.25%（73/80）比65.00%（52/80）］（P<0.05）。治疗后，观察组功能性吞咽障碍分期评估表、标准吞咽功能评价量表评分均低于对照组［（20.30±7.93）分比（34.56±8.89）分、（20.13±4.33）分比（26.53±5.80）分］，吞咽造影评分高于对照组［（9.46±1.25）分比（8.65±1.98）分］（均P<0.05）；观察组双侧椎动脉和基底动脉平均血流速度、收缩期血流速度均高于对照组，搏动指数均低于对照组（均P<0.05）。观察组并发症总发生率低于对照组［6.25%（5/80）比21.25%（17/80）］（P<0.05）。结论　神经肌肉电刺激联合会厌逐瘀汤加减治疗脑卒中后吞咽障碍患者效果较好，可改善吞咽功能、脑部血流状况，减少并发症。

关键词: 脑卒中后吞咽障碍, 神经肌肉电刺激, 会厌逐瘀汤, 吞咽功能, 临床价值