Abstract:

Objective　To explore the effect of staged deep acupuncture combined with oral training in the treatment of dysphagia after stroke. Methods　Ninety-six patients with post-stroke dysphagia admitted to Weihai Central Hospital from August 2019 to August 2021 were divided into a control group and a treatment group by the random number table method (48 cases in each group). The control group [28 males and 20 females, aged (57.84±10.08) years] was given oral sensorimotor training, and the treatment group [26 males and 22 females, aged (57.90±10.11) years] was given staged acupoint deep acupuncture on the basis of the control group. Before and after treatment, the swallowing function was detected by Water Swallow Test, the nutritional status was assessed by Nutritional Risk Screening 2002 (NRS2002), the cerebral hemodynamics was examined by transcranial color Doppler ultrasonography, the activities of daily living were examined by modified Barthel index (MBI), and the quality of life was assessed by Swallowing Quality of Life Questionnaire (SWAL-QOL), and the clinical effect was recorded in the two groups. t test was used for the measurement data, and chi-square test was used for the count data. Results　The treatment group had a higher effective rate compared with the control group [95.83% (46/48) vs. 79.17% (38/48)] (χ²=6.095, P=0.014). After treatment, the scores of Water Swallow Test, Functional Oral Intake Scale (FOIS), and Video Fluoroscopic Swallowing Study (VFSS) increased in both groups, the NRS2002 score decreased (all P<0.05); compared with those in the control group, the scores in the treatment group were better after treatment, with statistically significant differences (all P<0.05). After treatment, the mean flow velocity (Vm) and systolic velocity (Vs) significantly increased in both groups, and the resistance index (RI) decreased (all P<0.05); compared with those in the control group, the Vm and Vs were higher and the RI was lower in the treatment group after treatment, with statistically significant differences (all P<0.05). After treatment, the MBI and SWAL-QOL scores in the two groups increased, and the MBI and SWAL-QOL scores in the treatment group were higher than those in the control group, with statistically significant differences (all P<0.05). Conclusion　For patients with dysphagia after stroke, deep acupuncture on acupoints combined with oral training has an ideal clinical effect, which can improve patients' feeding and swallowing function, improve their cerebral hemodynamics and activities of daily living, reduce the risk of malnutrition, and improve their quality of life, which is worth promoting.

Key words: Swallowing staging, Deep acupuncture, Oral training, Stroke, Dysphagia

摘要： 目的　探讨分期穴位深刺联合口腔训练治疗脑卒中后吞咽障碍的临床疗效。方法　按随机数字表法将威海市中心医院2019年8月至2021年8月收治的96例脑卒中后吞咽障碍患者分入对照组与治疗组（每组48例）。对照组［男28例、女20例，年龄（57.84±10.08）岁］给予口腔感觉运动训练治疗，治疗组［男26例、女22例，年龄（57.90±10.11）岁］在对照组基础上联合分期穴位深刺治疗。两组治疗前后吞咽功能运用洼田饮水试验检测、营养状况利用营养风险筛查2002（Nutritional Risk Screening 2002，NRS2002）估评、脑血流动力学采用经颅彩色多普勒超声检查、日常生活能力参照改良Barthel指数（MBI）、生活质量利用生活质量量表（SWAL-QOL）评估变化情况，并记录两组临床疗效。计量资料采用t检验，计数资料采用四格表资料χ²检验。结果　与对照组相比，治疗组治疗有效率更高［95.83%（46/48）比79.17%（38/48）］（χ²=6.095，P=0.014）。治疗后两组洼田饮水试验、进食分级量表（Functional Oral Intake Scale，FOIS）和透视吞咽功能检测（Video Fluoroscopic Swallowing Study，VFSS）评分均升高，NRS2002评分均降低（均P<0.05）；且相比对照组，治疗组治疗后各指标评分均更优，差异均有统计学意义（均P<0.05）。治疗后两组脑血流动力学指标中血流平均流速（mean flow velocity，Vm）、最大峰值流速（systolic velocity，Vs）均明显升高，血管阻力指数（resistance index，RI）均降低（均P<0.05）；且相比对照组，治疗组治疗后Vm、Vs更高，RI更低，差异均有统计学意义（均P<0.05）。治疗后两组MBI和SWAL-QOL评分均升高，且治疗组治疗后MBI和SWAL-QOL评分均高于对照组，差异均有统计学意义（均P<0.05）。结论　针对脑卒中后吞咽障碍患者，采取分期穴位深刺联合口腔训练治疗临床疗效理想，可提高患者摄食吞咽功能，提高其脑血流动力学和日常生活活动能力，降低其营养不良风险，改善生活质量，值得推广。

关键词: 吞咽分期, 深刺法, 口腔训练, 脑卒中, 吞咽障碍