作者：王亚静，王文刚，王珊珊，相希

单位：

河北省秦皇岛市中医医院脑病科

Units：

Department of Encephalopathy, Qinhuangdao Hospital of Traditional Chinese Medicine, Qinhuangdao 066000, China

关键词：

卒中; 假性延髓麻痹; 吞咽障碍; 针刺疗法; 治疗结果;

Keywords：

Stroke; Pseudobulbar palsy; Deglutition disorders; Acupuncture therapy; Treatment outcome

CLC：

DOI：

10.12114/j.issn.1008-5971.2023.00.098

Funds：

河北省中医药管理局科研计划项目（2019526）

摘要：

目的 探讨三部开窍利咽针刺法治疗脑卒中后假性延髓麻痹致吞咽障碍患者的疗效。方法 选取2019年10月至2021年5月秦皇岛市中医医院收治的脑卒中后假性延髓麻痹致吞咽障碍患者80例，采用随机数字表法将患者分为常规组40例和试验组40例。常规组给予基础药物治疗、吞咽功能训练及常规针刺治疗，试验组给予基础药物治疗、吞咽功能训练及三部开窍利咽针刺法治疗，均连续治疗15 d。比较两组治疗后临床疗效，治疗前后吞咽功能[采用洼田饮水试验及标准吞咽功能评估法（SSA）评价]、面肌痉挛强度（依据面肌痉挛强度分级评价）、实验室检查指标[脑源性神经营养因子（BDNF）、神经元特异性烯醇化酶（NSE）、S-100B蛋白、一氧化氮合酶（NOS）、一氧化氮（NO）、超氧化物歧化酶（SOD）、丙二醛（MDA）水平]。结果 试验组临床疗效优于常规组（u=2.335,P=0.019）。治疗后，试验组洼田饮水试验分级及SSA评分低于常规组（P<0.05）。治疗后，试验组面肌痉挛强度分级低于常规组（P<0.05）。治疗后，两组BDNF、SOD水平分别较本组治疗前升高，NES、S-100B蛋白、NOS、NO、MDA水平分别较本组治疗前降低（P<0.05）。治疗后，试验组BDNF、SOD水平较常规组升高，NES、S-100B蛋白、NOS、NO、MDA水平较常规组降低（P<0.05）。结论 三部开窍利咽针刺法可有效提高脑卒中后假性延髓麻痹致吞咽障碍患者临床疗效，改善吞咽功能、面肌痉挛强度，促进神经元修复，减轻氧化应激损伤。

Abstract：

Objective To investigate the efficacy of three acupuncture methods for opening orifices and benefiting pharynx in the treatment of patients with dysphagia caused by pseudobulbar palsy after stroke. Methods A total of 80 patients with dysphagia caused by pseudobulbar palsy after stroke admitted to Qinhuangdao Hospital of Traditional Chinese Medicine from October 2019 to May 2021 were selected. The patients were divided into conventional group (40 cases) and experimental group (40 cases) by random number table method. The conventional group was given basic drug treatment, swallowing function training and routine acupuncture treatment. The experimental group was given basic drug treatment, swallowing function training and three acupuncture methods for opening orifices and benefiting pharynx, both of the two groups were continuously treated for 15 days. The clinical efficacy after treatment, the swallowing function [evaluated by water swallow test and Standardized Swallowing Assessment (SSA) ] , the facial spasm intensity (evaluated according to the grade of facial spasm intensity), and laboratory examination indexes [the level of brain-derived neurotrophic factor (BDNF) , neuron-specific enolase (NSE) , S-100B protein, nitric oxide synthase (NOS) , nitric oxide (NO) , superoxide dismutase (SOD) , malondialdehyde (MDA) ] before and after treatment were compared between the two groups. Results The clinical efficacy of the experimental group was better than that of conventional group (u=2.335, P=0.019) . After treatment, the grade of water swallow test and the SSA score in experimental group were lower than those in conventional group (P < 0.05) . After treatment, the grade of facial spasm intensity in experimental group was lower than that in conventional group (P < 0.05) . After treatment, the levels of BDNF, SOD in the two groups were higher than those before treatment, the levels of NES, S-100B protein, NOS, NO, MDA in the two groups were lower than those before treatment, respectively (P < 0.05) . After treatment, the levels of BDNF, SOD in experimental group were higher than those in conventional group, the levels of NES, S-100B protein, NOS, NO, MDA in experimental group were lower than those in conventional group (P< 0.05) . Conclusion The three acupuncture methods for opening orifices and benefiting pharynx can effectively improve the clinical efficacy of dysphagia caused by pseudobulbar palsy after stroke patients. It can improve the swallowing function and the facial spasm intensity, promote the repair of neurons, and reduce the damage of oxidative stress.

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