陈　璐　张根明（.北京中医药大学，北京 00029；2.北京中医药大学东直门医院，北京 00700）



针灸综合康复方案治疗中风后吞咽障碍疗效观察*

陈璐1张根明2△
（1.北京中医药大学，北京 100029；2.北京中医药大学东直门医院，北京 100700）

目的 观察针灸综合康复方案治疗卒中后吞咽障碍的临床疗效。方法 选取卒中后吞咽障碍患者60例，按随机数字表法分为治疗组30例和对照组30例。在常规内科治疗的基础上，治疗组给予针灸联合吞咽康复训练，对照组仅给予单纯的吞咽康复训练。每周3次，隔日1次。以治疗开始的第1、7、14、28日为疗效评价时点，用洼田饮水试验和基于中风病患者报告的临床结局评价量表（PRO）中流涎、吃饭时食物留滞在口腔的疗效评价标准分别对两组进行疗效评价。结果 1）治疗组和对照组总有效率分别为100.00%和96.67%，差异有统计学意义（P<0.05）。2）治疗组和对照组PRO量表中流涎的疗效分别为100.00%和88.89%，差异有统计学意义（P<0.05）。3）治疗组和对照组PRO量表中食物留滞在口腔的疗效分别为100.00%和92.00%，差异有统计学意义（P<0.05）。结论 针灸综合吞咽康复训练比单纯吞咽康复训练疗效好。

吞咽困难针灸康复训练PRO量表

【Abstract】Objective：To observe the clinical efficacy of acupuncture and moxibustion on dysphagia after stroke. Methods：Sixty cases were collected into the study，and were randomly divided into the experimental group（n= 30），and the control group（n=30）.On the basis of conventional medical treatment，the experimental group received acupuncture and swallowing rehabilitation training，whereas the control group only received swallowing rehabilitation training，3 times a week，once every other day and the total treatment lasted for 28 days.The efficacy was assessed by the Kubata water drinking test and drooling，the food left in the mouth in the PRO scale at the efficacy evaluation points，1th，7th，14th and 28th day of the treatment.Results：1）The total effective rates of the experimental group and the control group were 100.00%and 96.67%respectively，with significant difference（P< 0.05）；2）The effective rates of saliva flow in the PRO scale of the experimental group and the control group were 100.00%and 88.90%，respectively，with significant difference（P<0.05）；3）The effective rates of the food left in the mouth in the PRO scale of the experimental group and the control group were 100.00%and 92%respectively，with significant difference（P<0.05）.Conclusion：Compared with pure rehabilitation therapy，acupuncture combined with rehabilitation therapy treatment of post-stroke dysphagia has higher cure rate.

【Key words】Dysphagia；Acupuncture；Rehabilitation training；Patient-reported outcome scale

吞咽障碍是指由于下颌、双唇、舌、软腭、咽喉、食管括约肌或食管功能受损，不能安全有效地将食物由口腔送到胃内取得足够的营养和水分。脑中风是导致吞咽障碍的最主要病因之一，约30%～50%的脑中风患者有吞咽困难［1-2］。吞咽困难对患者的生活质量造成了较大影响，轻者仅有进食或饮水呛咳，重者只能靠鼻饲流食或静脉补液来维持生命，而且吞咽困难容易导致脱水、水电解质紊乱、吸入性肺炎、营养不良等各种并发症，重者还可能因痰液阻塞气道，导致窒息而危及生命，吞咽困难严重影响患者的生活和生存质量，给家庭和社会带来沉重的精神和经济负担［3］。……