刘晓蔓　王军　李诗梦　李春妍

摘要 目的：探究針刺配合语言训练对脑卒中后构音障碍的影响。方法：选取2017年7月至2019年1月北京中医药大学房山医院收治符合纳入条件脑卒中后构音障碍患者114例作为研究对象，按照就诊顺序编号随机分为对照组和观察组，每组57例。对照组常规西医治疗并配合语言康复训练，观察组在对照组基础上加用针刺治疗，均同时治疗4周。观察2组声学/电声门图参数基频（FO）、基频微扰（Jitter）、振幅微扰（Shimmer）、谐躁比（HNR）、声门接触率（CQ）、喉发声空气力学指标、语音清晰度、篇章正答率、构音障碍综合性评价量表、血液流变学以及疗效。结果：2组Jitter、Shimmer、CQ、构音障碍综合性评价量、血液流变学治疗前均显著下降，差异有统计学意义（P<0.05），且观察组均显著低于对照组，差异有统计学意义（P<0.05）;治疗后2组MPT、语音清晰度、篇章正答率较治疗前均显著升高，差异有统计学意义（P<0.05）;观察组治疗有效率显著高于对照组，差异有统计学意义（P<0.05）。结论：针刺配合语言训练能通过改善脑卒中后构音障碍言语和声学水平，促进血液循环，从而提高疗效，改善生命质量。

关键词 针刺;语言训练;脑卒中;构音障碍;声学/电声门图参数;喉发声动力学;血液流变学;疗效

A Randomized Controlled Study on Acupuncture Combined with Language Training in the Treatment of Post-stroke Articulation Disorder

LIU Xiaoman1，WANG Jun2，LI Shimeng2，LI Chunyan3

（1 Department of Rehabilitation，Fangshan Hospital，Beijing University of Chinese Medicine，Beijing 102400，China; 2 Department of Acupuncture，Dongzhimen Hospital，Beijing University of Chinese Medicine，Beijing 100700，China;3 Department of Renal Endocrinology，the People′s Liberation Army Joint Service Guarantee 970th Hospital，Beijing 264500，China）

Abstract Objective：To explore the effects of acupuncture combined with language training on dysarthria after stroke.Methods：A total of 114 patients with dysarthria after stroke admitted to Fangshan Hospital，Beijing University of Chinese Medicine from July，2017 to Jan.2019 were randomly divided into a control group（n=57）and a study group（n=57）.The control group was treated with routine Western medicine combined with language rehabilitation training，and the study group was treated with acupuncture on the basis of the control group.Both groups were treated for 4 weeks.The parameters of acoustics/electroglottography，speech articulation，text correct answer rate，comprehensive evaluation scale of dysarthria，respiration，anatomical position of pronunciation tissue，speech changes，hemorheology and curative effects were observed and compared between the 2 groups.Results：1）there was no significant difference in FO and HNR between the 2 groups than those before treatment（P>0.05），Jitter，Shimmer，CQ，respiration，lip movement，reflex，soft palate movement，larynx movement，tongue movement，jaw position，speech score，high shear whole blood viscosity，low shear whole blood viscosity and plasma viscosity were all decreased，while MPT，speech articulation and text correct answer rate were increased after treatment.The study group was superior to the control group（P<0.05）.2）the clinical effective rate of the study group was better than that of the control group（P<0.05）.Conclusion：Acupuncture combined with language training can improve dysarthria and quality of life after stroke.

Keywords Acupuncture; Language training; Stroke; Articulation disorder; Acoustic/electroglottogram parameters; Laryngeal vocal dynamics; Hemorheology; Therapeutic effects

中图分类号：R245;R743文献标识码：Adoi：10.3969/j.issn.1673-7202.2020.15.023

脑卒中具有发病率高、病死率高、致残率高3大特点，是威胁人类健康3大疾病之一，脑卒中后会出现各种并发症，如肢体偏瘫、感觉障碍、构音障碍等，构音障碍是脑卒中常见并发症之一。构音障碍指的是发音器官神经肌肉病变或构造异常所引起的发音、共鸣、韵律异常，表现为发声困难、发音不准、咬字不清晰、声调及速率、节律异常等，在临床上可分为迟缓型、痉挛型、运动失调型、运动过少型、混合型等构音障碍，其中痉挛型占全部的80%[1]。目前西医在对脑卒中构音障碍尚无特异性方法，且往往因强调肢体康复而忽略构音障碍治疗，部分患者终身难以康复，严重影响患者与人交流能力。中……