何玲燕,冯玲,邵寅芳.耳穴刺激治疗脑卒中后吞咽障碍的疗效观察[J].中华物理医学与康复杂志,2020,42(7):613-617
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| 耳穴刺激治疗脑卒中后吞咽障碍的疗效观察 |
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| DOI：10.3760/cma.j.issn.0254-1424.2020.07.007 |
| 中文关键词: 耳穴 脑卒中 吞咽障碍 表面肌电图 神经肌肉电刺激 |
| 英文关键词: Auricular points Stroke Dysphagia Surface electromyography Neuromuscular electrical stimulation |
| 基金项目:浙江省中医药科学研究基金计划A类项目（2017ZA139）；绍兴市科技计划项目（2018C30103） |
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| 中文摘要: |
| 目的 观察耳穴刺激治疗脑卒中后吞咽障碍患者的疗效。 方法 采用随机数字表法将80例脑卒中后吞咽障碍患者分为观察组及对照组，每组40例。2组患者均给予神经肌肉电刺激及吞咽康复训练等常规干预，观察组患者在此基础上辅以耳穴按压治疗，2组患者疗程均为4周。于治疗前、治疗4周后分别采用表面肌电图（sEMG）、标准吞咽功能评定量表（SSA）评估2组患者吞咽功能改善情况，采用汉密尔顿抑郁量表（HAMD）、汉密尔顿焦虑量表（HAMA）评估2组患者情绪改善情况，采用特异性吞咽障碍生活质量量表（SWAL-QOL）评定2组患者生活质量变化。 结果 治疗4周后2组患者咬肌、口轮匝肌、舌骨下肌、颏下肌群吞咽时限、最大波幅均较治疗前明显改善（P<0.05），2组患者SSA、HAMA、HAMD及SWAL-QOL评分亦显著优于治疗前水平（P<0.05）；进一步组间比较发现，治疗后观察组患者咬肌、口轮匝肌、舌骨下肌、颏下肌群吞咽时限［（6.51±0.43）s、（6.76±0.83）s、（6.83±0.74）s、（6.82±0.95）s］、最大波幅［（745.93±47.95）μV、（753.65±40.77）μV、（758.79±38.83）μV、（750.79±38.79）μV］、SSA［（22.63±3.02）分］、HAMA［（11.02±4.63）分］、HAMD［（10.26±3.74）分］及SWAL-QOL评分［（172.26±16.79）分］亦显著优于对照组水平，组间差异均具有统计学意义（P<0.05）。 结论 在常规康复干预基础上辅以耳穴按压治疗脑卒中后吞咽障碍患者具有协同作用，有助于重构吞咽反射，加速吞咽功能恢复，对改善患者负性情绪及生活质量具有明显促进作用。 |
| 英文摘要: |
| Objective To observe any therapeutic effect of stimulating acupoints on the ears of stroke survivors with dysphagia. Methods Eighty stroke survivors with dysphagia were randomly divided into an observation group and a control group, each of 40. Both groups were given neuromuscular electrical stimulation and routine deglutition training, but the observation group was additionally provided with auricular point pressing for 4 weeks. Surface electromyography (sEMG), water swallowing tests and standardized swallowing assessments (SSAs) were used to assess the subjects′ swallowing function before and after the 4 weeks of treatment. The Hamilton depression rating scale (HAMD) and Hamilton anxiety rating scale (HAMA) were used to assess any mood improvement. The swallowing-related quality of life (SWAL-QOL) scale was used to assess the patients′ life quality. Results After the treatment, the average deglutition time and the maximum amplitude of the masseter, orbicularis oris, submental and hyoid muscle signals of both groups had improved significantly. The average SSA, HAMA, HAMD and SWAL-QOL scores of both groups were also significantly improved as was the average swallowing time. All of the improvements were significantly greater in the observation group than in the control group. Conclusion Auricular point acupressure has a synergistic effect with routine rehabilitation in the treatment of dysphagia after stroke. It can help to reconstruct the swallowing reflex, promote the recovery of swallowing function, and improve emotions and life quality. |
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