王慧灵,高静,申昕,等.透刺吞咽针法联合冰水球囊扩张术治疗环咽肌失弛缓症的疗效观察[J].中华物理医学与康复杂志,2024,46(9):781-785
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| 透刺吞咽针法联合冰水球囊扩张术治疗环咽肌失弛缓症的疗效观察 |
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| DOI：10.3760/cma.j.issn.0254-1424.2024.09.003 |
| 中文关键词: 透刺吞咽针法 冰水球囊扩张术 脑干梗死 环咽肌失弛缓症 |
| 英文关键词: Swallowing acupuncture Balloon dilatation Ice water Brainstem stroke Cricopharyngeal achalasia Achalasia |
| 基金项目:河南省中医药科学研究专项资助（2019ZY2119，2019JDZX2067）；河南省二〇二三年科技发展计划项目（232102311210） |
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| 中文摘要: |
| 目的 观察透刺吞咽针法联合冰水球囊扩张术治疗脑干梗死后环咽肌失弛缓患者的临床疗效。 方法 采用随机数字表法将45例脑干梗死后环咽肌失弛缓患者分为透刺组、球囊扩张组和联合组，每组15例。3组患者均给予常规吞咽训练，透刺组在此基础上辅以透刺吞咽针法治疗，球囊扩张组则辅以冰水球囊扩张术干预，联合组于冰水球囊扩张术结束0.5 h后继续辅以透刺吞咽针法治疗，3组患者治疗终点均为恢复自主经口进食或治疗满3周。于治疗前、治疗终点时分别采用视频吞咽造影检查（VFSS）、功能性经口摄食量表（FOIS）、渗透-误吸量表(PAS)评估3组患者吞咽功能，并比较3组患者的胃管成功拔除率、胃管留置时间及环咽肌正常开放率。 结果 治疗终点时3组患者VFSS、FOIS、PAS评分均较治疗前明显改善（P<0.05），并且联合组VFSS、FOIS及PAS评分［分别为（7.80±1.26）分、（5.26±0.88）分和（2.26±0.88）分］、胃管成功拔除率（70.0%）、环咽肌正常开放率（73.3%）、胃管留置时长［(28.10±5.56)d］均显著优于透刺组及球囊扩张组水平(P<0.05)。 结论 透刺吞咽针法联合冰水球囊扩张术可有效改善脑干梗死后环咽肌失弛缓患者的吞咽功能，提高胃管拔除率及环咽肌开放率，缩短胃管留置时间，该中西医结合治疗方法值得临床推广、应用。 |
| 英文摘要: |
| Objective To observe the clinical efficacy of supplementing penetrating acupuncture for swallowing with ice-water balloon dilatation in the treatment of dysphagic patients with cricopharyngeal achalasia after a brainstem stroke. Methods Forty-five patients with cricopharyngeal achalasia after a brainstem stroke were randomly assigned to a penetrating acupuncture (PA) group, a balloon dilatation (BD) group or a combination group, each of 15. In addition to routine swallowing training, those in the PA and BD groups received penetrating swallowing acupuncture or iced-water balloon dilatation, while the combination group received penetrating swallowing acupuncture 30 minutes after iced-water balloon dilatation. The treatments lasted three weeks beginning right after the recovery of autonomous oral feeding. Before and after the treatment, all of the subjects′ swallowing function was evaluated using video fluoroscopy (VFSS), a functional oral intake scale (FOIS) and a penetration aspiration scale (PAS). Successful removal of the gastric tube, gastric tube retention time and normal opening rate of the cricopharyngeal muscle were also recorded. Results Significant improvement was observed in the average VFSS, FOIS and PAS results of all three groups after the treatments. The combination group′s average VFSS, FOIS and PAS scores were, however, significantly superior to those of the other two groups, as were successful removal of the gastric tube, gastric tube retention time and the normal opening rate of the cricopharyngeal muscle. Conclusion Combining penetrating swallowing acupuncture with ice-water balloon dilation can better improve the swallowing function of brainstem stroke survivors with cricopharyngeal achalasia. It improves the cricopharyngeal opening rate and shortens gastric tube indwelling time. This combination of traditional Chinese and Western medicine is therefore worthy of clinical promotion and application. |
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