急性脑卒中致吞咽障碍的早期针刺康复研究

目的：观察急性脑卒中致吞咽障碍的早期综合康复治疗效果。方法：（1）针刺治疗：取穴廉泉、风池、地仓、下关、颧删、廉泉向左右旁开各1寸处、颊车、承浆。（2）吞咽功能训练：对摄食-吞咽障碍的各个部位进行训练。（3）摄食训练：注意选择适于患者进食的体位,食物的形态及进食的一口量。结果：患者摄食-吞咽功能得到了不同程度的改善,及时地为患者补充足够的营养和水分,增加了机体的抵抗力,减少了肺炎的发生率,提高了生存质量。结论：对急性脑卒中致吞咽障碍的患者进行早期针刺治疗和康复训练具有明显效果。     

针刺治疗脑卒中后吞咽障碍

吞咽障碍是脑卒中后常见的并发症之一,近年来针刺治疗脑卒中后吞咽障碍取得了良好的临床疗效。综述近年来针刺治疗中风后吞咽障碍文献,以期指导未来的临床工作。目前以针刺为主治疗本病的方法包括:体针、项针、舌针、头针、电针、耳针、穴位注射、穴位贴敷、针刺结合康复训练治疗、针刺结合电刺激治疗、针刺结合电刺激及康复治疗,以及一些特色针法的应用,包括:通关利窍针刺法、调神通络针法、互动式针法、曾氏太极针法、四步针刺法等。     

针刺结合综合康复疗法治疗慢性期脑卒中后吞咽障碍的疗效观察

目的:观察针刺结合吞咽治疗仪及吞咽训练对慢性期脑卒中后吞咽障碍患者的治疗效果。方法:针刺结合综合康复疗法组20例患者采用针刺风池、翳风、完骨、人迎、舌三针、吞咽穴及治呛穴结合吞咽治疗仪及吞咽训练的方法治疗;吞咽训练组20例患者单纯采用吞咽训练的方法治疗。每组患者均治疗20次,以洼田氏饮水试验评定治疗前后疗效。结果:综合治疗组总有效率95%;单纯吞咽训练组总有效率65%,两组总有效率比较,差异有统计学意义(P0.05),而两组分别进行组内比较,治疗前后洼田氏积分差异亦有统计学意义(P0.01),提示针刺结合综合康复疗法以及单纯吞咽训练治疗均改善脑卒中后吞咽障碍患者的吞咽功能,而治疗组在综合治疗后疗效优于对照组。结论:对慢性期脑卒中后吞咽障碍患者进行针刺结合吞咽治疗仪及吞咽训练有利于吞咽功能的恢复,避免误吸等并发症的发生。     

针刺治疗脑卒中后吞咽障碍的临床研究

目的:对运用针刺方法对存在吞咽困难的脑卒中患者进行辅助治疗的临床效果进行研究分析。方法:抽取80例存在吞咽困难的脑卒中患者病例,将其分为A、B两组各40例。A组患者采用常规吞咽功能训练方式进行治疗;B组患者采用针刺联合吞咽功能训练的方法进行治疗。结果:B组治疗后的吞咽功能改善效果明显优于A组;治疗期间出现并发症的人数明显少于A组;症状开始改善时间明显早于A组;住院接受治疗的实际时间明显短于A组;治疗结束后病情的复发率明显低于A组。结论:运用针刺方法对存在吞咽困难的脑卒中患者进行辅助治疗的临床效果非常理想。     

针刺治疗脑卒中后吞咽障碍研究进展

吞咽功能障碍是脑卒中最常见的并发症之一,吞咽功能障碍的患者常因误吸而致呼吸道阻塞、吸入性肺炎,或因进食不足出现营养不良、脱水等各种并发症,进而导致患者病死率明显增高和生活质量下降,直接影响患者的生活自理能力和卒中的康复.中医学将本病归为＂中风＂、＂喑痱＂、＂喉痹＂等范畴,认为此病的病因病机为本虚标实,肝肾不足,气血衰少为本,风火相煽、瘀血内停、痰浊阻络为标,其病位多在舌咽、脑,但与心、肝、脾、肺、肾有关.脑卒中后吞咽障碍已成为临床研究治疗的难点,目前西医多采用被动的支持疗法,尚无有效的治疗方法,而针刺治疗本病已在临床上取得了较为满意的疗效.笔者就近年来针刺治疗本病的临床研究进展综述如下.     

脑卒中后吞咽障碍的康复护理

目的 对脑卒中后吞咽功能障碍的患者进行早期康复介入,并评估其临床疗效,探讨早期康复介入对于脑卒中后吞咽功能障碍患者的意义和价值,提高脑卒中后吞咽功能障碍患者的临床疗效;方法 将符合纳入标准的51例急性脑卒中吞咽困难病例采用随机数字表法分为2组,对照组采用传统的常规护理方法,康复组在此基础上采用早期系统化康复护理,3周后完成治疗并填写病例观察表,评定2组的疗效并进行对比;结果 经过3周治疗后,康复组总有效率优于对照组,疗效评定结果2组比较差异有统计学意义（P＜0.05）,治疗后功能评定结果2组比较差异有统计学意义（P＜0.05）;结论 对脑卒中后吞咽困难患者行早期康复介入,有助于患者恢复吞咽功能的改善或恢复,降低并发症的发生率.     

针刺对中风后吞咽障碍的影响

目的:观察针刺治疗脑卒中吞咽障碍的疗效。方法:181例脑卒中吞咽障碍患者分为针刺组,对照组和假针刺组,在内科基础治疗的前提下分别采用针刺治疗,康复训练配合穴位经皮电刺激,康复训练配合穴位假针刺。治疗前与治疗28天后分别以改良吞钡试验(MBS)评定疗效。结果:治疗后,改良吞钡试验评分与治疗前比较3组均有不同程度改善(P<0.05),且针刺组与其他组疗效比较有统计学意义(P<0.01)。结论:针刺可以改善脑卒中后吞咽障碍患者的吞咽功能。     

脑卒中后吞咽障碍的康复护理

脑卒中是造成吞咽障碍的首要病因,同时吞咽障碍是脑卒中患者死亡的独立危险因素,若不及时进行正确的处理,将严重地影响患者的功能恢复,甚至会威胁到患者的生存.我院2007年1月-2008年12月对住院的脑卒中后吞咽障碍患者进行治疗与康复护理,效果满意,现报道如下.     

针刺联合康复治疗脑卒中后吞咽障碍的临床观察

目的 在卒中单元中应用针刺联合康复治疗假性延髓麻痹所导致的吞咽障碍,并与同期单纯应用康复及单纯应用针刺的患者进行疗效对比,以观察针刺联合康复治疗假性延髓麻痹所致吞咽障碍的临床疗效.方法 用层内随机配对法将患者分为治疗组(针刺联合康复),对照Ⅰ组(单纯康复),对照Ⅱ组(单纯针刺).运用吞咽困难评定量表分别于治疗第1天、第3天、第6天、第14天对患者进行定量评分.结果 治疗组治疗第3天与第1天比较,吞咽困难评定量表评分差异有统计学意义(P＜0.05),表明治疗组治疗第3天起效.而对照Ⅰ组和对照Ⅱ组治疗第6天起效.各组均于15天达到高峰.说明治疗组具有起效快,疗效确切的特点.以洼田氏饮水试验作为吞咽障碍评测标准,对治疗前后三组疗效进行对比观察,治疗组疗效优于对照Ⅰ组和对照Ⅱ组(P＜0.01).结论 结果表明针刺联合康复治疗可改善假性延髓麻痹所导致的吞咽障碍.     

针刺治疗脑卒中后吞咽障碍研究进展

<正>脑卒中后吞咽障碍可致患者营养摄取不足、康复进程延长、生存质量降低,严重者甚至危及生命^[1]。脑卒中吞咽障碍发病率高,急性期发生率达37%～78%^[2],而恢复期达16%^[3]。与吞咽相关的神经组织包括颅神经、脑干、皮层下结构、皮层等^[4]。脑卒中后吞咽障碍是由于卒中累及与吞咽相关的神经组织,导致相应神经支配的     

项针配合康复训练治疗脑卒中后吞咽障碍临床研究

目的:观察项针配合康复训练对脑卒中后吞咽障碍(DFS)的改善作用.方法:将符合纳入标准的80例患者按入院时间先后随机分为项针组和康复组各40例.康复组在一般药物治疗基础上给予吞咽功能康复训练,项针组在常规组基础上给予项针治疗.结果:两组患者治疗后,洼田饮水试验、标准吞咽功能评估(SSA)评分、吞咽功能电视荧光透视检查(VFSS)评分以及咽通过时间改善均优于治疗前(均P＜0.05),项针组上述指标的改善均优于常规组(均P＜0.05);项针组总有效率为85.0％(34/40),高于康复组的65.0％(26/40),两组间比较差异有统计学意义(P＜0.05).结论:项针配合康复训练能显著改善脑卒中后患者的吞咽功能.     

针刺结合康复训练治疗脑卒中后吞咽困难疗效观察

目的探讨针刺结合康复训练治疗脑卒中后吞咽困难的效果。方法将72例脑卒中后吞咽困难患者随机分为2组,A组除接受常规治疗外,还接受针灸及吞咽康复训练,B组仅接受常规治疗及吞咽康复训练。2组治疗2个疗程后进行"摄食-吞咽障碍等级"评分,比较2组疗效。结果 2组患者治疗后评分均有明显改善,A组评分改善情况优于B组。结论针刺结合康复训练可明显改善脑卒中后吞咽困难。     

针灸治疗脑卒中后吞咽障碍161例

目的:观察针刺治疗脑卒中后吞咽障碍的临床疗效及安全性。方法:选取本院339例脑卒中后发生吞咽障碍的患者,随机分为治疗组168例和对照组171例,治疗组和对照组各脱落7例。对照组给予常规治疗(神经内科常规治疗方法及康复训练),治疗组在对照组治疗基础上配合针刺治疗,观察两组患者临床疗效。结果:无论是全分析集(FAS)还是符合方案集(PPS)治疗后两组间痊愈率比较具有统计学差异(P0.05),治疗组较对照组痊愈率高;无论是FAS还是PPS随访后两组间痊愈率不具有统计学差异(P0.05)。结论:针刺治疗脑卒中后吞咽障碍疗效显著。     

电刺激吞咽神经肌肉联合针刺治疗脑卒中后吞咽障碍疗效观察

ObjectiveTo seek a better therapy for treating post-stroke dysphagia.MethodsPatients with stroke and swallowing disorders were randomly divided into ordinary acupuncture group (group A, 58 cases) and swallowing neuromuscular electrical stimulation combined with acupuncture group (group B, 62 cases). Two-group patients were given the same basic internal medical treatment. In addition, group A was given normal acupuncture treatment with the choice of local points: Jīnjīn (

EX-HN 12), Yùyè (

EX-HN 13), Fēngchí (

GB 20), Yìfēng (

TE 17), Liánquán (

CV 23), Wángŭ (

GB 12). Group B was given swallowing neuromuscular electrical stimulation combined with acupuncture: GB 20, Fēngfŭ (

GV 16), TE 17, Yìmíng (

EX-HN 14), Yămén (

GV 15), Tiānróng (

SI 17), Tiānchuāng (

SI 16), CV 23, the uniform reinforcing-reducing manipulation was used; EX-HN 12, EX-HN 13, the piercing and blood-letting method (1-2 mL blood) was used; at the same time, the swallowing neuromuscular electrical stimulation therapy device was used to electrically stimulate the nerves and muscles in the throat and neck at specific output pulse current (50-100 Hz). Treatment was made twice a day, 30 minutes each time. Two weeks after the treatment, the patients were assessed in symptoms improvement and clinical efficacy.ResultsThe total effective rate in group B was 91.4% and 75.8% in group A; in the total efficiency comparison in both groups, χ²=5.232, P<0.05. The difference in improvement of symptoms with post-stroke dysphagia treated with above mentioned combination treatment was statistically significant between both groups (P<0.05).ConclusionsThe above mentioned swallowing neuromuscular electrical stimulation combined with acupuncture treatment has a better clinical effect when compared with ordinary acupuncture.     

针刺联合康复训练治疗脑卒中后吞咽障碍多中心随机对照临床观察

目的观察针刺配合康复训练治疗脑卒中后吞咽障碍的临床疗效。方法将229例脑卒中后吞咽障碍患者随机分为治疗1组(74例),治疗2组(75例),对照组(80例)。治疗1组采用针刺治疗,治疗2组采用针刺配合康复训练,对照组采用康复训练;每周治疗5次,连续治疗4周。评定3组患者中医吞咽障碍评价量表、洼田咽水试验量表以及吞咽障碍特异性生活质量量表疗效。结果针刺1组、针刺2组、对照组吞咽障碍中医评价量表总有效率分别为83.56%、74.67%、64.00%,3组比较差异有统计学意义(P<0.01);治疗1组、治疗2组、对照组洼田咽水试验量表总有效率分别为83.56%、89.33%、66.67%,3组比较差异有统计学意义(P<0.01)。3组患者治疗后吞咽障碍特异性生活质量量表积分均较本组治疗前明显改善(P<0.01),治疗后治疗1组和治疗2组与对照组比较差异亦有统计学意义(P<0.01)。结论针刺配合康复训练治疗脑卒中后吞咽障碍疗效肯定,针刺方案安全有效。     

Acupuncture combined with speech rehabilitation training for post-stroke spasmodic dysphonia: a multicenter randomized controlled trial

ObjectiveTo observe the clinical efficacy of acupuncture combined with speech rehabilitation training for post-stroke spasmodic dysphonia and compare the differences in efficacy among the therapy of acupuncture combined with speech rehabilitation training and the monotherapy.MethodsTwo hundred and seventy cases of patients with post-stroke spasmodic dysarthria were randomly divided into three groups with the ratio of 1:1:1. Group A: acupuncture combined with speech rehabilitation training group (90 cases), group B: acupuncture group (90 cases), group C: speech rehabilitation training group (90 cases). In the group B, acupuncture treatment was given at B?ihuì (

GV 20), Jīnjīn (

EX-HN 12) and Yùyè (

EX-HN 13) as well as tongue-three needles. In the group C, the treatment of speech rehabilitation training was provided. The two treatments mentioned above were combined in the group A. Patients were treated once a day for a month with improved Frenchay dysarthria rating scale as the indices of therapeutic effect evaluation.Results

Group A: the cured and markedly effective rate was 88.7%, and total effective rate was 94.3%; group B: the cured and markedly effective rate was 44.2% and total effective rate was 81.4%; group C: the cured and markedly effective rate was 23.5% and total effective rate was 61.2%. Both the cured and markedly effective rate and the total effective rate in the group A were significantly higher than those in the group B or group C (all P<0.05); both the cured and markedly effective rate and the total effective rate in the group B were higher than those of group C (both P<0.05);

In comparison of functional recovery of tongue in accordance with the Frenchay dysarthria rating scale, the recovery rate of the tongue-stationary state was 71.74% in the group A, 18.87% in the group B and 4.44% in the group C; the recovery rate of tongue lolling out was 66.23% in the group A, 27.63% in the group B and 1.59% in the group C; the recovery rate of tongue up and down motion was 44.19% in the group A, 4.94% in the group B and 1.35% in the group C; the recovery rate of lateral motion was 40.24% in the group A, 7.59% in the group B and 0.00% in the group C; the recovery rate of alternating motion was 29.07% in the group A, 7.14% in the group B and 1.23% in the group C; the recovery rate of speech was 29.07% in the group A, 5.88% in the group B and 1.22% in the group C. In the three groups, the recovery rates of stationary state and tongue lolling out were superior to those of up and down movement, lateral movement, alternating movement and speech (all P<0.05).ConclusionThe clinical efficacy of acupuncture combined with speech rehabilitation training for patients with post-stroke spasmodic dysarthria is significant, and the efficacy of acupuncture is superior to that of speech rehabilitation training; as for functional recovery of tongue like stationary state and tongue out, the therapy of acupuncture combined with speech rehabilitation training is effective.     

针灸结合康复训练综合治疗中风后肩手综合征的进展

针灸、康复训练等疗法治疗中风后肩手综合征各有优势,且针灸与康复疗法之间有很好的互补性,研究表明针灸与康复训练有机结合的综合疗法优于其单一治疗方法,已逐渐成为中风后肩手综合征的治疗方向和临床研究热点之一,因此,将针灸、康复训练等中西医疗法的优势有机综合应用是神经康复学的探索方向,也是现代多专业一体化治疗理念的有益探索,符合当前国家中医药管理局中医综合治疗模式的政策精神。     

针刺配合吞咽言语诊治仪治疗卒中后吞咽障碍的临床观察

脑卒中吞咽障碍发生率约占40%～50%,多数患者的吞咽功能可逐渐恢复,但约有10%的患者,吞咽障碍不能自行缓解,需要进行专门的康复治疗,采用针刺配合吞咽言语诊治仪治疗卒中后吞咽障碍,可以缓解肌废用性萎缩,加强其功能,改善咽喉部血流,实现吞咽反射弧的恢复与重建,总有效率可达97.5%。     

Treatment of 85 patients with dysphagia after stroke with deep needling at local glossopharyngeum

ObjectiveTo observe the clinical efficacy of deep needling at local glossopharyngeum in treatment of dysphagia after stroke.MethodsDeep needling at local glossopharyngeum was applied in 85 patients with dysphagia after stroke. Firstly, quick prick was conducted on lingual surface (mainly at the side of paralysis lingualis), Jīnjīn (

EX-HN 12) and Yùyè (

EX-HN 13) under the tongue; secondly, filiform needle with the length of 75 mm was used to perform quick prick at posterior wall of pharynx at the affected side about three or four times, and then the needle was removed rapidly. Filiform needle with the length of 75 mm was inserted perpendicularly at Liánquán (

CV 23) towards root of tongue; after deqi, the needle was pushed towards root of tongue in the depth of 60–70 mm, and the needle was retained for 30 min. Meanwhile, the patient was asked to swallow, and the feeling of abnormal deglutition without pain was considered as most appropriate. During needle retention, twirling for reinforcement was applied for two times. The manipulation was conducted once daily, and six days was considered as one course of treatment. Between two courses, one day was free of treatment; and there were four courses in total. Kubota's drinking water test evaluation scale was applied to assess the efficacy after the treatment for two weeks and four weeks.ResultsThe score of Kubota's drinking water test at the early stage of treatment was 5.08 ± 2.28, the score of evaluation of treatment with deep needling at local glossopharyngeum after treatment for two weeks was 4.56 ± 2.32, and the total effective rate was 89.4%; the score of evaluation after treatment for four weeks was 2.80 ± 2.12, and the total effective rate was 95.3%. Compare before the treatment, the score of Kubota's drinking water test was reduced after treatment for two and four weeks (P<0.05, P<0.01).ConclusionDeep needling at local glossopharyngeum in treatment of dysphagia after stroke has good effect.     

针刺治疗脑卒中后吞咽困难方案优选分析

针刺疗法治疗脑卒中后吞咽障碍的研究获得了较大的进展,方案得到了改进,疗效得到了提高。针灸治疗治疗本病具有安全、有效、价格低廉、易操作和易推广的优点,发展前景广阔,也弥补了现代医学治疗本病的不足。也存在不少问题:1缺少统一量化的疾病分级和疗效评价标准;2缺乏的统一的针刺、选穴标准,需要规范针刺手法、刺激强度、治疗时机。3各治疗方法疗效可比性差,对照组单一,样本量较少。