深层咽肌神经刺激联合针刺治疗 脑卒中后吞咽障碍40例

目的 观察深层咽肌神经刺激联合针刺治疗脑卒中后吞咽障碍的临床疗效。方法 采用随机数字表法将脑卒中后吞咽障碍患者分为观察组和对照组，每组40例。在吞咽康复训练的基础上，对照组采用针刺治疗，观察组采用针刺治疗和深层咽肌神经刺激治疗，疗程均为3周。3周后，采用洼田饮水试验、标准吞咽功能评价量表(standardized swallowing assessment， SSA)评价患者吞咽功能，采用吞咽相关生活质量量表(swallowing-related quality of life， SWAL-QOL)评价患者生活质量，采用改良Barthel指数(modified barthel index， MBI)评价患者的活动能力，测定血清白蛋白(albumin， ALB)、血红蛋白(hemoglobin， Hb)、血清前白蛋白(prealbumin， PAB)评价患者的营养状况，观察并比较两组患者的不良反应。结果 观察组吞咽困难疗效显著优于对照组(P＜0.05)。两组患者治疗后洼田饮水试验分级均较治疗前明显改善（P＜0.05），观察组治疗后洼田饮水试验分级变化明显优于对照组（P＜0.05）。与治疗前比较，治疗后两组患者SSA评分均明显降低（P＜0.05），且观察组SSA评分降低程度明显大于对照组(P＜0.05)；两组患者SWAL-QOL、MBI评分均明显升高(P＜0.05)，其中观察组患者MBI评分升高程度明显大于对照组(P＜0.05)。两组患者治疗后PAB、ALB、Hb水平显著升高（P＜0.05）；观察组治疗后ALB、Hb升高程度显著大于对照组（P＜0.05）。两组不良反应发生率比较，差异无统计学意义(P>0.05)。结论 深层咽肌神经刺激联合针刺可改善脑卒中后吞咽障碍患者吞咽障碍和营养状况，提高患者的生活质量。

Clinical Effect of Deep Pharyngeal Muscle Nerve Stimulation Combined with Acupuncture in Treatment of Dysphagia After Stroke: An Analysis of 40 Cases

Objective To investigate the clinical effect of deep pharyngeal muscle nerve stimulation combined with acupuncture in the treatment of dysphagia after stroke. Methods A total of 80 patients with dysphagia after stroke were divided into observation group and control group using a random number table, with 40 patients in each group. In addition to swallowing rehabilitation training, the patients in the control group were given acupuncture, and those in the observation group were given deep pharyngeal muscle nerve stimulation combined with acupuncture. The course of treatment was 3 weeks for both groups. After 3 weeks of treatment, the water swallow test (WST) and standardized swallowing assessment (SSA) scale were used to evaluate swallowing function, the swallowing-related quality of life (SWAL-QOL) scale was used to evaluate quality of life, modified Barthel Index (MBI) was used to evaluate the activity of daily living, and serum levels of albumin (Alb), hemoglobin (Hb), and prealbumin (PAB) were measured to assess nutritional status. Adverse reactions were compared between the two groups.Results The observation group had a significantly better improvement in dysphagia than the control group (P<0.05). Both groups had a significant improvement in WST grade after treatment (P<0.05), and the observation group had a significantly better improvement than the control group (P<0.05). After treatment, both groups had a significant reduction in SSA score and significant increases in SWAL-QOL and MBI scores (P<0.05), and compared with the control group, the observation group had a significantly greater reduction in SSA score and significantly greater increases in SWAL-QOL and MBI scores (P<0.05). Both groups had significant increases in the serum levels of PAB, Alb, and Hb after treatment (P<0.05), and the observation group had significantly greater increases in Alb and Hb than the control group (P<0.05). There was no significant difference in the incidence rate of adverse reactions between the two groups (P>0.05). Conclusion In patients with dysphagia after stroke, deep pharyngeal muscle nerve stimulation combined with acupuncture can improve dysphagia, nutritional status, and quality of life.