针灸治疗卒中后吞咽障碍患者43例的临床观察

发布时间：2018-03-21 05:19

本文选题：康复训练　切入点：脑卒中　出处：《北京中医药大学》2013年硕士论文　论文类型：学位论文

【摘要】：研究目的：吞咽障碍作为脑卒中最常见的后遗症之一,容易导致吸入性肺炎、营养不良甚至窒息等严重并发症,影响患者的生存质量。目前西医对脑卒中后吞咽障碍并无特效药,很大程度依靠吞咽功能的康复训练。针灸是我国传统医学的瑰宝,在长期的实践中积累了丰富的经验,现代研究表明,针灸配合吞咽功能的康复训练联合治疗脑卒中后吞咽障碍疗效显著,并且安全、经济,值得在临床中进一步推广。本课题进行了随机对照临床研究,采取了科学的评估方法,以客观评价规范化的针灸实施方案治疗脑卒中后吞咽障碍的疗效,为进一步的推广应用提供循证医学的证据。研究方法：本课题“针灸治疗卒中后吞咽障碍技术的研究”以脑卒中后吞咽障碍患者为研究对象,一共收取360例病例。本研究选取北京中医药大学东直门医院45例,其中1例由于自动出院、1例因为无法完善相关的辅助检查而自动退出,实际统计了43例,随机分为两组,治疗组21例,对照组22例。入组时严格依据客观原则,评价患者符合入组条件后,拆取随机信封进行分组,确定治疗方法。对照组设计在常规内科基础治疗加上吞咽功能的康复训练,治疗组在对照组基础上给予针灸综合治疗方案(体针、电针、点刺放血)。每周3次,隔日1次,14天为一个疗程。以治疗第14天、第28天、第42天、第60天为疗效评价时点,用洼田饮水试验评分对两组进行疗效评价对比。最后应用Access软件建立数据库,将数据导入SPSS软件中进行相关统计学分析。研究结果：基线比较：通过对受试者的性别、年龄、病程、中风的类型、治疗前洼田饮水试验评分等基线进行统计学分析,结果显示,两组之间差别无统计学意义(P0.05)。说明两组间的基线差别是无统计学差异的,具有可比性。结果比较：两组的临床疗效观察,评定疗效的标准为：痊愈：饮水试验评定1级；有效：饮水试验评定2级或未达到2级,但较治疗前提高1级或1级以上；无效：饮水试验评定3级以上。最终对两组治疗的有效率进行对比,经过统计分析,Z=-2.177,P=0.029(P0.05),差异有统计学意义。结论：以洼田饮水试验评分对治疗效果进行疗综合评价对比,结果显示两种治疗具有一定程度的效果,而针灸配合吞咽功能康复训练的效果要优于单独的康复训练,更能改善患者的吞咽功能,针刺操作安全有效,值得进一步推广应用。
[Abstract]:Objectives of the study:. As one of the most common sequelae of stroke, dysphagia can easily lead to severe complications such as aspiration pneumonia, malnutrition or even asphyxia, which affects the quality of life of patients. Acupuncture and moxibustion is the treasure of traditional medicine in China and has accumulated rich experience in long-term practice. Modern research shows that, Acupuncture and moxibustion combined with rehabilitation training of swallowing function are effective in the treatment of dysphagia after stroke, and are safe, economical and worthy of further promotion in clinical practice. Objective evaluation of the effect of standardized acupuncture and moxibustion on dysphagia after stroke provides evidence of evidence-based medicine for further application. Research methods:. In this study, 360 patients with post-stroke dysphagia were selected from Dongzhimen Hospital, Beijing University of traditional Chinese Medicine, to study the technique of acupuncture and moxibustion in treating dysphagia after stroke. Among them, 1 case of automatic discharge from hospital and 1 case of automatic withdrawal because of unable to perfect the related auxiliary examination. 43 cases were counted and randomly divided into two groups: treatment group (21 cases) and control group (22 cases). When entering the group, the objective principle was strictly followed. After the patients met the condition of entering the group, random envelopes were removed and divided into groups to determine the treatment methods. The control group was designed for routine basic medical treatment plus rehabilitation training for swallowing function. On the basis of the control group, the treatment group was given acupuncture and moxibustion comprehensive treatment (body acupuncture, electroacupuncture, prick and bloodletting. 3 times a week, once a day for 14 days as a course of treatment. The 14th day, 28th day, 42nd day, 60th day were used as the time points to evaluate the curative effect, the therapeutic effect was evaluated on the 14th day, the 28th day, the 42nd day, the 60th day). The curative effect of the two groups was evaluated and compared with the Wata drinking water test score. Finally, the database was established by using Access software, and the data was imported into the SPSS software to carry on the correlation statistical analysis. The results of the study were as follows:. Baseline comparison: based on the baseline analysis of the subjects' gender, age, course of disease, type of stroke, and scores of potable water test before treatment, the results showed that, There was no significant difference between the two groups (P 0.05), which indicated that the baseline difference between the two groups had no statistical difference and was comparable. Results: the clinical efficacy of the two groups was evaluated as follows: recovery: grade 1 of drinking water test, effective: grade 2 or not of grade 2 of drinking water test, but increased by grade 1 or more than before treatment. Ineffective: drinking water test evaluation above grade 3. Finally, the effective rate of the two groups was compared. After statistical analysis, the difference was statistically significant. The therapeutic effects were evaluated and compared with the Wata drinking water test score. The results showed that the two treatments had a certain degree of effect, and the effect of acupuncture combined with swallowing function rehabilitation training was better than that of single rehabilitation training. It can improve the swallowing function of the patients, and the acupuncture operation is safe and effective.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R246.6

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