针刺运动疗法治疗中风后吞咽障碍的疗效观察

发布时间：2018-01-06 05:28

本文关键词：针刺运动疗法治疗中风后吞咽障碍的疗效观察　出处：《广州中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:通过对比研究针刺运动疗法与单纯针刺结合康复训练治疗中风后吞咽障碍的临床疗效,对针刺运动疗法在中风后吞咽障碍治疗上的作用进行探讨和评价,为治疗本病探求更为有效而简便的方法,并让本研究所得结果及结论为今后进一步研究及临床运用提供可靠的临床依据。方法:将符合本研究的纳入标准的60例患者,用简单随机化方法随机分为治疗组和对照组各30例,两组病例均给予相应基础治疗,包括高血压、糖尿病、血脂异常等基础疾病的治疗及中风病常规治疗及瘫痪肢体综合训练。两组的治疗方法包括针刺(头针额中线、顶中线、顶颞前斜线下2/5(双)及舌三针)与康复训练(吞咽器官运动训练和摄食直接训练),治疗组(针刺运动疗法)是在针刺过程中同时进行康复训练,而对照组(单纯针刺结合康复训练)为针刺出针后再行康复训练。两组的针刺取穴、操作方法及康复训练方法,疗程(4周)均相同。治疗前以洼田饮水试验对患者吞咽功能进行评级筛选,并在治疗前后分别行洼田吞咽能力及吞咽困难评价标准评定,进行临床疗效评价。最后应用SPSS19.0统计软件对研究数据进行统计学分析。结果:(1)基线资料:两组病例的年龄、性别、病程、脑卒中类型等一般资料经比较,差异均无统计学意义(P0.05),提示两组间基线一致,具有可比性。治疗前的洼田饮水试验评分、洼田吞咽能力评级、吞咽困难评价标准经比较,差异无统计学意义(P0.05),说明治疗前两组病情具有可比性。(2)洼田吞咽能力评定法:两组内治疗前、后的对比,治疗后评级均较前提升,差异均有显著统计学意义(P0.01)。两组间治疗后及治疗前后差值比较,P0.05,均提示组间存在差异。治疗后,两组疗效比较显示,治疗组显效18例,有效10例,无效2例,总有效率为93.33%;对照组显效5例,有效21例,无效4例,总有效率86.67%,显示组间疗效差异具有显著统计学意义(P0.01)。(3)吞咽困难评价标准:两组内分别进行治疗前后的评分比较,结果显示差异具有显著统计学意义(P0.01),结合分布图可以直观地看出,两组治疗后的评分均较前提高,提示吞咽功能均较前改善。两组间治疗后评分比较,P0.05,提示组间差异具有统计学意义。两组得分水平比较,组间治疗后及组间治疗前后分差,差异均有统计学意义(P0.05)。依据该量表的评价标准,得出治疗组基本痊愈5例,明显好转3例,好转17例,无效5例,总有效率为83.33%;对照组基本痊愈2例,明显好转1例,好转16例,无效11例,总有效率是63.33%;两组间的疗效进行比较,P0.05,提示两组疗效比较差异有统计学意义。结论:针刺运动疗法(治疗组)与单纯针刺结合康复训练(对照组)治疗中风后吞咽障碍均有疗效,均能改善患者吞咽功能,但是针刺运动疗法较对照组疗效要好。因此,针刺运动疗法作为一种简便、高效、安全的治疗方法,对治疗中风后吞咽障碍具有一定优势,值得临床推广应用。
[Abstract]:Objective: To study the acupuncture therapy and simple comparison of clinical therapeutic effect of acupuncture combined with rehabilitation training in the treatment of dysphagia after stroke, to explore and evaluate the effect of acupuncture and exercise therapy in the treatment of dysphagia after stroke, for the treatment of this disease to search for a more effective and convenient method, and the results of this study provide clinical and conclusion a reliable basis for further research and clinical application. Methods: according to the inclusion criteria of 60 patients were randomly divided into treatment group and control group of 30 cases with simple randomized method, two patients were given basic treatment, including hypertension, diabetes, dyslipidemia and other basic diseases and treatment of stroke in the conventional treatment and paralyzed limb comprehensive training. Two groups of treatment methods include acupuncture (acupuncture frontal midline, top line, D 2/5 (double) and tongue and rehabilitation training (three pin) Swallowing organs exercise training and training), direct feeding treatment group (acupuncture and exercise therapy) is also in the process of acupuncture and rehabilitation training, while the control group (acupuncture combined with rehabilitation training) for the acupuncture needle after rehabilitation training. Two groups of acupoints, methods of operation and rehabilitation training method, course of treatment (4 week) are the same. Prior to the treatment of drinking water test on swallowing function rating screening, and before and after the treatment respectively Watian swallowing ability and dysphagia evaluation criteria, the evaluation of clinical efficacy. Finally using the SPSS19.0 statistical software for statistical analysis of data. Results: (1) baseline data: two a case of age, gender, disease duration, the general data of stroke type by comparison, there were no significant differences (P0.05) between the two groups, suggesting that the baseline is consistent, comparable. Watian drinking water test score before treatment, Watian swallowing The ability of pharyngeal dysphagia rating evaluation criteria by comparison, no statistically significant difference (P0.05), indicating the two groups before treatment was comparable. (2) Watian swallowing ability evaluation method: the treatment in the two groups before and after treatment comparison, after rating than before, the differences were statistically significant (P0.01). Between the two groups before and after treatment and after treatment difference, P0.05, showed that there are differences between groups. After treatment, compared the efficacy of the two groups, the treatment group 18 cases, 10 cases were effective, 2 cases ineffective, the total effective rate was 93.33%; the control group was 5 cases, effective 21 cases, invalid in 4 cases, the total efficiency of 86.67%, showing a significant difference between the two groups (P0.01). (3) dysphagia evaluation criteria: in the two groups respectively before and after treatment were compared. The results showed that there was a statistically significant difference (P0.01), combined with the distribution map can be seen visually, the two groups after treatment the Scores were better than before, suggesting that the swallowing function were improved. Comparison of P0.05 score between the two groups after treatment, the difference was statistically significant between the groups. That compared the scores level in the two groups, after treatment group and inter group difference before and after treatment, the differences were statistically significant (P0.05). According to the evaluation of the scale the standard, obtained in the treatment group 5 cases were cured, 3 cases improved obviously, 17 cases improved, 5 cases ineffective, the total effective rate was 83.33%; the control group 2 cases were cured, 1 cases improved obviously, 16 cases improved, 11 cases ineffective, the total efficiency is 63.33%; comparison of efficacy between the two groups. For P0.05, there were significant differences between the two groups. Conclusion: the curative effect that acupuncture and movement therapy (treatment group) and acupuncture combined with rehabilitation training (control group) had curative effect in the treatment of dysphagia after stroke can improve swallowing function in patients, but the acupuncture therapy is better effect than the control group. Therefore, acupuncture As a simple, efficient and safe treatment method, sports therapy has some advantages for the treatment of dysphagia after apoplexy. It is worthy of clinical application.

【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R246.6

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