目的 观察不同时期介入针刺和康复训练对脑卒中后吞咽障碍临床疗效的影响.方法 将155例患者按照分层随机的方法分为对照组80例(急性期26例,恢复期54例)和观察组75例(急性期21例,恢复期54例).两组均接受基础治疗和常规康复训练,观察组同时接受针刺治疗.每周治疗5次,连续治疗4周.以洼田饮水试验和吞咽障碍中医评价量表分别评价两组的总疗效和不同时期介入治疗的临床疗效.结果 根据洼田饮水试验评定,观察组总有效率89.33%,对照组总有效率66.67%,观察组疗效明显优于对照组(P<0.01);观察组中急性期有效率90.48%,恢复期有效率88.89%,急性期疗效明显优于恢复期(P<0.01).以吞咽障碍中医评价量表评价,对照组总有效率64.00%,观察组总有效率74.67%,无显著性差异(P>0.05);观察组中急性期有效率90.48%,恢复期有效率68.52%,急性期疗效显著优于恢复期(P<0.001).结论 针刺配合康复训练的疗效优于单纯的康复训练,且早期介入优于恢复期介入.%Objective To observe the therapeutic effect of acupuncture combined with rehabilitation on dysphagia after stroke at different stage. Methods According to the randomized trial principle, 155 cases were divided into two groups: control group (n=80) and observation group (n=75). The control group was treated with rehabilitation training, and the observation group was treated with acupuncture and rehabilitation training, 5 times every week for 4 weeks. The two groups were assessed by TCM swallowing assessment scores and Kubota test before and after treatment. Results According to Kubota test, the total rate was 66.67％ in the control group and 89.33％ in the observation group with a significant difference between the groups (P＜0.001). In the observation group, the total rate was 90.48％ at acute stage and 88.89％ at the convalescence stage with a significant difference (P＜0.01). According to TCM swallowing assessment, the total rate was 64.00％ in the control group and 74.67％ in the observation group with no significant difference between the groups (P＞0.05). In the observation group, the total rate was 90.48％ at acute stage and 68.52％ at the convalescence stage with a significant difference (P＜0.001). Conclusion Acupuncture combined with rehabilitation facilitates to improve the swallowing function in stroke patients following dysphagia especially at acute stage.
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