针刺联合电刺激对假性延髓麻痹吞咽功能及脑血流的影响

摘要

目的：观察针刺颈项部腧穴联合神经电刺激对脑卒中后假性延髓麻痹患者的吞咽功能及脑血流的影响。方法将符合诊断标准的患者随机分为对照组(35例)和治疗组(33例),对照组给予西药常规治疗,治疗组在对照组的基础上加用针刺颈项部腧穴联合神经电刺激治疗,每日1次,4星期为1个疗程。结果治疗后两组患者总有效率分别为93.9%和80.0%,治疗组明显优于对照组；治疗后全血黏度高切、全血黏度低切、红细胞压积、血浆黏度均较治疗前明显下降,与对照组比较,差异具有统计学意义(P＜0.05)；两组患者治疗前后 TCD 各项指标比较,治疗组治疗后左椎动脉、右椎动脉、基底动脉 Vm,Vs,PI较治疗前明显改善(P＜0.05),对照组治疗后左椎动脉、右椎动脉、基底动脉Vm和Vs较治疗前改善(P＜0.05),对照组治疗后PI 较治疗前未见明显改善,差异无统计学意义(P＞0.05),两组患者治疗后左椎动脉、右椎动脉、基底动脉 Vm,Vs,PI 组间比较差异均具有统计学意义(P＜0.05)。结论在常规治疗的基础上,针刺颈项部腧穴联合神经电刺激能够明显改善脑卒中后假性延髓麻痹患者的吞咽功能,其作用机制可能是通过改善脑部血流,促进脑组织功能的修复达到的。%Objective To observe the effect of acupuncture at nape points plus nerve electrical stimulation on deglutition function and cerebral blood flow in pseudobulbar palsy after cerebral stroke. Method The eligible subjects were randomized into a control group of 35 cases and a treatment group of 33 cases. The control group was intervened by conventional Western medication, while the treatment group was by acupuncture at nape points plus nerve electrical stimulation in addition to the Western medication, once a day, 4 weeks as a treatment course. Result The total effective rates were respectively 93.9%and 80.0%in the two groups, and the treatment group was significantly superior to the control group; after the intervention, the high whole blood viscosity, low whole blood viscosity, hematocrit, and plasma viscosity all dropped markedly in the treatment group, and were significantly different from that in the control group (P<0.05). The Transcranial Doppler (TCD) showed that the blood flow mean velocity (Vm), systolic velocity (Vs), and pulsatility index (PI) of the left vertebral artery, right vertebral artery, and basilar artery in the treatment group were significantly improved after the intervention (P<0.05), and the Vm and Vs of the left vertebral artery, right vertebral artery, and basilar artery in the control group were significantly improved after the intervention (P<0.05), while PI in the control group didn’t show significant improvement (P>0.05). After the intervention, there were significant differences in comparing the Vm, Vs, and PI of the left vertebral artery, right vertebral artery, and basilar artery between the two groups (P<0.05). Conclusion Acupuncture at nape points plus nerve electrical stimulation is effective in improving the deglutition function in pseudobulbar palsy after cerebral stroke, and its action mechanism is plausibly through improving the cerebral blood flow and promoting the recovery of brain function.