本文選題：康復(fù)訓(xùn)練　切入點(diǎn)：腦卒中　出處：《北京中醫(yī)藥大學(xué)》2013年碩士論文　論文類型：學(xué)位論文

【摘要】：研究目的： 吞咽障礙作為腦卒中最常見的后遺癥之一,容易導(dǎo)致吸入性肺炎、營養(yǎng)不良甚至窒息等嚴(yán)重并發(fā)癥,影響患者的生存質(zhì)量。目前西醫(yī)對腦卒中后吞咽障礙并無特效藥,很大程度依靠吞咽功能的康復(fù)訓(xùn)練。針灸是我國傳統(tǒng)醫(yī)學(xué)的瑰寶,在長期的實踐中積累了豐富的經(jīng)驗,現(xiàn)代研究表明,針灸配合吞咽功能的康復(fù)訓(xùn)練聯(lián)合治療腦卒中后吞咽障礙療效顯著,并且安全、經(jīng)濟(jì),值得在臨床中進(jìn)一步推廣。本課題進(jìn)行了隨機(jī)對照臨床研究,采取了科學(xué)的評估方法,以客觀評價規(guī)范化的針灸實施方案治療腦卒中后吞咽障礙的療效,為進(jìn)一步的推廣應(yīng)用提供循證醫(yī)學(xué)的證據(jù)。 研究方法： 本課題“針灸治療卒中后吞咽障礙技術(shù)的研究”以腦卒中后吞咽障礙患者為研究對象,一共收取360例病例。本研究選取北京中醫(yī)藥大學(xué)東直門醫(yī)院45例,其中1例由于自動出院、1例因為無法完善相關(guān)的輔助檢查而自動退出,實際統(tǒng)計了43例,隨機(jī)分為兩組,治療組21例,對照組22例。入組時嚴(yán)格依據(jù)客觀原則,評價患者符合入組條件后,拆取隨機(jī)信封進(jìn)行分組,確定治療方法。對照組設(shè)計在常規(guī)內(nèi)科基礎(chǔ)治療加上吞咽功能的康復(fù)訓(xùn)練,治療組在對照組基礎(chǔ)上給予針灸綜合治療方案(體針、電針、點(diǎn)刺放血)。每周3次,隔日1次,14天為一個療程。以治療第14天、第28天、第42天、第60天為療效評價時點(diǎn),用洼田飲水試驗評分對兩組進(jìn)行療效評價對比。最后應(yīng)用Access軟件建立數(shù)據(jù)庫,將數(shù)據(jù)導(dǎo)入SPSS軟件中進(jìn)行相關(guān)統(tǒng)計學(xué)分析。研究結(jié)果： 基線比較：通過對受試者的性別、年齡、病程、中風(fēng)的類型、治療前洼田飲水試驗評分等基線進(jìn)行統(tǒng)計學(xué)分析,結(jié)果顯示,兩組之間差別無統(tǒng)計學(xué)意義(P0.05)。說明兩組間的基線差別是無統(tǒng)計學(xué)差異的,具有可比性。 結(jié)果比較：兩組的臨床療效觀察,評定療效的標(biāo)準(zhǔn)為：痊愈：飲水試驗評定1級；有效：飲水試驗評定2級或未達(dá)到2級,但較治療前提高1級或1級以上；無效：飲水試驗評定3級以上。最終對兩組治療的有效率進(jìn)行對比,經(jīng)過統(tǒng)計分析,Z=-2.177,P=0.029(P0.05),差異有統(tǒng)計學(xué)意義。結(jié)論： 以洼田飲水試驗評分對治療效果進(jìn)行療綜合評價對比,結(jié)果顯示兩種治療具有一定程度的效果,而針灸配合吞咽功能康復(fù)訓(xùn)練的效果要優(yōu)于單獨(dú)的康復(fù)訓(xùn)練,更能改善患者的吞咽功能,針刺操作安全有效,值得進(jìn)一步推廣應(yīng)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.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R246.6

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