本文關(guān)鍵詞：針刺運(yùn)動(dòng)療法治療中風(fēng)后吞咽障礙的療效觀察　出處：《廣州中醫(yī)藥大學(xué)》2017年碩士論文　論文類(lèi)型：學(xué)位論文

  更多相關(guān)文章： 中風(fēng) 吞咽障礙 針刺運(yùn)動(dòng)療法 針刺 康復(fù)訓(xùn)練

【摘要】：目的:通過(guò)對(duì)比研究針刺運(yùn)動(dòng)療法與單純針刺結(jié)合康復(fù)訓(xùn)練治療中風(fēng)后吞咽障礙的臨床療效,對(duì)針刺運(yùn)動(dòng)療法在中風(fēng)后吞咽障礙治療上的作用進(jìn)行探討和評(píng)價(jià),為治療本病探求更為有效而簡(jiǎn)便的方法,并讓本研究所得結(jié)果及結(jié)論為今后進(jìn)一步研究及臨床運(yùn)用提供可靠的臨床依據(jù)。方法:將符合本研究的納入標(biāo)準(zhǔn)的60例患者,用簡(jiǎn)單隨機(jī)化方法隨機(jī)分為治療組和對(duì)照組各30例,兩組病例均給予相應(yīng)基礎(chǔ)治療,包括高血壓、糖尿病、血脂異常等基礎(chǔ)疾病的治療及中風(fēng)病常規(guī)治療及癱瘓肢體綜合訓(xùn)練。兩組的治療方法包括針刺(頭針額中線、頂中線、頂顳前斜線下2/5(雙)及舌三針)與康復(fù)訓(xùn)練(吞咽器官運(yùn)動(dòng)訓(xùn)練和攝食直接訓(xùn)練),治療組(針刺運(yùn)動(dòng)療法)是在針刺過(guò)程中同時(shí)進(jìn)行康復(fù)訓(xùn)練,而對(duì)照組(單純針刺結(jié)合康復(fù)訓(xùn)練)為針刺出針后再行康復(fù)訓(xùn)練。兩組的針刺取穴、操作方法及康復(fù)訓(xùn)練方法,療程(4周)均相同。治療前以洼田飲水試驗(yàn)對(duì)患者吞咽功能進(jìn)行評(píng)級(jí)篩選,并在治療前后分別行洼田吞咽能力及吞咽困難評(píng)價(jià)標(biāo)準(zhǔn)評(píng)定,進(jìn)行臨床療效評(píng)價(jià)。最后應(yīng)用SPSS19.0統(tǒng)計(jì)軟件對(duì)研究數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:(1)基線資料:兩組病例的年齡、性別、病程、腦卒中類(lèi)型等一般資料經(jīng)比較,差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),提示兩組間基線一致,具有可比性。治療前的洼田飲水試驗(yàn)評(píng)分、洼田吞咽能力評(píng)級(jí)、吞咽困難評(píng)價(jià)標(biāo)準(zhǔn)經(jīng)比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),說(shuō)明治療前兩組病情具有可比性。(2)洼田吞咽能力評(píng)定法:兩組內(nèi)治療前、后的對(duì)比,治療后評(píng)級(jí)均較前提升,差異均有顯著統(tǒng)計(jì)學(xué)意義(P0.01)。兩組間治療后及治療前后差值比較,P0.05,均提示組間存在差異。治療后,兩組療效比較顯示,治療組顯效18例,有效10例,無(wú)效2例,總有效率為93.33%;對(duì)照組顯效5例,有效21例,無(wú)效4例,總有效率86.67%,顯示組間療效差異具有顯著統(tǒng)計(jì)學(xué)意義(P0.01)。(3)吞咽困難評(píng)價(jià)標(biāo)準(zhǔn):兩組內(nèi)分別進(jìn)行治療前后的評(píng)分比較,結(jié)果顯示差異具有顯著統(tǒng)計(jì)學(xué)意義(P0.01),結(jié)合分布圖可以直觀地看出,兩組治療后的評(píng)分均較前提高,提示吞咽功能均較前改善。兩組間治療后評(píng)分比較,P0.05,提示組間差異具有統(tǒng)計(jì)學(xué)意義。兩組得分水平比較,組間治療后及組間治療前后分差,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。依據(jù)該量表的評(píng)價(jià)標(biāo)準(zhǔn),得出治療組基本痊愈5例,明顯好轉(zhuǎn)3例,好轉(zhuǎn)17例,無(wú)效5例,總有效率為83.33%;對(duì)照組基本痊愈2例,明顯好轉(zhuǎn)1例,好轉(zhuǎn)16例,無(wú)效11例,總有效率是63.33%;兩組間的療效進(jìn)行比較,P0.05,提示兩組療效比較差異有統(tǒng)計(jì)學(xué)意義。結(jié)論:針刺運(yùn)動(dòng)療法(治療組)與單純針刺結(jié)合康復(fù)訓(xùn)練(對(duì)照組)治療中風(fēng)后吞咽障礙均有療效,均能改善患者吞咽功能,但是針刺運(yùn)動(dòng)療法較對(duì)照組療效要好。因此,針刺運(yùn)動(dòng)療法作為一種簡(jiǎn)便、高效、安全的治療方法,對(duì)治療中風(fēng)后吞咽障礙具有一定優(yōu)勢(shì),值得臨床推廣應(yīng)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.

【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R246.6

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