發(fā)布時間：2018-08-20 16:07

【摘要】：目的:吞咽困難是腦卒中的常見并發(fā)癥之一,可導(dǎo)致營養(yǎng)不良、吸入性肺炎、電解質(zhì)紊亂及心理障礙等問題,嚴(yán)重影響腦卒中患者的生活質(zhì)量及生存周期,因而必須積極尋求有效的治療措施以恢復(fù)患者的吞咽功能�，F(xiàn)代醫(yī)學(xué)通過多種治療措施對于吞咽困難雖有一定療效,但總體臨床效果欠佳,且其治療過程存在康復(fù)慢、經(jīng)濟(jì)負(fù)擔(dān)重及過程復(fù)雜等缺點(diǎn),難以滿足現(xiàn)代的臨床治療需求。中醫(yī)治療卒中后吞咽困難有一定優(yōu)勢,尤其是針刺療法,其臨床療效已經(jīng)獲得一定的臨床認(rèn)可,而本文的研究目的即是證實(shí)針刺在治療本病方面的臨床有效性及安全性。方法:將我院針灸科及中風(fēng)科科自2015年6月至2016年6月間收治的60例腦卒中后吞咽困難的患者,按照其入院先后順序并結(jié)合其自身意愿,半隨機(jī)的平均分為觀察組及對照組兩組,每組各30例,其中對照組給予西醫(yī)常規(guī)治療,觀察組則在對照組基礎(chǔ)上聯(lián)合中醫(yī)針刺治療。每次針刺留針20min,每日一次,每針灸10天休息3天,共治療兩個療程。治療結(jié)束后分析兩組患者的吞咽能力、臨床效果、生活質(zhì)量、神經(jīng)功能缺損情況及中醫(yī)癥候評分情況。結(jié)果:治療前,兩組患者的基本資料大致相同,無明顯差異性。治療結(jié)束后,兩組患者吞咽功能以洼田飲水試驗(yàn)進(jìn)行評價,總體評價結(jié)果顯示,觀察組吞咽功能優(yōu)于對照組,其差異具有統(tǒng)計學(xué)意義。在臨床治療效果方面,觀察組臨床有效率達(dá)83.3%,明顯優(yōu)于對照組的53.3%,臨床差異明顯,具有統(tǒng)計學(xué)意義。在生活質(zhì)量評分方面,觀察組治療結(jié)束后評分為(75.24±3.67),明顯優(yōu)于對照組的(63.25±4.19),差異亦具有統(tǒng)計學(xué)意義。在神經(jīng)功能缺損方面,觀察組治療后評分為(3.36±0.71),明顯優(yōu)于照組(5.25±1.19),兩者差異明顯。在中醫(yī)癥候積分方面,觀察組治療結(jié)束后的評分為(11.64±2.71),明顯低于對照組(15.46±3.27),差異亦具有統(tǒng)計學(xué)意義(P0.05)。結(jié)論:針刺治療卒中后吞咽困難臨床療效確切,可有效改善患者的吞咽功能,提高臨床治療效果,糾正神經(jīng)功能缺損情況,降低并發(fā)癥的發(fā)生率,有利于改善患者的生活質(zhì)量,延長患者的生存周期。
[Abstract]:Objective: dysphagia is one of the common complications of stroke, which can lead to malnutrition, aspiration pneumonia, electrolyte disorders and psychological disorders, which seriously affect the quality of life and life cycle of stroke patients. Therefore, effective treatment must be actively sought to restore the patient's swallowing function. Although modern medicine has certain curative effect on dysphagia through various treatment measures, the overall clinical effect is not good, and its treatment process has the shortcomings of slow rehabilitation, heavy economic burden and complicated process, so it is difficult to meet the needs of modern clinical treatment. There are some advantages in the treatment of dysphagia after stroke, especially acupuncture. The clinical efficacy of acupuncture has been recognized. The purpose of this study is to prove the clinical efficacy and safety of acupuncture in the treatment of this disease. Methods: from June 2015 to June 2016, 60 patients with dysphagia after stroke were treated in our department of acupuncture and moxibustion and apoplexy from June 2015 to June 2016. Half random group was divided into observation group and control group with 30 cases in each group. The control group was treated with routine western medicine and the observation group was treated with traditional Chinese medicine acupuncture on the basis of the control group. Acupuncture for 20 minutes, once a day, every 10 days rest for 3 days, a total of two courses of treatment. After the treatment, the swallowing ability, clinical effect, quality of life, neurological deficit and TCM symptom score were analyzed. Results: before treatment, the basic data of the two groups were approximately the same, no significant difference. After the treatment, the swallowing function of the two groups was evaluated by the depression-drinking water test. The overall evaluation results showed that the swallowing function of the observation group was better than that of the control group, and the difference was statistically significant. The clinical effective rate of the observation group was 83.3, which was significantly better than that of the control group (53.3%). In terms of quality of life score, the score of the observation group was (75.24 鹵3.67) after treatment, which was significantly better than that of the control group (63.25 鹵4.19), and the difference was also statistically significant. In the aspect of nerve function defect, the score of the observation group after treatment was (3.36 鹵0.71), which was significantly better than that of the radiation group (5.25 鹵1.19), and the difference between the two groups was obvious. In TCM symptom score, the observation group after treatment was (11.64 鹵2.71), significantly lower than the control group (15.46 鹵3.27), the difference was also statistically significant (P0.05). Conclusion: acupuncture is effective in treating dysphagia after stroke. It can effectively improve the swallowing function of patients, improve the clinical therapeutic effect, correct the situation of nerve function defect, reduce the incidence of complications, and improve the quality of life of patients. Prolong the patient's life cycle.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R246.6

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