Article(id=1322925092010852367, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322923490592043032, articleNumber=null, orderNo=null, doi=10.13193/j.issn.1673-7717.2025.05.039, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=null, receivedDateStr=null, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793339520695, onlineDateStr=2026-10-30, pubDate=1746806400000, pubDateStr=2025-05-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793339520695, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793339520695, creator=13701087609, updateTime=1793339520695, updator=13701087609, issue=Issue{id=1322923490592043032, tenantId=1146029695717560320, journalId=1255847919539208197, year='2025', volume='43', issue='5', pageStart='1', pageEnd='258', issueExtLink='null', onlineDate='null', pubDate='1746806400000', pubDateStr='2025-05-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793339138887, creator='13701087609', updateTime=1793340572227, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322929502539612595, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322923490592043032, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322929502539612596, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322923490592043032, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=214, endPage=217, ext={EN=ArticleExt(id=1322925093499830290, articleId=1322925092010852367, tenantId=1146029695717560320, journalId=1255847919539208197, language=EN, title=Clinical Study of Midnight-Noon Ebb-Flow Acupuncture with Buqi Quyu Decoction(补气祛瘀汤)in Treatment of Post-stroke Cricopharyngeal Muscle Atrophy Type Dysphagia, columnId=1256183365644968140, journalTitle=Chinese Archives of Traditional Chinese Medicine, columnName=Platform of Provincial Project, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the clinical effect of midnight-noon ebb-flow acupuncture combined with Buqi Quyu Decoction(补气祛瘀汤)in the treatment of post-stroke cricopharyngeal muscle atrophy type dysphagia.

Method

A total of 60 patients with post-stroke cricopharyngeal muscle atrophy type dysphagia were randomly divided into two groups,including an experimental group(30 cases)and a control group(30 cases). Two groups received basic therapy,while the control group received Buqi Quyu Decoction. The experimental group received midnight-noon ebb-flow acupuncture on the basis of the control group. The surface electromyographic changes of the submandibular muscle group between two groups as well as the results of water swallow test(WST),standardized swallowing assessment(SSA),swallowing disorder specific quality of life(SWAL-QOL)and swallowing X-ray fluoroscopy(VFSS)were compared. The clinical efficacy and overall incidence of complications were observed. Statistical analysis was conducted using SPSS 26.0.

Result

After treatment,the root mean square(RMS)values of the submandibular muscle group in two groups decreased(P<0.05). Compared with that in the control group,the RMSvalue of the submandibular muscle group in the experimental group was lower(P<0.05). After treatment,the results of WST examination of the two groups decreased,and the result of WST examination of the experimental group was lower than that of the control group(P<0.05). After treatment,the SSA scores of the two groups decreased,while the scores of SWAL-QOL and VFSS increased. The experimental group had lower SSA scores and higher scores of SWAL-QOL and VFSS(P<0.05). The total clinical effective rate of the treatment experimental group was higher than that of the control group,and the incidence rate was lower than that of the control group(P<0.05).

Conclusion

The treatment of Buqi Quyu Decoction combined with midnight-noon ebb-flow acupuncture has a good therapeutic effect on patients with post-stroke cricopharyngeal muscle atrophy type dysphagia,with advantages in improving swallowing function and high safety.

, authors=Mengting WU, Wei LIU, authorsList=Mengting WU, Wei LIU, authorCompany=null, correspAuthors=Wei LIU, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322925095567622169, articleId=1322925092010852367, tenantId=1146029695717560320, journalId=1255847919539208197, language=CN, title=子午流注针法联合补气祛瘀汤治疗卒中后环咽肌失弛型吞咽障碍临床研究, columnId=1256183369033965799, journalTitle=中华中医药学刊, columnName=省级项目平台, runingTitle=null, highlight=null, articleAbstract=
目的

探究子午流注针法联合补气祛瘀汤在卒中后环咽肌失弛型吞咽障碍治疗中的临床作用。

方法

收集卒中后环咽肌失弛型吞咽障碍患者60例,随机分为两组,试验组和对照组各30例。两组接受基础疗法,对照组予以补气祛瘀汤,试验组在对照组的基础上予以子午流注针法。对比两组颏下肌群表面肌电变化、洼田俊夫饮水试验(water swallow test,WST)、标准吞咽功能评估量表(standardized swallowing assessment,SSA)、吞咽障碍特异性生活质量量表(swallow quality-of-life questionnaire,SWAL-QOL)、吞咽X线荧光透视造影检查(videofluoroscopic swallowing study,VFSS)、临床疗效及并发症总发生率。

结果

治疗后两组下颏下肌群肌电均方根值(root mean square,RMS)水平降低(P<0.05);与对照组相比,试验组下颏下肌群RMS水平较低(P<0.05)。治疗后两组患者WST检查情况降低,且试验组WST检查低于对照组(P<0.05)。治疗后,两组SSA评分降低,SWAL-QOL评分、VFSS评分升高,且试验组SSA评分更低,SWALQOL、VFSS评分更高(P<0.05)。疗后试验组临床总有效率高于对照组,发生率低于对照组(P<0.05)。

结论

给予卒中后环咽肌失弛型吞咽障碍患者补气祛瘀汤联合子午流注针法的治疗措施,疗效佳,具有改善吞咽功能的优势,安全性高。

, authors=吴梦婷, 刘薇, authorsList=吴梦婷, 刘薇, authorCompany=null, correspAuthors=刘薇, authorNote=

吴梦婷(1986-),女,浙江温州人,副主任医师,硕士,研究方向:神经康复。

, correspAuthorsNote=
刘薇(1987-),女,福建福州人,副主任中医师,硕士,研究方向:神经康复。E-mail:。
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吴梦婷(1986-),女,浙江温州人,副主任医师,硕士,研究方向:神经康复。

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吴梦婷(1986-),女,浙江温州人,副主任医师,硕士,研究方向:神经康复。

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authorNames=李贺, 张柳萍, 陈丽莉, journalName=国际护理学杂志, refType=null, unstructuredReference=李贺,张柳萍,陈丽莉,等. 子午流注联合益经汤治疗及达标互动理念的应用对卵巢储备功能减退患者临床疗效、心理状态及应对方式的影响[J]. 国际护理学杂志,2022,41(19):3573-3577., articleTitle=子午流注联合益经汤治疗及达标互动理念的应用对卵巢储备功能减退患者临床疗效、心理状态及应对方式的影响, refAbstract=null), Reference(id=1322925120339181683, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322925092010852367, doi=null, pmid=null, pmcid=null, year=2022, volume=31, issue=17, pageStart=2455, pageEnd=2458,2467, url=null, language=null, rfNumber=[38], rfOrder=37, authorNames=尹娟, 刘淑娟, 周敏, journalName=现代中西医结合杂志, refType=null, unstructuredReference=尹娟,刘淑娟,周敏,等. 子午流注针灸法结合慢病管理模式对肝肾亏虚型类风湿关节炎患者疾病活动度、晨僵状况及步行能力的影响[J]. 现代中西医结合杂志,2022,31(17):2455-2458,2467., articleTitle=子午流注针灸法结合慢病管理模式对肝肾亏虚型类风湿关节炎患者疾病活动度、晨僵状况及步行能力的影响, refAbstract=null), Reference(id=1322925120746029172, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322925092010852367, doi=null, pmid=null, pmcid=null, year=2022, volume=28, issue=19, pageStart=115, pageEnd=120, url=null, language=null, rfNumber=[39], rfOrder=38, authorNames=秦美影, 冯亮, 苏晶, journalName=中国实验方剂学杂志, refType=null, unstructuredReference=秦美影,冯亮,苏晶,等. 酸枣仁汤联合子午流注针刺法对颈源性失眠患者椎动脉血流动力学、炎性因子、神经营养因子的影响[J]. 中国实验方剂学杂志,2022,28(19):115-120., articleTitle=酸枣仁汤联合子午流注针刺法对颈源性失眠患者椎动脉血流动力学、炎性因子、神经营养因子的影响, refAbstract=null), Reference(id=1322925121194819701, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322925092010852367, doi=null, pmid=null, pmcid=null, year=2021, volume=37, issue=5, pageStart=1122, pageEnd=1125, url=null, language=null, rfNumber=[40], rfOrder=39, authorNames=张学娟, 吴冬寒, 王玮莉, journalName=长春中医药大学学报, refType=null, unstructuredReference=张学娟,吴冬寒,王玮莉,等. 子午流注穴位按摩联合神阙灸对癌因性疲乏的晚期大肠癌患者T淋巴细胞亚群和生活质量的影响[J]. 长春中医药大学学报,2021,37(5):1122-1125., articleTitle=子午流注穴位按摩联合神阙灸对癌因性疲乏的晚期大肠癌患者T淋巴细胞亚群和生活质量的影响, refAbstract=null), Reference(id=1322925122092400758, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322925092010852367, 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组别例数男/女/(例)年龄/(岁)脑卒中病程/(个月)
试验组3019/1155.44±5.928.11±0.93
对照组3018/1255.39±5.898.09±0.98
), ArticleFig(id=1322925099468324915, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322925092010852367, language=CN, label=表1, caption=

两组卒中后环咽肌失弛型吞咽障碍患者一般资料比较

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组别例数男/女/(例)年龄/(岁)脑卒中病程/(个月)
试验组3019/1155.44±5.928.11±0.93
对照组3018/1255.39±5.898.09±0.98
), ArticleFig(id=1322925099548016692, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322925092010852367, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间静息空吞咽吞咽水吞咽浓流质吞咽糊状
试验组30治疗前6.33±0.7328.55±3.4228.32±3.3330.22±3.4234.29±4.23
治疗后3.33±0.46*#16.34±1.83*#13.12±1.66*#15.24±1.77*#17.22±2.31*#
对照组30治疗前6.37±0.7628.80±3.4028.40±3.4030.42±3.5034.30±4.29
治疗后4.93±0.55*20.44±2.65*18.43±2.32*20.13±2.64*22.32±2.53*
), ArticleFig(id=1322925099749343285, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322925092010852367, language=CN, label=表2, caption=

两组卒中后环咽肌失弛型吞咽障碍患者下颏下肌群RMS比较(±s)

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组别例数时间静息空吞咽吞咽水吞咽浓流质吞咽糊状
试验组30治疗前6.33±0.7328.55±3.4228.32±3.3330.22±3.4234.29±4.23
治疗后3.33±0.46*#16.34±1.83*#13.12±1.66*#15.24±1.77*#17.22±2.31*#
对照组30治疗前6.37±0.7628.80±3.4028.40±3.4030.42±3.5034.30±4.29
治疗后4.93±0.55*20.44±2.65*18.43±2.32*20.13±2.64*22.32±2.53*
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组别例数时间Ⅰ级Ⅱ级Ⅲ级Ⅳ级Ⅴ级
试验组30治疗前0(0)0(0)15(50.00)12(40.00)3(10.00)
治疗后17(56.67)8(26.67)4(13.33)1(3.33)0(0)
对照组30治疗前0(0)0(0)16(53.33)10(33.33)4(13.33)
治疗后13(43.33)5(16.67)7(23.33)4(13.33)1(3.33)
), ArticleFig(id=1322925099904532535, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322925092010852367, language=CN, label=表3, caption=

两组卒中后环咽肌失弛型吞咽障碍患者洼田俊夫饮水试验情况比较

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组别例数时间Ⅰ级Ⅱ级Ⅲ级Ⅳ级Ⅴ级
试验组30治疗前0(0)0(0)15(50.00)12(40.00)3(10.00)
治疗后17(56.67)8(26.67)4(13.33)1(3.33)0(0)
对照组30治疗前0(0)0(0)16(53.33)10(33.33)4(13.33)
治疗后13(43.33)5(16.67)7(23.33)4(13.33)1(3.33)
), ArticleFig(id=1322925100185550904, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322925092010852367, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间SSA评分SWAL-QOL评分VFSS评分
试验组30治疗前31.55±3.7695.22±9.835.33±0.57
治疗后22.23±2.53*#183.44±20.35*#9.06±0.91
对照组30治疗前31.62±3.6595.77±9.825.30±0.59
治疗后27.73±3.42*163.23±17.22*7.76±0.82
), ArticleFig(id=1322925100269436985, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322925092010852367, language=CN, label=表4, caption=

两组卒中后环咽肌失弛型吞咽障碍患者吞咽功能、生活质量、吞咽X线荧光透视造影评分比较(±s)

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组别例数时间SSA评分SWAL-QOL评分VFSS评分
试验组30治疗前31.55±3.7695.22±9.835.33±0.57
治疗后22.23±2.53*#183.44±20.35*#9.06±0.91
对照组30治疗前31.62±3.6595.77±9.825.30±0.59
治疗后27.73±3.42*163.23±17.22*7.76±0.82
), ArticleFig(id=1322925100592398394, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322925092010852367, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数治愈显效有效无效总有效
试验组307(23.33)13(43.33)8(26.67)2(6.67)28(93.33)*
对照组304(13.33)9(30.00)4(13.33)13(43.33)17(56.67)
), ArticleFig(id=1322925102223982651, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322925092010852367, language=CN, label=表5, caption=

两组卒中后环咽肌失弛型吞咽障碍患者临床疗效比较

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组别例数治愈显效有效无效总有效
试验组307(23.33)13(43.33)8(26.67)2(6.67)28(93.33)*
对照组304(13.33)9(30.00)4(13.33)13(43.33)17(56.67)
), ArticleFig(id=1322925102324645949, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322925092010852367, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数吸入性肺炎营养不良脱水总发生
试验组300(0)2(6.67)0(0)2(6.67)*
对照组301(3.33)3(10.00)5(16.67)9(30.00)
), ArticleFig(id=1322925102404337728, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322925092010852367, language=CN, label=表6, caption=

两组卒中后环咽肌失弛型吞咽障碍患者并发症比较

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组别例数吸入性肺炎营养不良脱水总发生
试验组300(0)2(6.67)0(0)2(6.67)*
对照组301(3.33)3(10.00)5(16.67)9(30.00)
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子午流注针法联合补气祛瘀汤治疗卒中后环咽肌失弛型吞咽障碍临床研究
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吴梦婷 , 刘薇
中华中医药学刊 | 省级项目平台 2025,43(5): 214-217
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中华中医药学刊 |省级项目平台 2025 , 43 (5) : 214 -217
子午流注针法联合补气祛瘀汤治疗卒中后环咽肌失弛型吞咽障碍临床研究
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吴梦婷(1986-),女,浙江温州人,副主任医师,硕士,研究方向:神经康复。

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吴梦婷, 刘薇
作者信息
  • 浙江中医药大学附属温州市中医院,浙江 温州 325000
通讯作者:
刘薇(1987-),女,福建福州人,副主任中医师,硕士,研究方向:神经康复。E-mail:。
作者简介:

吴梦婷(1986-),女,浙江温州人,副主任医师,硕士,研究方向:神经康复。

Clinical Study of Midnight-Noon Ebb-Flow Acupuncture with Buqi Quyu Decoction(补气祛瘀汤)in Treatment of Post-stroke Cricopharyngeal Muscle Atrophy Type Dysphagia
Mengting WU, Wei LIU
Affiliations
  • Wenzhou TCM Hospital of Zhejiang Chinese Medical University,Wenzhou 325000,Zhejiang,China
出版时间: 2025-05-10 doi: 10.13193/j.issn.1673-7717.2025.05.039
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目的

探究子午流注针法联合补气祛瘀汤在卒中后环咽肌失弛型吞咽障碍治疗中的临床作用。

方法

收集卒中后环咽肌失弛型吞咽障碍患者60例,随机分为两组,试验组和对照组各30例。两组接受基础疗法,对照组予以补气祛瘀汤,试验组在对照组的基础上予以子午流注针法。对比两组颏下肌群表面肌电变化、洼田俊夫饮水试验(water swallow test,WST)、标准吞咽功能评估量表(standardized swallowing assessment,SSA)、吞咽障碍特异性生活质量量表(swallow quality-of-life questionnaire,SWAL-QOL)、吞咽X线荧光透视造影检查(videofluoroscopic swallowing study,VFSS)、临床疗效及并发症总发生率。

结果

治疗后两组下颏下肌群肌电均方根值(root mean square,RMS)水平降低(P<0.05);与对照组相比,试验组下颏下肌群RMS水平较低(P<0.05)。治疗后两组患者WST检查情况降低,且试验组WST检查低于对照组(P<0.05)。治疗后,两组SSA评分降低,SWAL-QOL评分、VFSS评分升高,且试验组SSA评分更低,SWALQOL、VFSS评分更高(P<0.05)。疗后试验组临床总有效率高于对照组,发生率低于对照组(P<0.05)。

结论

给予卒中后环咽肌失弛型吞咽障碍患者补气祛瘀汤联合子午流注针法的治疗措施,疗效佳,具有改善吞咽功能的优势,安全性高。

补气祛瘀汤  /  子午流注针法  /  卒中后环咽肌失弛型吞咽障碍
Objective

To explore the clinical effect of midnight-noon ebb-flow acupuncture combined with Buqi Quyu Decoction(补气祛瘀汤)in the treatment of post-stroke cricopharyngeal muscle atrophy type dysphagia.

Method

A total of 60 patients with post-stroke cricopharyngeal muscle atrophy type dysphagia were randomly divided into two groups,including an experimental group(30 cases)and a control group(30 cases). Two groups received basic therapy,while the control group received Buqi Quyu Decoction. The experimental group received midnight-noon ebb-flow acupuncture on the basis of the control group. The surface electromyographic changes of the submandibular muscle group between two groups as well as the results of water swallow test(WST),standardized swallowing assessment(SSA),swallowing disorder specific quality of life(SWAL-QOL)and swallowing X-ray fluoroscopy(VFSS)were compared. The clinical efficacy and overall incidence of complications were observed. Statistical analysis was conducted using SPSS 26.0.

Result

After treatment,the root mean square(RMS)values of the submandibular muscle group in two groups decreased(P<0.05). Compared with that in the control group,the RMSvalue of the submandibular muscle group in the experimental group was lower(P<0.05). After treatment,the results of WST examination of the two groups decreased,and the result of WST examination of the experimental group was lower than that of the control group(P<0.05). After treatment,the SSA scores of the two groups decreased,while the scores of SWAL-QOL and VFSS increased. The experimental group had lower SSA scores and higher scores of SWAL-QOL and VFSS(P<0.05). The total clinical effective rate of the treatment experimental group was higher than that of the control group,and the incidence rate was lower than that of the control group(P<0.05).

Conclusion

The treatment of Buqi Quyu Decoction combined with midnight-noon ebb-flow acupuncture has a good therapeutic effect on patients with post-stroke cricopharyngeal muscle atrophy type dysphagia,with advantages in improving swallowing function and high safety.

Buqi Quyu Decoction(补气祛瘀汤)  /  midnight-noon ebb-flow acupuncture  /  post-stroke cricopharyngeal muscle atrophy type dysphagia
吴梦婷, 刘薇. 子午流注针法联合补气祛瘀汤治疗卒中后环咽肌失弛型吞咽障碍临床研究. 中华中医药学刊, 2025 , 43 (5) : 214 -217 . DOI: 10.13193/j.issn.1673-7717.2025.05.039
Mengting WU, Wei LIU. Clinical Study of Midnight-Noon Ebb-Flow Acupuncture with Buqi Quyu Decoction(补气祛瘀汤)in Treatment of Post-stroke Cricopharyngeal Muscle Atrophy Type Dysphagia[J]. Chinese Archives of Traditional Chinese Medicine, 2025 , 43 (5) : 214 -217 . DOI: 10.13193/j.issn.1673-7717.2025.05.039
国内脑卒中患病人数超(260~719)/10万每年,且大部分患者在患病后无法独立生活[1-2]。吞咽功能障碍是本病常见并发症之一,环咽肌失弛缓症是一种由于环咽肌无法完全松弛诱发吞咽困难症状的吞咽功能障碍疾病,其发病后易合并机体内营养、水分的流失,继而存在摄入障碍,导致内分泌紊乱、吸入性肺炎及体质量减轻等,对患者脑功能恢复产生恶劣影响,进而导致病死率、致残率增高,住院时间延长[3]。除常规康复训练与药物措施外,针灸治疗也是一种较为安全有效的外治疗法[4]。子午流注针法是一种通过机体内气血周流入流出与日月星辰、四时八正之气的盛衰强弱而得出的特殊针灸治疗措施[5],其根据当时气血情况、穴位与归经的归属性及进行选穴针刺,以治疗不同疾病,具有其特异性作用[6],这一疗法体现了中医整体观念与时间针法特性,并逐步应用于改善脑卒中后遗症。目前应用及相关文献较少,基于此本项目就子午流注针法联合补气祛瘀汤治疗卒中后环咽肌失弛型吞咽障碍的效果进行分析,报道如下。
收集2022年8月1日—2023年9月30日在医院康复科治疗的60例卒中后环咽肌失弛型吞咽障碍的住院患者,随机分为试验组30例与对照组30例。两组一般资料见表1,差异无统计学意义(P>0.05)。
(1)符合《吞咽障碍诊疗》[7]中环咽肌失弛型诊断标准;(2)参考《中医内科常见病诊疗指南中医病证部分》[8]中“噎膈”诊断;(3)患者年龄超过18岁;(4)自愿参加研究,签署同意书。
(1)合并运动性失语、感觉性失语者;(2)合并严重心、脑、肾等系统疾病患者;(3)合并出血倾向者;(4)既往口腔、咽、食管结构异常;(5)存在甲状腺相关疾病,咽喉部局部病变者。
两组接受基础疗法,对照组予以吞咽康复训练联合补气祛瘀汤,试验组在对照组的基础上予以子午流注针法。
遵循《脑卒中一级预防诊治指南》[9]予以常规卒中干预,进行血压、血糖的控制,维持体温,持续吸氧,应用神经营养、清除自由基等药物治疗。吞咽康复训练包括咽部冷刺激训练、屏气发声训练、微笑或皱眉的面部运动、吞咽动作练习以及唇部运动体操锻炼等,每日30 min,每周5次。
处方:鸡血藤30 g,黄芪15 g,伸筋草10 g,红花6 g,桂枝6 g,桑枝6 g,桃仁5 g,党参5 g,酒地龙5 g,全蝎3 g,蜈蚣1 g。上述药取汁200 mL,分2次,早晚各1次。
开穴:由于本病证型属心神失养证,以心为主,属实证,依据子午流注纳支法选穴原则,选择少府、神门、通里时辰为午时(11∶00—13∶00),平补平泻;神门穴未时(13∶00—15∶00)行泄法;小海穴申时(15∶00—17∶00)行泻法。配穴选择风池、翳风、通里、咽后壁、水沟、上廉泉、金津、玉液。操作方法:先开穴后再刺配穴并留针30 min,1次/d。
两组均治疗4周。
应用表面肌电分析反馈仪UMISE-I对颏下肌群表面肌电测试(包括二腹肌前腹、下颌舌骨肌、颏舌骨肌),于静息、空吞咽(主动吞咽唾液)、吞咽水、浓流质、糊状食物5 mL时进行测量。选择有效吞咽作为1次,获得肌电均方根值(root mean square,RMS),测3次取平均值。
患者取坐位或半卧位,喝下30 mL温开水,以有无呛咳、饮水时间进行分级,分Ⅰ~Ⅴ级。
包含3个部分:①意识、唇的闭合情况、头与躯干的控制情况、呼吸、自主咳嗽能力、软腭运动、喉功能、咽反射进行检测,总分为8~23分;②有无喉运动、重复吞咽、吞咽时喘鸣及吞咽后喉功能情况,分值区间5~11分;③未存在上述问题时,对吞咽所需时间长短咳嗽与否进行观察,分值区间5~12分。评分越高表明吞咽功能越差。
以食物选择、进食时间、语言交流、心理健康、食欲、睡眠、疲劳、社会交往、症状、频率等情况进行分析,分数越高表明生活质量越好。
对是否存在食物漏出、软腭活动灵活程度、吞咽反射启动时间、双口唇的闭合能力情况、舌头推送功能、环咽肌开闭程度、口腔内存在滞留与否、喉上抬幅度、会厌谷处以及梨状隐窝处存在残留食物与否、误咽情况等进行综合评估,总分为0~10分。分数越低提示吞咽障碍越严重。
分为治愈、显效、无效3项,其中治愈为经干预吞咽功能恢复如初,洼田饮水试验I级;显效为吞咽呛咳可能偶尔存在,洼田饮水试验Ⅱ级;有效为吞咽呛咳存在但并未影响正常生活,洼田饮水试验Ⅱ级;无效为未达到上述标准,洼田饮水试验为Ⅲ~Ⅴ级。治疗总有效率为治愈率、显效率及有效率之和。
应用SPSS 26.0系统软件分析,计数资料应用[例(%)]表达,进行卡方分析;计量资料应用()表示,采取单因素t检验。P<0.05表明差异有统计学意义。
治疗后两组患者静息、空吞咽、吞咽水、吞咽浓流质、吞咽糊状等下颏下肌群RMS水平降低(P<0.05);与对照组相比,试验组下颏下肌群RMS水平较低(P<0.05),如表2。
治疗后两组患者WST检查情况降低,且试验组WST检查低于对照组(P<0.05),如表3。
治疗后,两组SSA评分降低,SWAL-QOL评分、VFSS评分升高,且试验组SSA评分更低,SWAL-QOL、VFSS评分更高(P<0.05),如表4。
经联合干预后,试验组临床总有效率较对照组高(P<0.05),如表5。
试验组治疗后并发症总发生率较对照组低(P<0.05),如表6。
脑卒中合并吞咽障碍的关键因素是脑组织受损后,延髓吞咽中枢及相关神经同时受损[14],控制吞咽功能异常状态。曾有文献表明,吞咽障碍是诱发脑卒中生存时间缩短的关键因素[15],而我国新增脑卒中患者逐年增加[16]。环咽肌失弛缓症是吞咽障碍的常见类型[17],有研究显示卒中后环咽肌失弛缓症的发生率占吞咽障碍总发生率的80%。患者常表现为喉部梗阻感[18]、进食较为费力,进而产生营养不良、呛咳、反流、误吸以及诱发肺部感染等肺部并发症[19],对患者康复影响恶劣且死亡风险增加[20]。因此,选择适宜安全的干预措施尤为关键。早期康复训练能够有效防止咽部肌群由于卒中后所致的失用型萎缩[21-22],早期康复中锻炼措施发挥重要意义,但康复训练患者如果不持续应用其效果较差,而且单独应用起效较慢,患者心理压力增加[23]。本科室在康复训练的同时采取补气祛瘀汤口服治疗,方中鸡血藤能活血补血、舒筋活络;黄芪能补气升阳、生津养血、托毒排脓、敛疮生肌;伸筋草具有祛风除湿、舒筋活络的功效;红花能活血通经、散瘀止痛;桂枝能够温通经脉、助阳化气、平冲降气;桑枝善于祛风湿、通经络;桃仁能活血祛瘀;党参具有健脾益肺、养血生津的功效;酒地龙能通经活络;全蝎、蜈蚣能够息风镇痉、通经活络、消肿止痛、攻毒散结;上述药物能够补气祛瘀、温通活络、舒筋息风,对改善脑卒中后吞咽障碍具有显著意义。但药物应用也存在弊端,最初吞咽障碍患者进食困难影响用药,且其治疗时间长,疗效不理想。基于此选择子午流注针法这一外治措施,从而能够使疗效提升。针灸疗法常应用于脑卒中后吞咽障碍,并获得较为满意的疗效[24],生理角度经针刺疗法能够对皮质区产生激活作用,诱发吞咽功能区皮质的改变[25],促进新陈代谢,恢复吞咽反射通路,或进一步使吞咽反射通路代偿增强[26]。子午流注针法是一种较为特殊的针灸疗法,有学者将子午流注组应用于临床,进行开穴位针刺后联合康复训练能够改善吞咽障碍[27]。王少琴等[28-29]通过对不同时间段针刺缺血性中风患者情况进行观察,结果表明不同时间段进行针刺能抑制体内血小板的激活情况存在差异。但目前鲜有卒中后吞咽障碍的个体化计时子午流注针法的治疗方案的相关研究。本课题选穴及取穴时辰为循经取穴法[30-32]、补母泻子法[33]以及表里经取穴法[34-36]。选取心经本穴、原穴、络穴分别对应少府、神门、通里,时间段为气血流注心经之时;在依据五行属性以确定母子关系,为实证,因此选择心经旺盛之时未时,进行神门穴的开穴[37-39],采取泄法;由于心经与小肠经相表里,实证则泻小肠经子穴小海穴[40-42],选择经气血旺盛之时即申时采取泄法。我们研究显示,与对照组相比,试验组下颏下肌群RMS水平、WST检查情况、SSA评分较低,SWAL-QOL评分、VFSS评分、总有效率较高,提示补气祛瘀汤联合子午流注针法及康复训练治疗这一干预措施,能够有效提高治疗效果。
本实验通过对60例卒中后环咽肌失弛型吞咽障碍患者的颏下肌群表面肌电变化、WST评分、SSA评分、SWAL-QOL评分、VFSS评分、临床疗效、并发症总发生率进行研究,证实给予卒中后环咽肌失弛型吞咽障碍患者子午流注针法联合补气祛瘀汤治疗措施,疗效佳,具有改善吞咽功能的优势,安全性高。
  • 浙江省中医药科技计划项目(2024ZL989)
  • 浙江省医药卫生科技计划项目(2023KY1159)
  • 温州市基础性科研项目(2022Y0398)
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2025年第43卷第5期
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doi: 10.13193/j.issn.1673-7717.2025.05.039
  • 首发时间:2026-10-30
  • 出版时间:2025-05-10
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浙江省中医药科技计划项目(2024ZL989)
浙江省医药卫生科技计划项目(2023KY1159)
温州市基础性科研项目(2022Y0398)
作者信息
    浙江中医药大学附属温州市中医院,浙江 温州 325000

通讯作者:

刘薇(1987-),女,福建福州人,副主任中医师,硕士,研究方向:神经康复。E-mail:。
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2种不同金属材料的力学参数
科
Family
属数
Number of
genus
种数
Number of
species
占总种数比例
Percentage of
total species (%)
属
Genus
种数
Number of
species
占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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