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Article(id=1322926200104038688, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322925862630339452, articleNumber=null, orderNo=null, doi=10.13193/j.issn.1673-7717.2025.07.042, 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=1793339784884, onlineDateStr=2026-10-30, pubDate=1752076800000, pubDateStr=2025-07-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793339784884, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793339784884, creator=13701087609, updateTime=1793339784884, updator=13701087609, issue=Issue{id=1322925862630339452, tenantId=1146029695717560320, journalId=1255847919539208197, year='2025', volume='43', issue='7', pageStart='1', pageEnd='258', issueExtLink='null', onlineDate='null', pubDate='1752076800000', pubDateStr='2025-07-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793339704424, creator='13701087609', updateTime=1793340532184, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322929334587105328, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322925862630339452, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322929334587105329, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322925862630339452, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=212, endPage=215, ext={EN=ArticleExt(id=1322926200892567841, articleId=1322926200104038688, tenantId=1146029695717560320, journalId=1255847919539208197, language=EN, title=Combination of Fire Needle and Cold Stimulation of Pharynx in Treatment of Post-Stroke Dysphagia in Oropharyngeal Phase, columnId=1256183365644968140, journalTitle=Chinese Archives of Traditional Chinese Medicine, columnName=Platform of Provincial Project, runingTitle=null, highlight=null, articleAbstract=
Objective

To observe the clinical efficacy of fire needle combined with cold stimulation of pharynx for the treatment of oropharyngeal dysphagia after stroke.

Methods

Eighty patients with oropharyngeal dysphagia after stroke who were admitted to the hospital from February 2020 to May 2023 were selected and randomly divided into cold stimulation group（40 cases，routine treatment＋cold stimulation）and fire needle group（40 cases，cold stimulation＋fire needle）by computer random number generator. The scores of TCM syndrome，swallowing function grade，swallowing function score，quality of life and nutritional status were compared before and after treatment in both groups. The clinical efficacy and adverse reactions were compared between the two groups.

Results

After treatment，the scores of dysphagia，limb hemiplegia，tongue stiffness，dysarthria and total score，the percentage of swallowing function gradeⅢ，and the nutritional risk screening 2002 scale（NRS-2002）score in the fire needle group were lower than those in the cold stimulation group（P<0.05），while the percentage of swallowing function gradeⅠandⅡ，the swallowing function score and the swallowing disorder specific quality of life scale（SWAL-QOL）score in the fire needle group were higher than those in the cold stimulation group（P<0.05）. The total effective rate in the fire needle group was higher than that in the cold stimulation group（P<0.05）. No obvious adverse reactions were observed in both groups.

Conclusion

Fire needle combined with cold stimulation of pharynx can relieve oropharyngeal dysphagia after stroke，improve the treatment effect，quality of life and nutritional status of patients，and is safe and reliable.

, authors=Dan CHEN1, Shanshan WANG1, Haihui XING2, authorsList=Dan CHEN, Shanshan WANG, Haihui XING, authorCompany=null, correspAuthors=Haihui XING, 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=1322926202230550826, articleId=1322926200104038688, tenantId=1146029695717560320, journalId=1255847919539208197, language=CN, title=火针点刺咽部联合咽部冷刺激治疗脑卒中后口咽期吞咽障碍的临床研究, columnId=1256183369033965799, journalTitle=中华中医药学刊, columnName=省级项目平台, runingTitle=null, highlight=null, articleAbstract=
目的

观察火针点刺咽部联合咽部冷刺激治疗脑卒中后口咽期吞咽障碍（post-stroke oropharyngeal dysphagia，POD）的临床疗效。

方法

选取2020年2月—2023年5月于医院就诊的POD患者80例，以计算机随机数字生成器分为冷刺激组（40例，常规治疗＋咽部冷刺激治疗）、火针组（40例，冷刺激组＋火针点刺咽部治疗）。比较治疗前、后冷刺激组、火针组中医证候积分、吞咽功能评级、吞咽功能评分、生活质量及营养状况评分；比较冷刺激组、火针组临床疗效、不良反应。

结果

治疗后火针组吞咽困难、肢体偏瘫、舌强语謇积分及总分，吞咽功能评级Ⅲ级百分率，营养风险筛查2002量表（nutritional risk screening 2002，NRS-2002）评分均低于冷刺激组（P<0.05），吞咽功能评级Ⅰ级、Ⅱ级百分率，吞咽功能评分，吞咽障碍特异性生存质量量表（swallowing quality of life questionnaire，SWAL-QOL）评分高于冷刺激组（P<0.05）。火针组临床总有效率高于冷刺激组（P<0.05）。冷刺激组、火针组均无明显不良反应。

结论

火针点刺咽部联合咽部冷刺激可减轻POD，提升治疗效果、生活质量，改善患者营养状况，且安全可靠。

, authors=陈丹1, 王珊珊1, 邢海辉2, authorsList=陈丹, 王珊珊, 邢海辉, authorCompany=null, correspAuthors=邢海辉, authorNote=

陈丹（1985-），女，江苏南京人，副主任中医师，硕士，研究方向：针灸治疗在神经系统疾病、骨关节疾病中的应用。

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邢海辉（1986-），男，江苏高淳人，副主任中医师，硕士，研究方向：中医药在神经系统疾病的应用。E-mail：。
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陈丹（1985-），女，江苏南京人，副主任中医师，硕士，研究方向：针灸治疗在神经系统疾病、骨关节疾病中的应用。

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陈丹（1985-），女，江苏南京人，副主任中医师，硕士，研究方向：针灸治疗在神经系统疾病、骨关节疾病中的应用。

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组别例数吞咽困难肢体偏瘫舌强语謇总分
治疗前治疗后治疗前治疗后治疗前治疗后治疗前治疗后
冷刺激组402.25±0.421.30±0.25*1.52±0.381.10±0.28*1.43±0.321.02±0.24*5.20±0.983.42±0.82*
火针组402.23±0.480.95±0.12*1.49±0.410.82±0.11*1.45±0.360.81±0.11*5.17±1.052.58±0.79*
t值0.1987.9820.3395.8870.2635.0310.1324.666
P值0.843<0.0010.735<0.0010.794<0.0010.895<0.001
), ArticleFig(id=1322926206370328905, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926200104038688, language=CN, label=表1, caption=

两组脑卒中后口咽期吞咽障碍患者治疗前后中医证候积分比较（±s）

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数吞咽困难肢体偏瘫舌强语謇总分
治疗前治疗后治疗前治疗后治疗前治疗后治疗前治疗后
冷刺激组402.25±0.421.30±0.25*1.52±0.381.10±0.28*1.43±0.321.02±0.24*5.20±0.983.42±0.82*
火针组402.23±0.480.95±0.12*1.49±0.410.82±0.11*1.45±0.360.81±0.11*5.17±1.052.58±0.79*
t值0.1987.9820.3395.8870.2635.0310.1324.666
P值0.843<0.0010.735<0.0010.794<0.0010.895<0.001
), ArticleFig(id=1322926206441632074, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926200104038688, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数显效有效无效总有效
冷刺激组407（17.50）20（50.00）13（32.50）27（67.50）
火针组4020（50.00）16（40.00）4（10.00）36（90.00）
χ2值6.050
P值0.014
), ArticleFig(id=1322926206517129547, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926200104038688, language=CN, label=表2, caption=

两组脑卒中后口咽期吞咽障碍患者临床疗效比较

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组别例数显效有效无效总有效
冷刺激组407（17.50）20（50.00）13（32.50）27（67.50）
火针组4020（50.00）16（40.00）4（10.00）36（90.00）
χ2值6.050
P值0.014
), ArticleFig(id=1322926206609404236, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926200104038688, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数治疗前治疗后
ⅠⅡⅢⅣⅤⅠⅡⅢⅣⅤ
冷刺激组400（0.00）0（0.00）25（62.50）10（25.00）5（12.50）0（0.00）15（37.50）*21（52.50）4（10.00）0（0.00）*
火针组400（0.00）0（0.00）20（50.00）13（32.50）7（17.50）4（10.00）*25（62.50）*10（25.00）*1（2.50）*0（0.00）*
χ2值--1.2700.5490.3924.2115.0006.3731.920-
P值--0.2600.4590.5310.0400.0250.0120.166-
), ArticleFig(id=1322926206680707405, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926200104038688, language=CN, label=表3, caption=

两组脑卒中后口咽期吞咽障碍患者治疗前后吞咽功能评级比较

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数治疗前治疗后
ⅠⅡⅢⅣⅤⅠⅡⅢⅣⅤ
冷刺激组400（0.00）0（0.00）25（62.50）10（25.00）5（12.50）0（0.00）15（37.50）*21（52.50）4（10.00）0（0.00）*
火针组400（0.00）0（0.00）20（50.00）13（32.50）7（17.50）4（10.00）*25（62.50）*10（25.00）*1（2.50）*0（0.00）*
χ2值--1.2700.5490.3924.2115.0006.3731.920-
P值--0.2600.4590.5310.0400.0250.0120.166-
), ArticleFig(id=1322926206760399182, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926200104038688, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数治疗前治疗后
冷刺激组404.25±1.376.59±0.52*
火针组404.32±1.497.28±0.61*
t值0.2195.444
P值0.827<0.001
), ArticleFig(id=1322926208412954959, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926200104038688, language=CN, label=表4, caption=

两组脑卒中后口咽期吞咽障碍患者治疗前后吞咽功能评分比较（±s）

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数治疗前治疗后
冷刺激组404.25±1.376.59±0.52*
火针组404.32±1.497.28±0.61*
t值0.2195.444
P值0.827<0.001
), ArticleFig(id=1322926208513618256, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926200104038688, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数SWAL-QOL评分NRS-2002评分
治疗前治疗后治疗前治疗后
冷刺激组40135.47±21.15161.27±22.30*3.05±0.472.24±0.52*
火针组40140.33±20.27179.86±26.97*3.10±0.511.65±0.51*
t值1.0493.3600.4565.123
P值0.2970.0010.650<0.001
), ArticleFig(id=1322926208597504337, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926200104038688, language=CN, label=表5, caption=

两组脑卒中后口咽期吞咽障碍患者治疗前后生活质量及营养状况评分比较（±s）

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数SWAL-QOL评分NRS-2002评分
治疗前治疗后治疗前治疗后
冷刺激组40135.47±21.15161.27±22.30*3.05±0.472.24±0.52*
火针组40140.33±20.27179.86±26.97*3.10±0.511.65±0.51*
t值1.0493.3600.4565.123
P值0.2970.0010.650<0.001
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火针点刺咽部联合咽部冷刺激治疗脑卒中后口咽期吞咽障碍的临床研究
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陈丹 1 , 王珊珊 1 , 邢海辉 2
中华中医药学刊 | 省级项目平台 2025,43(7): 212-215
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中华中医药学刊 |省级项目平台 2025 , 43 (7) : 212 -215
火针点刺咽部联合咽部冷刺激治疗脑卒中后口咽期吞咽障碍的临床研究
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陈丹（1985-），女，江苏南京人，副主任中医师，硕士，研究方向：针灸治疗在神经系统疾病、骨关节疾病中的应用。

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陈丹（1985-），女，江苏南京人，副主任中医师，硕士，研究方向：针灸治疗在神经系统疾病、骨关节疾病中的应用。

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陈丹1, 王珊珊1, 邢海辉2
作者信息
  • 1.皖南医学院附属宣城医院，宣城市人民医院，安徽 宣城 242000
  • 2.南京市高淳中医院，江苏 南京 211300
通讯作者:
邢海辉（1986-），男，江苏高淳人，副主任中医师，硕士，研究方向：中医药在神经系统疾病的应用。E-mail：。
作者简介:

陈丹（1985-），女，江苏南京人，副主任中医师，硕士，研究方向：针灸治疗在神经系统疾病、骨关节疾病中的应用。

Combination of Fire Needle and Cold Stimulation of Pharynx in Treatment of Post-Stroke Dysphagia in Oropharyngeal Phase
Dan CHEN1, Shanshan WANG1, Haihui XING2
Affiliations
  • 1.The Affiliated Xuancheng Hospital of Wannan Medical College，Xuancheng People’s Hospital，Xuancheng 242000，Anhui，China
  • 2.Nanjing Gaochun Traditional Chinese Medicine Hospital，Nanning211300，Jiangsu，China
出版时间: 2025-07-10 doi: 10.13193/j.issn.1673-7717.2025.07.042
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摘要
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目的

观察火针点刺咽部联合咽部冷刺激治疗脑卒中后口咽期吞咽障碍（post-stroke oropharyngeal dysphagia，POD）的临床疗效。

方法

选取2020年2月—2023年5月于医院就诊的POD患者80例，以计算机随机数字生成器分为冷刺激组（40例，常规治疗＋咽部冷刺激治疗）、火针组（40例，冷刺激组＋火针点刺咽部治疗）。比较治疗前、后冷刺激组、火针组中医证候积分、吞咽功能评级、吞咽功能评分、生活质量及营养状况评分；比较冷刺激组、火针组临床疗效、不良反应。

结果

治疗后火针组吞咽困难、肢体偏瘫、舌强语謇积分及总分，吞咽功能评级Ⅲ级百分率，营养风险筛查2002量表（nutritional risk screening 2002，NRS-2002）评分均低于冷刺激组（P<0.05），吞咽功能评级Ⅰ级、Ⅱ级百分率，吞咽功能评分，吞咽障碍特异性生存质量量表（swallowing quality of life questionnaire，SWAL-QOL）评分高于冷刺激组（P<0.05）。火针组临床总有效率高于冷刺激组（P<0.05）。冷刺激组、火针组均无明显不良反应。

结论

火针点刺咽部联合咽部冷刺激可减轻POD，提升治疗效果、生活质量，改善患者营养状况，且安全可靠。

脑卒中  /  吞咽障碍  /  火针点刺咽部  /  咽部冷刺激
Objective

To observe the clinical efficacy of fire needle combined with cold stimulation of pharynx for the treatment of oropharyngeal dysphagia after stroke.

Methods

Eighty patients with oropharyngeal dysphagia after stroke who were admitted to the hospital from February 2020 to May 2023 were selected and randomly divided into cold stimulation group（40 cases，routine treatment＋cold stimulation）and fire needle group（40 cases，cold stimulation＋fire needle）by computer random number generator. The scores of TCM syndrome，swallowing function grade，swallowing function score，quality of life and nutritional status were compared before and after treatment in both groups. The clinical efficacy and adverse reactions were compared between the two groups.

Results

After treatment，the scores of dysphagia，limb hemiplegia，tongue stiffness，dysarthria and total score，the percentage of swallowing function gradeⅢ，and the nutritional risk screening 2002 scale（NRS-2002）score in the fire needle group were lower than those in the cold stimulation group（P<0.05），while the percentage of swallowing function gradeⅠandⅡ，the swallowing function score and the swallowing disorder specific quality of life scale（SWAL-QOL）score in the fire needle group were higher than those in the cold stimulation group（P<0.05）. The total effective rate in the fire needle group was higher than that in the cold stimulation group（P<0.05）. No obvious adverse reactions were observed in both groups.

Conclusion

Fire needle combined with cold stimulation of pharynx can relieve oropharyngeal dysphagia after stroke，improve the treatment effect，quality of life and nutritional status of patients，and is safe and reliable.

stroke  /  dysphagia  /  fire needle of pharynx  /  cold stimulation of pharynx
陈丹, 王珊珊, 邢海辉. 火针点刺咽部联合咽部冷刺激治疗脑卒中后口咽期吞咽障碍的临床研究. 中华中医药学刊, 2025 , 43 (7) : 212 -215 . DOI: 10.13193/j.issn.1673-7717.2025.07.042
Dan CHEN, Shanshan WANG, Haihui XING. Combination of Fire Needle and Cold Stimulation of Pharynx in Treatment of Post-Stroke Dysphagia in Oropharyngeal Phase[J]. Chinese Archives of Traditional Chinese Medicine, 2025 , 43 (7) : 212 -215 . DOI: 10.13193/j.issn.1673-7717.2025.07.042
正文
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脑卒中后口咽期吞咽障碍（post-stroke oropharyngeal dysphagia，POD）是脑卒中最常见的并发症之一，即脑卒中导致的口腔、咽部及喉部肌肉功能障碍，食物或液体无法安全、有效从口腔输送到胃中[1]。统计显示，POD的发生率在30%～78%，以吞咽困难为多见，不仅影响患者营养及水分摄入，增加营养不良、脱水及低血压等风险，且会导致食物或唾液误入气道，引发吸入性肺炎、呼吸衰竭或败血症等严重并发症，危及生命，病死率是非POD患者的3倍以上[2-3]。现阶段临床对POD的治疗主要包括药物治疗、物理治疗、康复训练、营养支持及手术治疗等，通过神经营养剂改善脑血流和神经功能、吞咽训练、喉部肌肉注射等方式恢复患者咽喉功能，但效果并不理想，且存在一定的局限性和不良反应[4]。火针点刺是中医针灸疗法中的一种特殊技术，将针刺燃烧后迅速插入穴位，刺激经络系统的气血循环，调整阴阳平衡，促进自愈，常用于风湿性疾病、骨科疾病等的治疗[5-6]。咽部冷刺激是治疗吞咽障碍的方法之一，通过冷刺激咽喉区域促进咽喉肌肉的收缩和神经反射，帮助改善吞咽功能。目前鲜有关于火针点刺咽部联合咽部冷刺激治疗POD的报道。本研究采用前瞻性研究，探讨火针点刺咽部联合咽部冷刺激对POD患者的治疗效果和安全性，为临床提供一种新的治疗方案，报道如下。
1　研究对象与方法
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1.1　研究对象
采用前瞻性研究方式，选取2020年2月—2023年5月于本院就诊的POD患者80例，以计算机随机数字生成器分为冷刺激组、火针组，各40例。冷刺激组男26例，女14例；年龄55～77岁，平均（65.53±4.14）岁；吞咽障碍病程10～75 d，平均（42.18±8.47）d；火针组男27例，女13例；年龄53～78岁，平均（65.65±4.27）岁；吞咽障碍病程15～72 d，平均（42.08±8.33）d。冷刺激组、火针组一般资料均衡可比（P>0.05）。院伦理委员会批准本研究，患者及家属均知情同意。
1.2　纳入、排除标准
纳入标准：（1）符合《脑卒中康复指南》中脑卒中诊断标准[7]，经头颅CT或MRI检查证实；（2）符合《欧洲卒中组织和欧洲吞咽障碍协会关于卒中后吞咽困难诊断和治疗的指南》中诊断标准[8]，洼田饮水试验≥3级；（3）首次发生脑卒中；（4）吞咽障碍发生在脑卒中后1周内；（5）年龄>18岁；（6）可配合本研究治疗和评估。
排除标准：（1）严重的心、肝、肾等脏器功能不全或其他严重系统性疾病；（2）咽部或食管的解剖结构异常或器质性病变；（3）有精神障碍或认知功能障碍；（4）对本研究治疗方案有过敏反应或不耐受；（5）研究期间接受其他治疗方法或使用影响吞咽功能的药物。
1.3　方法
冷刺激组采用常规治疗＋咽部冷刺激治疗。（1）常规采用脑微循环改善、神经营养等药物，进行能量支持、基础护理等，并维持水电解质平衡，配合进食、唇舌肌运动及深呼吸等吞咽功能训练，30 min/次，6次/周，训练时间为30 d。（2）咽部冷刺激：选择醋、酸梅粉或柠檬汁等可食用酸性物质，用湿棉棒充分蘸取，入冰箱中冷冻数小时至冰棒，嘱患者张口，以冰棒轻刺激腭咽弓、舌根及咽后壁等吞咽反射位置，重复5～10次，15 min/次，6次/周，训练时间为30 d。
火针组采用冷刺激组＋火针点刺咽部治疗。火针点刺咽部：选用0.8 mm×50 mm火针，将3块充分浸润过生理盐水的纱布拧干，分别平铺于上、下唇与舌体表面，用一次性压舌板压低患者舌体。于腭舌弓、腭咽弓的中间及头尾各取1个点，舌根部两侧及中部各取1个点，咽喉壁上下左右及中心各1 cm位置取5个点。采用“雀啄法”操作火针。操作人员对手部进行常规消毒，右手持针柄，左手持酒精灯，将针尖、针体放置在火焰外焰加热至针体下1/3位置通红，趁热于一个刺激点点刺3下，前两下轻刺激，深度1 mm左右，最后一下重刺激，深度2 mm左右。隔天1次，1个疗程2周，治疗2个疗程，每个疗程间休息2 d。
1.4　观察指标
1.4.1　治疗前后中医证候积分
自制《脑卒中后口咽期吞咽障碍中医证候积分表》，经专家函询法审核通过，包括吞咽困难、肢体偏瘫、舌强语謇，每项无（0分）、轻（1分，指症状程度较轻，对日常生活功能影响较小，可能会导致一定的不适感，但一般不会严重干扰工作、学习和社交活动，通常表现为症状频率低、程度轻、持续时间短暂）、中（2分，指症状程度较为明显，对日常生活功能造成一定影响，可能会显著干扰工作、学习和社交，导致其生活质量下降，通常表现为症状频率中等、程度中等、持续时间适中）、重（3分，指症状程度非常严重，对个体的日常生活功能造成严重影响，导致个体无法正常地从事工作、学习和社交活动，严重影响其生活质量和自理能力，通常表现为症状频率高、程度重、持续时间较长），总分0～9分，分数越高，症状越严重。采用该量表对50例患者进行预调查，结果显示Cronbach'sα系数为0.897，重测信度系数为0.950，可应用于该群体中。
1.4.2　临床疗效
根据《中医循证临床实践指南·中医内科》中相关标准[9]，显效：吞咽障碍明显改善，中医证候积分降低≥70%；有效：吞咽障碍有所改善，30%≤中医证候积分降低<70%；无效：吞咽障碍未改善，中医证候积分降低<30%。显效及有效为临床有效。
1.4.3　治疗前后吞咽功能评级
根据洼田俊夫饮水试验判断[10]。患者坐饮30 mL温水，可顺利地将水一次性饮下为Ⅰ级：分2次喝完，无呛咳为Ⅱ级；可将水一次性饮下，有呛咳为Ⅲ级；分两次以上饮下，有呛咳为Ⅳ级；频繁呛咳，无法全部饮下为Ⅴ级。
1.4.4　治疗前后吞咽功能评分
根据藤岛一郎标准评价[11]，无法进行吞咽训练及经口饮食为1分；严重误咽，只能进行基础的吞咽训练，无法经口饮食为2分；误咽有所减少，可进行吞咽训练，仍无法经口饮食为3分；经引导可少量进食，仍需要胃饲或静脉补充营养为4分；一餐经口进食，需额外补充营养为5分；三餐经口进食，需额外补充营养为6分；三餐经口进食，无须胃饲或静脉补充营养为7分；特别难以吞咽的食物除外，可经口进食为8分；能经口进食，但需要进行临床观察或指导为9分；摄食、吞咽能力正常为10分。
1.4.5　治疗前后生活质量及营养状况评分
生活质量采用吞咽障碍特异性生存质量量表（swallowing quality of life questionnaire，SWAL-QOL）评价。谭嘉升等[12]参考国内外推荐的量表汉化程序，将英文版量表编译成中文，其信度为0.945～0.990，重测信度相关系数范围为0.965～0.992，内部一致性指标Cronbachα系数为0.708～0.933。该量表包括11个维度（心理负担、语言交流、食物选择、进食恐惧、食欲等）44个条目，每个条目1～5分，总分44～220分，分数越高，患者生活质量越好；营养状况采用营养风险筛查2002量表（nutritional risk screening 2002，NRS-2002）评价，该量表由欧洲肠外肠内营养学会编制[13]，包括体质量指数（body mass index，BMI）、近期体质量变化、近期膳食变化及疾病严重程度共计4个方面，如患者年龄≥70岁，则总分加1分。NRS-2002总分≥3分为营养不良，<3分为营养正常。
1.4.6　冷刺激组、火针组不良反应
统计冷刺激组、火针组出血、疼痛、血肿、晕针、心律失常及皮肤感染等不良反应。
1.5　统计学方法
数据的分析用统计学软件SPSS 19.0，计量资料用表示，用t检验；计数资料用例（%）表示，用χ2 检验。P<0.05为差异有统计学意义。
2　结果
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2.1　治疗前后中医证候积分
治疗前冷刺激组、火针组吞咽困难、肢体偏瘫、舌强语謇积分及总分比较，差异均无统计学意义（P>0.05）；治疗后冷刺激组及火针组上述分数均降低，火针组均低于冷刺激组（P<0.05）。见表1。
2.2　临床疗效
火针组临床总有效率高于冷刺激组（P<0.05）。见表2。
2.3　治疗前后吞咽功能评级
治疗前冷刺激组、火针组吞咽功能评级比较，差异无统计学意义（P>0.05）；治疗后火针组Ⅰ级、Ⅱ级百分率高于冷刺激组（P<0.05），Ⅲ级百分率低于冷刺激组（P<0.05）；治疗后火针组Ⅰ级、Ⅱ级百分率高于治疗前（P<0.05），Ⅲ级、Ⅳ级、Ⅴ级百分率低于治疗前（P<0.05）；冷刺激组Ⅱ级百分率高于治疗前（P<0.05），Ⅴ级百分率低于治疗前（P<0.05）。见表3。
2.4　治疗前后吞咽功能评分
治疗前冷刺激组、火针组吞咽功能评分比较，差异均无统计学意义（P>0.05）；治疗后冷刺激组及火针组吞咽功能评分均升高，火针组高于冷刺激组（P<0.05）。见表4。
2.5　治疗前后生活质量及营养状况评分
治疗前冷刺激组、火针组SWAL-QOL评分、NRS-2002评分比较，差异均无统计学意义（P>0.05）；治疗后冷刺激组及火针组SWAL-QOL评分均升高（P<0.05），火针组高于冷刺激组（P<0.05），NRS-2002评分均降低（P<0.05），火针组低于冷刺激组（P<0.05）。见表5。
2.6　不良反应
冷刺激组、火针组均无明显不良反应。火针组出现1例血肿，暂停火针点刺1 d后明显好转。
3　讨论
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POD也被称为神经性吞咽障碍或神经源性吞咽障碍，其发病机制被认为与脑卒中影响吞咽神经回路及吞咽过程中多个肌肉群协调和感觉反馈异常相关[14-15]。吞咽神经回路主要位于延髓前部，但也涉及大脑皮层和皮质下结构激活，脑卒中后吞咽神经回路传导及调节功能受损，进而导致吞咽反射延迟或缺失、声门关闭不全、舌肌力量减弱、软腭提升障碍等咽喉功能障碍[16-17]。POD主要表现为呛咳或窒息感、吞咽困难、声音改变及饮食受限，不仅直接损害患者身体健康，还会影响心理状态和社会交往，降低生活质量及康复效果[18]。此外，POD患者可出现焦虑、抑郁、自卑等负面情绪，导致精神压力增加，不利于神经功能恢复；同时多主动避免与他人共进餐，导致社会孤立和支持性缺乏，心理适应力及自身社会功能降低。因此，及时有效地治疗POD对于改善患者的生活质量及预后意义重大。
本研究结果显示，火针组在中医证候积分、临床疗效及吞咽功能上均优于冷刺激组，提示火针点刺咽部联合咽部冷刺激可有效治疗POD。中医治疗POD具有其独特优势，可从整体和辨证论治的角度，调节机体阴阳平衡，改善局部血液循环及神经功能[19-20]。中医将POD归为“吞气”“吞哽”“吞噎”等证范畴，认为POD病机为风邪侵袭脑髓、痰湿上蒙于心、下阻于肾，血瘀内阻于脑髓，导致清阳不升、津液不布、气血失和、经络阻滞[21]。火针刺咽是一种传统中医针灸治疗方法，其原理是利用火针对咽部穴位进行刺激，以达到温通经络、活血化瘀、散结消肿、祛除风邪的目的，从而恢复脑髓功能，其可直接作用于咽部黏膜和肌肉，产生较强的局部反应，不仅可消除局部水肿、充血和粘连，改善局部血液循环及神经传导，又可增加局部组织的抵抗力及修复能力[22-24]。经络学说认为，火针点刺咽部可以通达咽部所属手太阴肺经、手阳明大肠经、足阳明胃经、足太阳膀胱经等经络，达到调节气血、疏通经络、平衡阴阳的功效[25]。袁影等[26]采用火针治疗脑卒中后假性延髓麻痹致吞咽障碍，结果显示其可明显改善患者吞咽障碍症状，提高其生活质量。余小江等[27]总结显示，陈兴华在治疗中风后吞咽障碍时运用舌咽部火针点刺疗法，可改善局部气血流通，促进患者吞咽功能的恢复，而改善中风后吞咽障碍症状。咽部冷刺激是一种物理治疗方法，其原理是利用冷水或冰块间接作用于口咽部及喉部的感觉神经末梢，从而刺激迷走神经核和延髓吞咽中枢，增强吞咽反射和咽肌收缩，改善吞咽协调性和效率。火针点刺咽部联合咽部冷刺激将中医针灸与物理治疗相结合，通过火针的高温及冷刺激的低温形成温差刺激，既能改善局部血液循环和组织代谢，又能增强神经肌肉协调功能和吞咽反射，达到消除咽部炎症、增强咽部敏感性促进吞咽功能恢复的目的，具有安全、起效快、便捷及价廉等优势。
POD与营养不良间存在密切关系，吞咽障碍会导致吞咽困难、咀嚼困难或进食过程中的疼痛等问题，从而使个体在进食、饮水过程中感到困难和不适，导致摄入食物量减少，无法满足机体营养需求，从而降低生活质量[28-29]。本研究中治疗后火针组SWAL-QOL评分高于冷刺激组，NRS-2002评分低于冷刺激组，提示火针点刺咽部联合咽部冷刺激可降低患者营养不良风险，提示其生活质量，分析原因为该治疗方式可改善咽部肌肉的协调性和力量、增强咽喉神经的功能，从而增加进食量。此外，本研究显示火针点刺并不会增加不良反应，安全性高。在正确使用的前提下，火针可安全有效地应用于临床实践，经过专业培训和资质认证的中医医师操作下能够正确刺激穴位，避免伤害，但应注意无菌操作、正确控制温度和时间，并根据个体情况合理调整刺激强度和穴位，避免过度刺激导致不适或其他不良反应。
综上所述，火针点刺咽部联合咽部冷刺激可改善POD，提升治疗效果、生活质量，降低营养不良风险，且不会增加不良反应。
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  • 安徽省重点研究与开发计划项目(202104j07020008)
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2025年第43卷第7期
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doi: 10.13193/j.issn.1673-7717.2025.07.042
  • 首发时间：2026-10-30
  • 出版时间：2025-07-10
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安徽省重点研究与开发计划项目(202104j07020008)
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    1.皖南医学院附属宣城医院，宣城市人民医院，安徽 宣城 242000
    2.南京市高淳中医院，江苏 南京 211300

通讯作者:

邢海辉（1986-），男，江苏高淳人，副主任中医师，硕士，研究方向：中医药在神经系统疾病的应用。E-mail：。
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2种不同金属材料的力学参数
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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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