Clinical study on Weijin Xiangjiao acupuncture in the treatment of dysphagia after ischemic stroke
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摘要:目的
探讨维筋相交针刺法联合疏血通对缺血性脑卒中(IS)合并吞咽障碍的疗效及对血清胶质细胞源神经营养因子(GDNF)、神经元特异性烯醇化酶(NSE)表达水平的影响。
方法选取2019年1月—2020年8月收治的102例IS合并吞咽障碍患者为研究对象, 将其随机分为观察组(n=51)和疏血通组(n=51)。疏血通组采用疏血通注射液治疗, 1次/d, 连续治疗2周。观察组在疏血通组治疗的基础上给予维筋相交针刺法治疗, 1次/d, 每周治疗5次，连续治疗2周。观察患者治疗前后吞咽功能、血流动力学指标水平及血清GDNF、NSE的表达水平，并观察2组的临床疗效。
结果观察组治疗总有效率(94.12%)高于疏血通组(70.59%), 差异有统计学意义(P=0.004)。治疗后，2组吞咽功能评价量表(SSA)评分、洼田饮水试验(WST)评分、血浆黏度、高切全血黏度、血清NSE表达水平均低于治疗前，血清GDNF表达水平高于治疗前，差异均有统计学意义(P < 0.05)。治疗后，观察组SSA评分、WST评分、血浆黏度、高切全血黏度、血清NSE表达水平均低于疏血通组，且观察组患者血清GDNF高于疏血通组，差异均有统计学意义(P < 0.05)。
结论维筋相交针刺法联合疏血通治疗IS合并吞咽障碍可有效改善患者的吞咽功能和血流动力学指标水平，升高血清GDNF水平，降低血清NSE水平。
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关键词:
- 维筋相交针刺法 /
- 疏血通 /
- 缺血性脑卒中 /
- 吞咽障碍 /
- 胶质细胞源神经营养因子 /
- 神经元特异性烯醇化酶
Abstract:ObjectiveTo investigate the clinical efficacy of Weijin Xiangjiao acupuncture combined with Shuxuetong on dysphagia after ischemic stroke (IS) and its influences on the expression levels of serum glial cell-derived neurotrophic factor (GDNF) and neuron specific enolase (NSE).
MethodsA total of 102 patients with IS complicated with dysphagia treated in hospital from January 2019 to August 2020 were selected and randomly divided into observation group (n=51) and Shuxuetong group (n=51). Shuxuetong group was treated with Shuxuetong injection once a day for 2 weeks. The observation group was treated with Weijin Xiangjiao acupuncture on the basis of Shuxuetong group, once a day, 5 times a week for 2 weeks. The swallowing function, the levels of hemodynamic indicators and the expression levels of serum GDNF and NSE were observed before and after treatment, and clinical efficacy of two groups were observed.
ResultsThe total effective rate of treatment of the observation group was significantly higher than that of the Shuxuetong group (94.12% versus 70.59%, P=0.004). After treatment, the scores of Standardized Swallowing Assessment (SSA), Water Swallow Test (WST), plasma viscosity, high shear whole blood viscosity and serum NSE expression levels in the two groups were significantly lower than those before treatment, and the serum GDNF expression levels in the two groups were significantly higher than that before treatment (P < 0.05); after treatment, the SSA score, WST score, plasma viscosity, high shear whole blood viscosity and serum NSE expression level in the observation group were significantly lower than those in the Shuxuetong group, and the serum GDNF in the observation group was significantly higher than that in the Shuxuetong group (P < 0.05).
ConclusionWeijinjiaotong acupuncture combined with Shuxuetong in the treatment of IS patients complicated with dysphagia can effectively improve the swallowing function and hemodynamics, increase the level of serum GDNF and reduce the level of serum NSE.
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表 1 2组临床疗效比较[n(%)]
组别 n 显效 有效 无效 总有效 观察组 51 26(50.98) 22(43.14) 3(5.88) 48(94.12)* 疏血通组 51 19(37.25) 17(33.33) 15(29.41) 36(70.59) 与疏血通组比较, *P < 0.05。 
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表 2 2组吞咽功能比较(x±s)
分 组别 n SSA评分 WST评分 治疗前 治疗后 治疗前 治疗后 观察组 51 35.09±5.31 20.46±3.20*# 5.84±0.71 2.55±0.37*# 疏血通组 51 34.83±5.27 26.51±3.15* 5.67±0.66 4.28±0.43* SSA: 吞咽功能评价量表; WST: 洼田饮水试验。与治疗前比较, *P < 0.05; 与疏血通组比较, #P < 0.05。
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表 3 2组血流动力学指标水平比较(x±s)
mPa·s 组别 n 血浆黏度 高切全血黏度 治疗前 治疗后 治疗前 治疗后 观察组 51 3.49±0.33 1.97±0.25*# 7.03±0.81 5.45±0.62*# 疏血通组 51 3.56±0.34 2.58±0.30* 6.91±0.75 6.11±0.65* 与治疗前比较, *P < 0.05; 与疏血通组比较, #P < 0.05。
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表 4 2组血清GDNF、NSE水平比较(x±s)
组别 n GDNF/(μg/nL) NSE/(μg/mL) 治疗前 治疗后 治疗前 治疗后 观察组 51 3.26±0.95 7.54±1.68*# 51.74±8.35 25.28±5.19*# 疏血通组 51 3.32±1.01 5.21±1.12* 51.33±8.24 36.75±6.06* GDNF: 胶质细胞源神经营养因子; NSE: 神经元特异性烯醇化酶。与治疗前比较, *P < 0.05; 与疏血通组比较, #P < 0.05。
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