Effect of timing acupoint stimulation for dysphagia patients after stroke
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摘要:目的 探讨择时穴位刺激对脑卒中后吞咽障碍患者的影响。方法 选取90例脑卒中后吞咽障碍的住院患者，随机分为对照组、择时穴位刺激组和常规穴位刺激组，每组30例。对照组采用常规吞咽功能训练和口腔护理，择时穴位刺激组和常规穴位刺激组分别在对照组基础上加用择时的穴位刺激和常规时间的穴位刺激, 2次/d, 共2周。采用洼田饮水试验(WST)结果评价有效率，进食评估问卷调查工具-10(EAT-10)、吞咽障碍特异性生活质量量表(SWAL-QOL)评估3组患者的吞咽功能及生活质量。结果 干预后，择时穴位刺激组的总有效率高于常规穴位刺激组和对照组，且常规穴位刺激组的总有效率高于对照组，差异有统计学意义(P < 0.05)。干预后, 3组EAT-10评分均低于干预前，且择时穴位刺激组的EAT-10评分低于常规穴位刺激组和对照组，差异有统计学意义(P < 0.05)。干预后，对照组SWAL-QOL评分与干预前比较，差异无统计学意义(P > 0.05); 干预后，择时穴位刺激组、常规穴位刺激组的SWAL-QOL评分均高于干预前，且择时穴位刺激组评分高于常规穴位刺激组和对照组，常规穴位刺激组评分高于对照组，差异有统计学意义(P < 0.05)。结论 常规穴位刺激对脑卒中后吞咽障碍患者的疗效优于常规护理，而择时穴位刺激的临床效果则更优。Abstract:Objective To explore the effect of timing acupoint stimulation for dysphagia patients after stroke.Methods A total of 90 patients with dysphagia after stroke were selected, and were randomly divided into control group, timing acupoint stimulation group, and conventional acupoint stimulation group, with 30 cases in each group. Control group was given routine swallowing function training and oral care; on the basis of control group, timing acupoint stimulation group and conventional acupoint stimulation group were given timing acupoint stimulation and conventional time acupoint stimulation, respectively, twice a day for two weeks. Drinking Water Test (WST), the 10-item Eating-assessment Tool (EAT-10) and the Swallowing Quality-of-life Questionnaire (SWAL-QOL)were used to evaluate the swallowing function and quality of life of the three groups.Results After intervention, the total effective rate of timing acupoint stimulation group was higher than that of the conventional acupoint stimulation group and the control group, and the total effective rate of the conventional acupoint stimulation group was higher than that of the control group (P < 0.05). After intervention, the EAT-10 scores of the three groups were lower than that before intervention, and the EAT-10 score of the timing acupoint stimulation group was lower than that of the conventional acupoint stimulation group and the control group (P < 0.05). After intervention, there was no significant difference in SWAL-QOL score in the control group compared with before intervention (P > 0.05). After intervention, the SWAL-QOL scores of the timing acupoint stimulation group and the conventional acupoint stimulation group were higher than before intervention, and the SWAL-QOL score of the timing acupoint stimulation group was higher than that of the conventional acupoint stimulation group and the control group, and was higher in the conventional acupoint stimulation group than that of the control group (P < 0.05).Conclusion The curative effect of conventional acupoint stimulation for patients with dysphagia after stroke is better than that of conventional nursing, and the timing acupoint stimulation is better.
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Keywords:
- timing /
- acupoint stimulation /
- post-stroke dysphagia /
- swallowing function /
- quality of life
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表 1 3组患者一般资料比较(x±s)[n(%)]
指标 对照组(n=30) 择时穴位刺激组(n=30) 常规穴位刺激组(n=29) F/χ2 P < /italic> 性别 男 20(66.67) 20(66.67) 15(51.72) 0.828 0.401 女 10(33.33) 10(33.33) 14(48.28) 年龄/岁 66.48±9.09 68.30±13.00 65.27±11.77 1.065 0.587 学历 初中及以下 10(33.33) 13(43.33) 8(27.59) 3.405 0.508 高中 13(43.33) 10(33.33) 15(51.72) 大专及以上 7(23.33) 7(23.33) 6(20.69) BMI/(kg/m2) 21.34±1.84 21.12±0.02 20.84±1.64 1.957 0.376 病程/周 4.80±4.60 4.30±4.13 5.66±4.51 2.309 0.315 卒中类型 脑梗死 27(90.00) 29(96.67) 27(93.10) 1.468 0.480 脑出血 3(10.00) 1(3.33) 2(6.90) 卒中部位 左侧 6(20.00) 6(20.00) 3(10.34) 7.737 0.106 右侧 1(3.33) 2(6.67) 7(24.14) 双侧 23(76.67) 22(73.33) 19(65.52) 卒中次数 首次 16(53.33) 15(50.00) 11(37.93) 1.559 0.459 非首次 14(46.67) 15(50.00) 18(62.07) 合并疾病 高血压 29(96.67) 29(96.67) 25(86.21) 3.118 0.794 心脏病 6(20.00) 8(26.67) 5(17.24) 糖尿病 6(20.00) 5(16.67) 8(27.59) 心脏病 6(20.00) 8(26.67) 5(17.24) 血脂异常 4(13.33) 2(6.67) 5(17.24) BMI: 体质量指数。 
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表 2 3组患者干预前后洼田饮水试验评级结果比较[n(%)]
组别 时点 Ⅰ级 Ⅱ级 Ⅲ级 Ⅳ级 Ⅴ级 吞咽能力异常 对照组(n=30) 干预前 0 4 14 11 1 26(86.67) 干预后 0 7 14 8 1 23(76.67)* 择时穴位刺激组(n=30) 干预前 0 2 13 10 5 28(93.33) 干预后 2 15 10 2 1 13(43.33)*#△ 常规穴位刺激组(n=29) 干预前 0 5 17 6 1 24(82.76) 干预后 3 12 12 1 1 14(48.28)*# 与干预前比较, *P < 0.05; 与对照组比较, #P < 0.05; 与常规穴位刺激组比较, △P < 0.05。
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表 3 3组患者干预后临床疗效比较[n(%)]
组别 n 显效 有效 无效 总有效 对照组 30 0 6(20.00) 24(80.00) 6(20.00) 择时穴位刺激组 30 2(6.67) 24(80.00) 4(13.33) 26(86.67)*# 常规穴位刺激组 29 2(6.90) 15(51.72) 12(41.38) 17(58.62)*) 与对照组比较, *P < 0.05; 与常规穴位刺激组比较, #P < 0.05。
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表 4 3组患者干预前后EAT-10评分比较(x±s)
分 组别 n EAT-10评分 干预前 干预后 对照组 30 16.67±5.31 7.69±2.55*# 择时穴位刺激组 30 17.37±4.85 5.63±1.45* 常规穴位刺激组 29 16.17±5.56 7.27±2.03*# EAT-10: 进食评估问卷调查工具-10。
与干预前比较, *P < 0.05;
与择时穴位刺激组比较, #P < 0.05。
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表 5 3组患者干预前后生活质量评分比较(x±s)
分 组别 n SWAL-QOL评分 干预前 干预后 对照组 30 111.60±13.20 112.17±21.52 择时穴位刺激组 30 108.77±13.42 132.97±13.56*#△ 常规穴位刺激组 29 113.86±9.85 121.63±11.54*# SWAL-QOL: 吞咽障碍特异性生活质量量表。
与干预前比较, *P < 0.05; 与对照组比较, #P < 0.05;
与常规穴位刺激组比较, △P < 0.05。
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[1] ORTEGA O, MARTÍN A, CLAVÉ P. Diagnosis and management of oropharyngeal dysphagia among older persons, state of the art[J]. J Am Med Dir Assoc, 2017, 18(7): 576-582. doi: 10.1016/j.jamda.2017.02.015
[2] WU S, WU B, LIU M, et al. Stroke in China: advances and challenges in epidemiology, prevention, and management[J]. Lancet Neurol, 2019, 18(4): 394-405. doi: 10.1016/S1474-4422(18)30500-3
[3] ELTRINGHAM S A, KILNER K, GEE M, et al. Impact of dysphagia assessment and management on risk of stroke-associated pneumonia: a systematic review[J]. Cerebrovasc Dis, 2018, 46(3/4): 99-107. http://www.onacademic.com/detail/journal_1000040479076010_6bc9.html
[4] ALLEN J, GREENE M, SABIDO I, et al. Economic costs of dysphagia among hospitalized patients[J]. Laryngoscope, 2020, 130(4): 974-979. doi: 10.1002/lary.28194
[5] KIM J Y, LEE Y W, KIM H S, et al. The mediating and moderating effects of meaning in life on the relationship between depression and quality of life in patients with dysphagia[J]. J Clin Nurs, 2019, 28(15/16): 2782-2789. doi: 10.1111/jocn.14907
[6] 谭慧颖, 方俊明, 石孟云, 等. 子午流注针法临床研究进展[J]. 大众科技, 2019, 21(12): 60-62. doi: 10.3969/j.issn.1008-1151.2019.12.020 [7] 张峰, 杨嘉兴, 黄信, 等. 关于子午流注针法的思考[J]. 中国民间疗法, 2018, 26(12): 114-116. https://www.cnki.com.cn/Article/CJFDTOTAL-ZMJL201812077.htm [8] 何竟, 郑敏, 何成奇, 等. 穴位刺激疗法治疗脑卒中后吞咽障碍的系统评价[J]. 中国针灸, 2009, 29(1): 66-71. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGZE200901035.htm [9] 中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国各类主要脑血管病诊断要点2019[J]. 中华神经科杂志, 2019, 52(9): 710-715. [10] 国家中医药管理局脑病急症协作组. 中风病诊断与疗效评定标准(试行)[J]. 北京中医药大学学报, 1996, 19(1): 55-56. https://www.cnki.com.cn/Article/CJFDTOTAL-JZYB601.023.htm [11] 中国吞咽障碍康复评估与治疗专家共识组. 中国吞咽障碍评估与治疗专家共识(2017年版)第一部分评估篇[J]. 中华物理医学与康复杂志, 2017, 39(12): 881-892. doi: 10.3760/cma.j.issn.0254-1424.2017.12.001 [12] 李小寒, 尚少梅. 基础护理学[M]. 第5版. 北京: 人民卫生出版社, 2012: 143-144. [13] 国家技术监督局. 经穴部位[M]. 北京: 中国标准出版社, 1999: 12-12. [14] BELAFSKY P C, MOUADEB D A, REES C J, et al. Validity and reliability of the eating assessment tool (EAT-10)[J]. Ann Otol Rhinol Laryngol, 2008, 117(12): 919-924. doi: 10.1177/000348940811701210
[15] MCHORNEY C A, ROBBINS J, LOMAX K, et al. The SWAL-QOL and SWAL-CARE outcomes tool for oropharyngeal dysphagia in adults: Ⅲ. Documentation of reliability and validity[J]. Dysphagia, 2002, 17(2): 97-114. doi: 10.1007/s00455-001-0109-1
[16] 陈新星, 田玲. 脑卒中后吞咽障碍患者针刺与康复训练的时机选择[J]. 实用临床医药杂志, 2020, 24(6): 123-125, 129. doi: 10.7619/jcmp.202006034 [17] 赵丽佳. 因时护理模式联合针灸电刺激康复治疗对脑梗死合并吞咽障碍患者吞咽功能及依从性的影响[J]. 医疗装备, 2020, 33(8): 184-185. https://www.cnki.com.cn/Article/CJFDTOTAL-YLZB202008125.htm [18] 宋怡. 时间护理对住院脑梗死患者神经功能及生活质量的影响[J]. 实用临床医药杂志, 2015, 19(16): 7-9. doi: 10.7619/jcmp.201516003 [19] 况莉, 许燕玲, 曹燕, 等. 脑卒中病人吞咽障碍生活质量量表的研究进展[J]. 护理研究, 2019, 33(17): 3005-3008. https://www.cnki.com.cn/Article/CJFDTOTAL-SXHZ201917020.htm [20] KJAERSGAARD A, PALLESEN H. First-hand experience of severe dysphagia following brainstem stroke: two qualitative cases[J]. Geriatrics, 2020, 5(1): 15. http://www.researchgate.net/publication/339708951_First-Hand_Experience_of_Severe_Dysphagia_Following_Brainstem_Stroke_Two_Qualitative_Cases/download
[21] 单媛媛, 甘谱琴, 王婷, 等. 脑卒中后吞咽障碍病人焦虑状态与生活质量的logistic回归分析[J]. 安徽医药, 2019, 23(2): 326-329. https://www.cnki.com.cn/Article/CJFDTOTAL-AHYY201902033.htm [22] 何振燕. 早期中医康复对脑卒中患者吞咽障碍、生活质量的影响研究[J]. 中医临床研究, 2020, 12(32): 82-84. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYLY202032029.htm [23] 窦惠珍, 丛地霞. 时间护理结合酸刺激在脑卒中吞咽障碍中的应用[J]. 中国卫生标准管理, 2018, 9(20): 182-184. https://www.cnki.com.cn/Article/CJFDTOTAL-WSBZ201820083.htm [24] 王东阳. 时间护理对改善脑卒中患者抑郁情绪的应用评价[J]. 中国医药指南, 2017, 15(26): 257-258. https://www.cnki.com.cn/Article/CJFDTOTAL-YYXK201726209.htm
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