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中华脑科疾病与康复杂志(电子版) ›› 2024, Vol. 14 ›› Issue (02) : 80 -85. doi: 10.3877/cma.j.issn.2095-123X.2024.02.003

临床研究

头针联合辣椒素治疗脑卒中后慢性期吞咽障碍的临床疗效分析
徐金1, 龙耀斌1, 郑继青1,†()   
  1. 1. 530007　南宁，广西医科大学第二附属医院康复医学科
  • 收稿日期:2023-08-02 出版日期:2024-04-15
  • 通信作者: 郑继青

Clinical efficacy analysis of scalp acupuncture combined with capsaicin in the treatment of chronic dysphagia after stroke

Jin Xu1, Yaobin Long1, Jiqing Zheng1,†()   

  1. 1. Deparment of Rehabilitation, the Second Affiliated Hospital, Guangxi Medical University, Nanning 530007, China
  • Received:2023-08-02 Published:2024-04-15
  • Corresponding author: Jiqing Zheng
  • Supported by:
    Guangxi Medical University Youth Science Foundation(GXMUYSF202342); Natural Science Foundation of Guangxi Province(2022GXNSFAA035511); Guangxi Medical and Health Key Discipline Construction Project(Guiwei Kejiao Fa [2022] No. 4)
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引用本文：

徐金, 龙耀斌, 郑继青. 头针联合辣椒素治疗脑卒中后慢性期吞咽障碍的临床疗效分析[J/OL]. 中华脑科疾病与康复杂志(电子版), 2024, 14(02): 80-85.

Jin Xu, Yaobin Long, Jiqing Zheng. Clinical efficacy analysis of scalp acupuncture combined with capsaicin in the treatment of chronic dysphagia after stroke[J/OL]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2024, 14(02): 80-85.

目的

探讨头针（SA）联合辣椒素治疗脑卒中后慢性期吞咽障碍患者的临床疗效。

方法

选取广西医科大学第二附属医院康复医学科自2022年1月至2023年4月收治的90例脑卒中后慢性吞咽障碍患者，采用随机数字表法分为辣椒素组、SA组及SA联合辣椒素组，每组30例，疗程均为1个月。治疗前后分别使用洼田饮水试验（WST）、标准化床边吞咽功能检查（SSA）、进食评估工具-10（EAT-10）、电视X线透视吞咽功能检查（VFSS）进行评估，判断干预后患者吞咽功能改善的程度。

结果

治疗后，3组患者的WST分级均较治疗前下降，且3组间比较，差异均具有统计学差异（P<0.05）；3组患者的SSA、EAT-10和VFSS评分均较治疗前有不同程度的改善，其中SA联合辣椒素组的各项指标改善均优于辣椒素组、SA组，差异均有统计学意义（P<0.05)。

结论

与单独使用辣椒素或SA比较，使用SA联合辣椒素对脑卒中后慢性期吞咽障碍患者的吞咽功能的改善更明显。

关键词: 脑卒中, 吞咽障碍, 辣椒素, 头针
Objective

To investigate the clinical efficacy of scalp acupuncture (SA) combined capsaicin in patients with chronic dysphagia after stroke, and to explore a non-invasive, safe and effective method for the treatment of such patients.

Methods

Ninety patients diagnosed with stroke and suffering from chronic dysphagia from January 2022 to April 2023 were collected and divided into 3 groups by random number table method: capsaicin group, SA group and SA combined with capsaicin group, with 30 cases in each group. The course of treatment was 1 month. Before and after treatment, the patients were evaluated by Watian drinking water test (WST), the standard swallowing function assessment scale (SSA), eating assessment tool-10 (EAT-10) and videofluoroscopic swallowing study (VFSS), respectively, to determine the degree scores of 3 groups swallowing function after intervention.

Results

The WST grading of all three groups significantly were decreased compared to before treatment, the difference among the three groups after treatment was statistically significant (P<0.05). The SSA, EAT-10, and VFSS scores of 3 groups after treatment all showed varying degrees of improvement compared to before treatment, and the improvement of various indexes in the SA combined with capsaicin group was better than that in the capsaicin group and SA group, and the differences were statistically significant (P<0.05).

Conclusion

Compared with using capsaicin or SA alone, the combination of SA and capsaicin has a more significant improvement in swallowing function in patients with chronic dysphagia after stroke.

Key words: Stroke, Dysphagia, Capsaicin, Scalp acupuncture
表1 3组患者的一般资料比较
Tab.1 Comparison of general information among three groups
项目 辣椒素组（n=29） SA组（n=28） SA联合辣椒素组（n=29） F/χ2/Z值 P值
性别       0.524 1.292
男 22 19 18    
女 7 9 11    
年龄（岁，Mean±SD） 55.34±10.13 58.68±9.21 56.86±9.02 0.884 0.417
病程（d，Mean±SD） 46.69±14.07 42.57±13.76 45.62±14.84 0.639 0.530
MMSE评分（分，Mean±SD） 20.90±4.17 20.82±4.46 22.17±3.35 1.031 0.361
WST分级       0.458 0.795
3级 14 11 13    
4级 13 15 15    
5级 2 2 1    
图1 吞咽功能的X线透射检查A：未开始吞咽时有部分造影剂后漏（箭头所示）；B：会厌谷造影剂滞留（箭头所示）；C：造影剂经喉进入气管（箭头所示），发生误吸；D：会厌谷及梨状窝造影剂滞留，气管内可见造影剂（箭头所示）；E：经反复吞咽后会厌谷少部分造影剂残留，梨状窝有部分造影剂滞留（箭头所示）
Fig.1 X-ray fluoroscopic examination of swallowing function
表2 3组患者治疗前后WST分级比较
Tab.2 Comparison of WST grading before and after treatment among the three groups
WST分级 辣椒素组（n=29） SA组（n=28） SA联合辣椒素组（n=29）
治疗前 治疗后 治疗前 治疗后 治疗前 治疗后
1级 0 3 0 2 0 8
2级 0 12 0 13 0 14
3级 14 11 11 10 13 5
4级 13 3 15 3 15 2
5级 2 0 2 0 1 0
Z值 -4.648 -4.858 -5.600
P值 <0.001 <0.001 <0.001
表3 3组患者治疗前后SSA评分比较（分）
Tab.3 Comparison of SSA score before and after treatment among the three groups (score)
组别 例数 治疗前（Mean±SD） 治疗后[M（P25，P75）] Z值 P值
辣椒素组 29 30.58±3.67 26.00（21.00，29.00） -3.867 <0.001
SA组 28 30.25±3.50 25.00（22.00，29.00） -4.027 <0.001
SA联合辣椒素组 29 29.62±3.26 22.00（21.00，24.50）ab -5.449 <0.001
F/H值   0.575 7.821    
P值   0.565 0.020    
表4 3组患者治疗前后EAT-10评分比较（分，Mean±SD）
Tab.4 Comparison of EAT-10 score before and after treatment among the three groups (score, Mean±SD)
组别 例数 治疗前 治疗后 t值 P值
辣椒素组 29 23.10±6.03 16.79±6.64 11.602 <0.001
SA组 28 22.89±4.78 15.64±5.39 5.265 <0.001
SA联合辣椒素组 29 22.79±5.09 12.17±5.01ab 16.204 <0.001
F值   0.030 5.148    
P值   0.968 0.008    
表5 3组患者治疗前后VFSS评分比较（分）
Tab.5 Comparison of VFSS score before and after treatment among the three groups (score)
组别 例数 治疗前（Mean±SD） 治疗后[M（P25，P75）] Z值 P值
辣椒素组 29 63.28±10.46 51.00（33.50，58.75） -5.593 <0.001
SA组 28 65.05±8.77 46.25（31.63，60.25） -3.602 <0.001
SA联合辣椒素组 29 63.93±10.95 33.50（21.25，44.75）ab -4.096 <0.001
F/H值   0.224 7.572    
P值   0.800 0.023    
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