中国针灸

目的：观察陈应龙子午补泻针法治疗脑卒中后咽期吞咽障碍的临床疗效，并初探其生物力学机制。方法：将72例脑卒中后咽期吞咽障碍患者随机分为子午补泻针法组（36例，脱落2例、剔除1例）和常规针刺组（36例，脱落1例、剔除1例）。其中常规针刺组选用廉泉及双侧风池、完骨、通里、照海、合谷、太冲进行常规针刺，子午补泻针法组在常规针刺组取穴基础上施加陈应龙子午补泻针法。两组均每次留针30 min，每日治疗1次，治疗6 d后休息1 d，共治疗4周。治疗前后分别评估两组患者标准吞咽功能评估量表（SSA）评分、Rosenbek渗漏/误吸量表（PAS）分级、下颌骨-舌骨距离缩短率、中文版吞咽生存质量量表（SWAL-QOL）评分，比较两组患者鼻饲管拔除率，并评定两组临床疗效和安全性。结果：治疗后，两组患者SSA评分、PAS分级均较治疗前降低（P<0.001），且子午补泻针法组低于常规针刺组（P<0.01,P<0.05）。治疗后，两组患者下颌骨-舌骨距离缩短率、SWAL-QOL评分较治疗前升高（P<0.001），且子午补泻针法组下颌骨-舌骨距离缩短率高于常规针刺组（P<0.001）。子午补泻针法组鼻饲管拔除率为87.9%(29/33)，高于常规针刺组的61.8%(21/34,P<0.05)。子午补泻针法组总有效率为84.8%(28/33)，高于常规针刺组的61.8%(21/34,P<0.05)。两组均未发生严重不良反应。结论：陈应龙子午补泻针法能有效改善脑卒中后咽期吞咽障碍，降低误吸风险，提高生活质量，其疗效可能与增加舌骨位移幅度有关。

Objective To observe the clinical effect of CHEN Yinglong 's ziwu reinforcing and reducing acupuncture method on post-stroke swallowing dysfunction(PSD) in the pharyngeal phase, and explore its biomechanical mechanism.Methods A total of 72 patients with PSD in the pharyngeal phase were randomly divided into a ziwu reinforcing and reducing acupuncture group(36 cases, 2 cases dropped out and 1 case was eliminated) and a conventional acupuncture group(36 cases, 1 case dropped out and 1 case was eliminated). The patients in the conventional acupuncture group were treated with conventional acupuncture at Lianquan(CV 23) and bilateral Fengchi(GB 20), Wangu(GB 12), Tongli(HT 5), Zhaohai(KI 6), Hegu(LI 4), Taichong(LR 3). The patients in the ziwu reinforcing and reducing acupuncture group were treated with CHEN Yinglong 's ziwu reinforcing and reducing acupuncture method on the basis of the conventional acupuncture group's acupoints. Both groups were treated with acupuncture for 30 min each time, once a day, and rested for 1 day after 6 days of treatment, and the treatment lasted 4 weeks. Before and after treatment, the standardized swallowing assessment(SSA) score,Rosenbek penetration aspiration scale(PAS) grade, the shortening rate of mandibular-hyoid distance, swallowing quality of life(SWAL-QOL) score were evaluated in the two groups. The removal rate of nasogastric feeding tube was compared in the two groups, and the clinical efficacy and safety of the two groups were compared. Results After treatment, the SSA scores and PAS grade of the two groups were lower than those before treatment(P<0.001), and above indexes in the ziwu reinforcing and reducing acupuncture group were lower than those in the conventional acupuncture group(P<0.01, P<0.05). After treatment, the shortening rates of mandibular-hyoid distance and SWAL-QOL scores in the two groups were higher than those before treatment(P<0.001), and the shortening rate of mandibular-hyoid distance in the ziwu reinforcing and reducing acupuncture group was higher than that in the conventional acupuncture group(P<0.001). The removal rate of nasogastric feeding tube in the ziwu reinforcing and reducing acupuncture group was 87.9%(29/33), which was higher than 61.8%(21/34) in the conventional acupuncture group(P<0.05). The total effective rate of the ziwu reinforcing and reducing acupuncture group was 84.8%(28/33), which was higher than 61.8%(21/34) of the conventional acupuncture group(P<0.05).Neither group experienced serious adverse reactions. Conclusion CHEN Yinglong 's ziwu reinforcing and reducing acupuncture method can effectively improve swallowing dysfunction in the pharyngeal phase after stroke, reduce the risk of aspiration, and improve quality of life. Its therapeutic effect may be related to increasing the displacement amplitude of the hyoid bone.