Comparative Study On The Effect Of "Tongguan Liqiao" Acupuncture On Dysphagia After Anterior And Posterior Circulatory Infarction

Objective:To clarify the therapeutic effect,difference and influencing factors of "Tongguan Liqiao" acupuncture in the treatment of swallowing disorder of anterior and posterior circulation cerebral infarction,and to provide the basis for the preliminary assessment of patients’ prognosis and the clinical application of precise treatment measures.Methods: The patients in this study were enrolled in the ward of the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine from June2020 to January 2021,including 108 patients with dysphagia after cerebral infarction were collected.According to the clinical manifestations of the patients after cerebral infarction combined with the location of the infarct lesions seen in cranial CT/MRI/MRA,patients with dysphagia after cerebral infarction were further divided into anterior circulation infarction group(54 cases)and posterior circulation infarction group(54 cases)according to the Oxfordshire community Stroke Project(OCSP)Classification.Both groups of patients were treated with conventional treatment for stroke and "Tongguan Liqiao" acupuncture,the main points were:neiguan double(PC6),renzhong(GV26),sanyinjiao(SP6),fengchi double(GB20),wangu double(GB12),yifeng double(SJ17),yanhoubi.The observation period was 2 weeks.Acupuncture was performed 6 days a week,30 minutes each time,12 times in total.Before and after treatment,the subjects were evaluated by Kubota drinking Water Test(WST),Functional Oral Intake Scale(FOIS)and National Institutes of Health Stroke Scale(NIHSS).The efficacy of acupuncture was evaluated according to the score changes,and statistical analysis was conducted.Results:(1)To analyze the therapeutic effect and difference of "Tongguan Liqiao" acupuncture in the treatment of dysphagia after anterior and posterior circulation infarction:Before the treatment,the former and the posterior circulation infarction group Kubota drinking Water Test(WST)score is 3(3,4)and 3(3,4)points respectively.After treatment,the WST rating of the two groups is 2(2,3)and 3(2,3)respectively.The WST score of subjects in both groups was improved compared with before,and the difference was statistically significant(P < 0.05).And the curative effect of anterior circulation infarction group was more obvious than that of posterior circulation infarction group,and the difference was statistically significant(P<0.05).Before the treatment,the former and posterior circulation infarction group Functional Oral Intake Scale(FOIS)score is 4(4,5)and 4(4,5)points respectively,After treatment,the FOIS rating of the two groups is 5(4,6)and 5(4,6)points respectively.The difference was statistically significant(P<0.05)within group,but there was no significant difference between groups(P>0.05).Before the treatment,the former and posterior circulation infarction group National Institute of Health stroke scale(NIHSS)score is 8(5.75,10.25)and 7(5,10)points respectively,After treatment,the NIHSS rating of the two groups is 6(4,9)and 7(4,8)points respectively.The difference was statistically significant(P<0.05)within group,but there was no significant difference between groups(P>0.05).(2)Analysis of influencing factors on the efficacy of "Tongguan Liqiao" acupuncture in the treatment of dysphagia after anterior and posterior circulatory infarction:The degree of neurological impairment(OR:0.820,95%CI:0.694-0.968,P=0.019)may be a risk factor affecting the improvement of WST scores in subjects with dysphagia after anterior circulation infarction.A history of cerebral infarction(OR:0.272,95%CI:0.079-0.933,P=0.038)may be a risk factor affecting the improvement of WST scores in subjects with dysphagia after posterior circulation infarction.Conclusion: Based on the existing data,the preliminary results show that:(1)"Tongguan Liqiao" acupuncturemethod has good safety and external effectiveness in the real medical environment.(2)After 2 weeks of treatment,the anterior circulation cerebral infarction group was superior to the posterior circulation cerebral infarction group in terms of improving the drinking capacity.However,considering the scores of the two groups in terms of improving the feeding capacity and the degree of neurological function deficit,the difference in the improvement of swallowing function after anterior and posterior circulation cerebral infarction was not significant between "Tongguanliqiao" acupuncture method.(3)The severity of the neurological deficit is a risk factor for the improvement of WST in dysphagia after anterior circulation infarction.Previous history of cerebral infarction is a risk factor for the improvement of WST in dysphagia after posterior circulation infarction.The severity of the neurological deficit and the previous history of cerebral infarction both reflect the severity of the disease from the side.Therefore,the severity of the disease may be the key to the improvement of swallowing function in both the anterior and posterior circulation infarction groups.