| Objective:Objective to compare and analyze the clinical efficacy of acupuncture therapy and swallowing rehabilitation training in the treatment of patients with dysphagia at different stages after stroke,so as to provide a more effective scheme and basis for clinical application.Methods:The 84 patients with dysphagia after stroke in this study were all from the Second Affiliated Hospital of Heilongjiang University of traditional Chinese medicine.They were randomly divided into two groups,the treatment group and the control group,42 in each group.The treatment group was given acupuncture therapy,and the control group was given swallowing rehabilitation training,5 days a week,once a day,for 2 weeks.Before treatment,video fluoroscopic swallowing study(VFSS)was used to identify the stages(oral phase,pharyngeal phase and mixed oral and pharyngeal phase).Before and after treatment,standard swallowing assessment(SSA),Fujishima Ichiro swallowing efficacy assessment scale and modified Barthel index were used to evaluate the efficacy,Ultrasonic examination was used to observe the changes of tongue thickness,movement amplitude,movement time,movement speed and the movement distance between hyoid bone and thyroid cartilage.Results:(1)A total of 84 subjects were included in this study.During the study period,4 patients fell off,and 80 subjects were completed.In the treatment group,there were 7 cases of dysphagia in oral phase,13 cases in pharyngeal phase,and 20 cases in mixed oral and pharyngeal phase.In the control group,there were 8 cases of dysphagia in oral phase,15 cases in pharyngeal phase,and 17 cases in mixed oral and pharyngeal phase.(2)The SSA scores of the two groups were compared:The SSA score of the two groups after treatment was significantly lower than that before treatment(P < 0.05);After treatment,the SSA score of the treatment group was lower than that of the control group(P< 0.05).Compared with the treatment group,the SSA score of the control group decreased more significantly(P < 0.05);Compared with the control group,the SSA score of the treatment group in pharyngeal phase and oropharyngeal mixed phase decreased more significantly(P < 0.05),and the difference was statistically significant.(3)Comparison of swallowing efficacy evaluation scores between the two groups:The scores of the two groups after treatment were significantly higher than those before treatment(P < 0.05);After treatment,the swallowing efficacy score of the treatment group was higher than that of the control group(P < 0.05).Compared with the treatment group,the score of patients in oral phase in the control group increased more significantly(P < 0.05),the difference was statistically significant;Compared with the control group,the scores of patients in pharyngeal phase and oropharyngeal mixed phase in the treatment group increased more significantly(P < 0.05),and the difference was statistically significant.(4)Comparison of modified Barthel index scores between the two groups:The modified Barthel Index scores of the two groups after treatment were significantly higher than those before treatment(P < 0.05);After treatment,the modified Barthel index score of the treatment group was higher than that of the control group(P< 0.05),and the difference was statistically significant.Compared with the control group,the treatment group oral phase,pharyngeal phase,oral pharyngeal mixed phase patients score increased more significantly(P< 0.05),the difference was statistically significant.(5)Comparison of ultrasound parameters between the two groups:Oral phase:there were significant differences in tongue thickness,movement amplitude,movement time and movement speed between the two groups before and after treatment(P< 0.05);Compared with the control group,the tongue thickness,movement amplitude,movement time and movement speed of the control group were improved more significantly(P < 0.05),and the difference was statistically significant.Pharyngeal phase:there were significant differences in the distance between hyoid bone and thyroid cartilage between the two groups before and after treatment(P < 0.05);Compared with the control group,the movement distance from hyoid bone to thyroid cartilage in the treatment group increased more significantly(P< 0.05),and the difference was statistically significant.Oropharyngeal mixed phase:there were significant differences in tongue thickness,motion parameters,and motion distance between hyoid bone and thyroid cartilage between the two groups before and after treatment(P< 0.05);Compared with the control group,the tongue thickness,movement range,movement time and movement speed of the control group were improved more significantly(P < 0.05),and the movement distance from hyoid bone to thyroid cartilage of the treatment group was increased more significantly(P<0.05),with statistical significance.Conclusions:1.Both acupuncture therapy and swallowing rehabilitation training can improve the swallowing function and activities of daily living of patients with dysphagia after stroke.Compared with swallowing rehabilitation training,acupuncture therapy has more significant clinical effect on dysphagia after stroke,especially for patients with dysphagia in swallowing stage and mixed swallowing stage.2.Both acupuncture therapy and swallowing rehabilitation training can improve the coordination of swallowing movement in patients with dysphagia after stroke.Among them,swallowing rehabilitation training has better effect in improving tongue thickness and tongue motor function,and acupuncture therapy has better effect in improving the motor ability from hyoid bone to thyroid cartilage. |
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