Clinical Observation The Effectiveness Of CENA On The Treatment Of Dysphagia In Patients With Patients With Tracheotomy PBA After Severe Cerebral Hemorrhage

Objective:To observe the effectiveness of cross electro-nape acupuncture(CENA)on the treatment of dysphagia in patients with patients with tracheotomy pseudo bulbar affect(PBA)after severe cerebral hemorrhage;To explore the influence of CENA on the related factors of extubation(swallowing function,cough reflex function,consciousness)and extubation rate in patients with tracheotomy;To provide innovative methods and reliable experimental research basis for the treatment of patients with tracheotomy PBA after severe cerebral hemorrhage.Methods:96 subjects who met the inclusion criteria were divided into the CENA group,electro acupuncture(EA)group,and acupuncture group,with 32 in each group.The neurological department provided routine basic treatment,including Antihypertensive,hypoglycemic,hypolipidemic,anti-inflammatory,expectorant,nutritional support,monitoring of ion and hemoglobin levels,application of antibiotics to control infection according to drug sensitivity results,and daily nursing treatment.The three groups were given basic treatment.The electrode connection method of the CENA group was bilateral Yifeng(TE17)and Fengchi(GB20)cross power.Yifeng(TE17)was the positive electrode and Fengchi(GB20)was the negative electrode.The electrode connection mode of the EA group was ipsilateral power of Yifeng(GB20)and Fengchi(GB20).Yifeng(TE17)was the positive electrode and Fengchi(GB20)was the negative electrode.The acupuncture group was not powered on,with simple acupuncture at Yifeng(TE17)Point and Fengchi(GB20)Point.The continuous wave was selected,with a frequency of 1.5 Hz and a current intensity rotation adjustment scale of 4.Based on the patient’s tolerance,acupuncture and moxibustion therapy was conducted for 30 min in each time.After the treatment,the needle was removed.On the premise of ensuring the patient’s safety,the current intensity was strictly limited to be 4,and it could be slightly adjusted if the patient was abnormally uncomfortable.Acupuncture was performed twice a day from Monday to Saturday(once on Sunday)for a total of 4 weeks.The SSA score,CFG score,FOUR score,and NIHSS score before and after treatment were compared respectively to evaluate the effect of the ECNA on swallowing function,cough reflex function,consciousness,and neurological deficit.The extubation rate of the three groups after treatment was compared in order to explore the effect of the ECNA on extubation in patients with severe cerebral hemorrhage who had a PBA.Results:1.The effect of "crossed electric needle" on swallowing function and nerve function was selected by SSA scale and NIHSS score1.1The effect of CENA on swallowing function was evaluated by Standard Swallowing Function Scale(SSA Scale).(1)Before treatment: Before treatment,there was no statistical difference among the three groups,and they were comparable(P > 0.05).(2)Before and after treatment: Their SSA scores decreased after treatment,and compared with them before treatment,the differences among the three groups were statistically significant(P < 0.05).(3)After treatment: After treatment,the three groups were compared,and the difference was statistically significant(P< 0.05).There was a statistically significant difference between the CENA group and the EA group and the acupuncture group(P<0.05).1.2 The effect of CENA on neurological deficits was evaluated using the NIHSS score.(1)Before treatment: Before treatment,there was no statistical difference among the three groups,and they were comparable(P>0.05).(2)Before and after treatment: After treatment,their NIHSS scores were increased,and compared with them before treatment,the differences among the three groups were statistically significant(P< 0.05).(3)After treatment: After treatment,the three groups were compared,and the difference was not statistically significant(P>0.05).2.The influence of the CENA on the factors related to the sealing"2.1 The effect of CENA on cough reflex function was evaluated by the cough reflex score(GFC score).(1)Before treatment: Before treatment,there was no statistical difference among the three groups,and they were comparable(P>0.05).(2)Before and after treatment: After treatment,their GFC scores were decreased,and compared with them before treatment,the differences among the three groups were statistically significant(P< 0.05).(3)After treatment: After treatment,the three groups were compared,and the difference was statistically significant(P < 0.05).There was a statistically significant difference between the CENA group and the EA group and the acupuncture group(P<0.05).(4)As for the curative effect of the three groups,the good improvement rate of the CENA group,the EA group and the acupuncture group was 90.0%,60.0%,and 43.4 %,respectively.The rank sum test showed that the difference was statistically significant.2.2.The effect of CENA on consciousness was evaluated by the full outline of unresponsiveness(FOUR)score(1)Before treatment: Before treatment,there was no statistical difference among the three groups,and they were comparable(P>0.05).(2)Before and after treatment: After treatment,their FOUR scores were increased,and compared with them before treatment,the differences among the three groups were statistically significant(P< 0.05).(3)After treatment: After treatment,the three groups were compared,and the difference was statistically significant(P<0.05).There was a statistically significant difference between the CENA group and the EA group and the acupuncture group(P<0.05).2.3 The effect of CENA on the extubation rate was evaluated by the number of patients who experienced extubation after treatmentThe extubation rate of the CENA group,the EA group,and the acupuncture group was 73.3%,36.7%,and 26.7%,respectively.The rank sum test showed that difference was statistically significant.Conclusion:1.CENA could effectively promote the recovery of swallowing funct-ion and nerve function in patients with tracheostomy intubation pseudobulbar palsy after severe cerebral hemorrhage.2.CENA could help improve the factors influencing extubation and increase the rate of extubation in patients with tracheostomy intubation pseudooblongata palsy after severe cerebral hemorrhage.