| ObjectiveBased on the regularity analysis of acupoints of acupuncture treatment of post-stroke dysphagia and the systematic review of acupuncture combined with rehabilitation therapy on dysphagia after stroke, we treated the patients of dysphagia after stroke with acupuncture at Fengfu(GV16) of Governor Vessel, Lianquan(CV23) of Conception Vessel combined with rehabilitation therapy. The clinical efficacy and safety of acupuncture treatment of dysphagia after stroke were evaluated by videof luoroscopic swallowing study, water swallowing test, standardized swallowing assessment, that preliminary clinical observation for the further study of the mechanism of acupuncture at Governor Vessel and Conception Vessel for dyaphagia after stroke.Methods1.The regularity analysis of acupoints of acupuncture treatment of post-stroke dysphagia.We searched all the relevant literature on the treatment of post-stroke dysphagia in the China journal full text database (CNKI), VIP Chinese journal full text database, Wanfang database and Chinese biomedical literature CD-ROM Database (CBM), Ovid Lww database and Pubmed from January 1999 to December 2015. Then we screened articles according to inclusion and exclusion criteria, and extracted data messages including the title, author, book name, age, acupoints, techniques of acupuncture and moxibustion, course, etc. We established a literature analysis database of the acupuncture treatment for post-stroke dysphagia by using the TCM inheritance support system 5.0 software and statistical analyzed the acupoints’type, meridian tropism and frequency of use.2. The systematical review of acupuncture treatment combined with rehabilitation therapy on dysphagia after stroke.We took randomized controlled trials of high quality, defined as scored more than 4 points by Jadad measuring scale, that comparing the efficacy and safety of acupuncture treatment combined with rehabilitation training and simple rehabilitation training on post stroke dysphagia, as the research object by means of systematic review. We searched databases in Chinese and English without restriction in the test group of needle material, types of electroacupuncture, acupoints’ selection, reinforcing and reducing method, needle retention time and course of treatment. Maneuvers of rehabilitation training in both groups were not restricted. In accordance with the inclusion criteria and exclusion criteria, we extracted the data from eventual included articles, including the sample size, random programs, treatment options, outcomes, shedding and withdrawal, follow-up and so on. Meta analysis was performed by the RevMan 5.3 software provided by Cochrance collaboration website (http://www.cochrance.org).3. Clinical study of the treatment of eletroacupuncture at acupoints of Conception Vessel and governor vessel for dysphagia post stroke.Preclinical research showed that the number of dysphagia patients after stroke of cerebral cortex was only a few. Finally we included 10 patients of dysphagia after stroke and they were randomly divided into the acupuncture group and control group,5 patients in each group. Patients of both groups received routine rehabilitation training, while those in the acupuncture group electroacupuncture therapy was added. The acupuncture treatment was provided by electroacupuncture at Fengfu(GV16) of Governor Vessel, Lianquan(CV23) of Conception Vessel, with frequency of 2Hz,30 minutes per day and course of 10 days. Swallowing function of patients in both groups were evaluated by swallowing function by videofluoroscopic swallowing study, water swallowing test, standardized swallowing assessment before and after treatment.Using the SPSS21.0 statistical software package to establish a database, and to manage and analyze data. Analysis methods included descriptive statistics, paired-samples T-test of intragroup comparison before and after the treatment、independent sample T-test of comparison between groups and rank sum test of ranked data between groups, and test level above were 0.05.Results1. The results of regularity analysis of acupointsA total of 402 acupuncture prescriptions for acupuncture treatment of dysphagia after stroke were retrieved and included.62 acupoints of fourteen channels were applied in these prescriptions and 33 extra nerve points were involved. Total applied frequency of acupoints was 1981 times. The acupoint Lianquan(CV23) of Conception Vessel was most commonly used. Fengfu(GV16) of Governor Vessel was also one of acupoints applied frequently.The acupuncture treatment of dysphagia after stroke focused on the selection of local acupoints. The top five most frequently used acupoints were Lianquan(CV23), Fengchi(GB20), Yifeng(TE17), Jinjin(HN12), Yuye(HN13), that all located in glossopharyngeal part and the neck. Acupoints of head, face, and neck were seleted as high as 79.3%, significantly higher than those in other parts. Meridians related to the acupoints applied in acupuncture prescriptions were involved 14 meridians, including 12 meridians of foot and hand and Conception Vessel, Governor Vessel. The top 3 meridians applied frequently in acupuncture prescriptions were Gall Bladder Channel of Foot-Shaoyang, Conception Vessel and Governor Vessel. Special acupoints were widely used in prescriptions that 58 of them were selected, and were applied 1407 times of cumulative frequency, which accounted 71.02% of total application frequency, far more frequently than non special acupoints. The special acupoints were major part of acupuncture prescriptions.2. The systematic review of literatureTotally 2857 articles were electronic retrieved from databases. Exclude articles didn’t meet the inclusion criteria, including review, different interventions and low quality randomized design.12 randomized controlled trial articles were finally included, with 1172 cases of dysphagia patients after stroke from hospital ward or outpatient.Meta analysis showed that acupuncture combined with rehabilitation training had a better effect on clinical total effective rate, water drinking test, Fujishima Koizumi test scores and VFSS scores, compared with simple rehabilitation training. The difference was statistically significant and acupuncture combined with rehabilitation training could better improve swallowing fuction of dysphagia after stroke. Both of them were quite effective improving patients’quality of life. Compared with simple rehabilitation training, acupuncture could increase the incidence of adverse reactions of dysphagia after stroke, including pain, bleeding and so on. Therefore, taking measures to reduce the occurrence of adverse events as much as possible in the process of acupuncture therapy was important. Adverse events should be processed immediately once they happened.Based on the Meta analysis of acupuncture combined with rehabilitation training for the patients with dysphagia after stroke, the GRADE system was used to evaluate the quality of evidence of Meta analysis. We evaluated the Kubota Swallowing Scale, water swallowing test, Fujishima Koizumi test scores, VFSS scores and SWAL-QOL scores by GRADE system according to data summaries and data packets of literature. The results indicated that the grades of Kubota Swallowing Scale and water swallowing test were reduced to medium quality because of the heterogeneity, and the other 4 groups were all evaluated as advanced quality, suggesting that the results of meta analysis is more reliable and accurate.3 The results of clinical researchComparison with dilute liquid and semi liquid VFSS index of patients in two groups before and after treatment, it showed that pharyngeal delay time, pharyngeal transit time decreased as compared with those before treatment in acupuncture group, and pharyngeal transit time decreased in control group as well. The differences were statistically significant (p<0.05) by paired samples T-test. The pharyngeal delay time and pharyngeal transit time of dilute liquid and semi liquid VFSS index of acupuncture group after treatment were reduced compared to the control group, and the difference was significant(P <0.05) by two independent samples T-test.Comparison with solid VFSS index of patients in two groups before and after treatment, it showed that pharyngeal transit time decreased as compared with those before treatment in acupuncture group, and in control group as well. The differences were statistically significant (p<0.05) by paired samples T-test. The pharyngeal delay time and pharyngeal transit time of solid VFSS index of acupuncture group after treatment were reduced compared to the control group, and the difference was significant (P<0.05) by two independent samples T-test.Comparison with SSA scores of patients in two groups before and after treatment,it showed that scores in the acupuncture group decreased as compared with those before treatment and the difference is statistically significant (P<0.05) by two independent samples T-test. The SSA scores difference of acupuncture group after treatment were reduced compared with the control group, and the difference was statistically significant (P<0.05) by two independent samples T-test.Two groups of patients were assessed by the water swallowing test after treatment,4 patients of treatment group were effective, and 1 ineffective, while 2 patients of the control group were effective, and 3 ineffective.During the course of the study,1 patient had experienced pain, and the pain was disappeared after reduction of electroacupuncture stimulation intensity, and no other adverse events occurred. Conclusion1. Conception Vessel and Governor Vessel are commonly used in the treatment of dysphagia after stroke. The acupoint Lianquan(CV23) of Conception Vessel and Fengfu(GV16) of Governor Vessel are two commonly applied acupoints.2. Acupuncture combined with rehabilitation training in the treatment of dysphagia after stroke can significantly improve the swallowing function of patients, and acupuncture is an effective treatment method.3. Acupuncture at Lianquan(CV23) of Conception Vessel and Fengfu(GV16) of Governor Vessel can improve swallowing function of dysphagia patients after stroke. Its mechanism still needs further study. |
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