针刺结合重复经颅磁刺激对缺血性脑卒中吞咽功能障碍的临床观察*

目的：评价针刺结合重复经颅磁刺激对缺血性脑卒中吞咽功能障碍的临床疗效。方法：60例脑卒中后吞咽功能障碍患者全部来自福建中医药大学附属康复医院脑病康复科的住院患者，按随机数字表分为两组，观察组和对照组各30例。观察组在常规吞咽康复治疗的基础上针刺廉泉、哑门、风府，并接受rTMS治疗；对照组在常规吞咽康复治疗的基础上接受rTMS 治疗，共治疗 4周。在治疗前和治疗 4周后由同一专业评定人员对 2组患者进行洼田饮水试验（WTDWT）和标准吞咽功能评定量表（SSA）评定，并进行血清 VEGF、BDNF 水平检测。结果：治疗 4 周后，两组组患者 WTDWT、SSA 评分及血清 VEGF、 BDNF 水平组内比较均较治疗前改善（P＜0.05），且观察组 WTDWT、SSA 评分及血清 VEGF、BDNF 水平均优于对照组（P＜ 0.05）。结论：在常规吞咽康复治疗的基础上，结合针刺廉泉、哑门、风府和rTMS治疗可显著改善缺血性脑卒中患者的吞咽功能，且效果优于仅使用rTMS和常规吞咽康复治疗的患者，这种改善可能与血清中VEGF和BDNF水平的增加有关。

Clinical Observation of Acupuncture Combined with Repeated Transcranial Magnetic Stimulation on Swallowing Dysfunction in Ischemic Stroke

Objective: To evaluate the clinical effect of acupuncture combined with repeated transcranial magnetic stimulation on swallowing dysfunction in ischemic stroke. Methods: The 60 patients with swallowing dysfunction after stroke were all inpatients from the encephalopathy rehabilitation department of the Rehabilitation Hospital affiliated to Fujian University of Chinese Medicine. They were divided into two groups according to the random numbers table, with 30 cases in observation group and control group. The observation group stabbed LianQuan (RN23), YaMen (DU15) and FengFu (DU16) on the basis of conventional swallowing rehabilitation therapy and received rTMS; the control group received rTMS on the basis of conventional swallowing rehabilitation therapy for a total of 4 weeks. The depression drinking water test (WTDWT) and the standard swallowing function rating Scale (SSA) were evaluated by the same professional assessors before and after 4 weeks of treatment, and the serum VEGF and BDNF levels were tested. Results: After 4 weeks of treatment, WTDWT, SSA score and serum VEGF and BDNF levels improved compared with before treatment, all statistically significant (P＜0.05), and WTDWT, SSA score and serum VEGF and BDNF were better than those in the control group (P＜0.05). Conclusion: On the basis of conventional swallowing rehabilitation therapy, combined with acupuncture LianQuan (RN23), YaMen (DU15), FengFu (DU16) and rTMS can significantly improve swallowing function in ischemic stroke patients compared with only rTMS and conventional swallowing rehabilitation. This improvement may be related to the increased serum levels of VEGF and BDNF.