二腹肌低频调制中频电针刺激对脑卒中后吞咽障碍舌骨位移的影响

摘要目的：探讨二腹肌低频调制中频电针治疗对脑卒中后吞咽障碍患者舌骨垂直抬高及前移的影响。方法：选取我院2012年12月至2014年6月期间脑卒中后存在舌骨上提障碍患者共45例，采用前瞻性随机对照研究方法，分成电针组、电疗组和对照组，各15例。电针组采用连接低频调制中频针灸针刺激二腹肌前腹运动点加手法治疗，电疗组采用低频脉冲吞咽治疗仪加手法治疗，电疗时间及手法治疗各20min，对照组仅给予40min手法治疗，每日一次，疗程4周。收集治疗前后吞钡照影检查中舌骨抬高及前移的幅度，并进行统计学分析。结果：治疗4周后，吞钡照影检查结果显示，电针组与电疗组患者舌骨上抬及前移的幅度较治疗前提高，差异具有显著性意义（P<0.05）；电针组与电疗组及对照组相比，差异具有显著性意义（P<0.05）。电针组FOIS评分较治疗前显著性提高（P<0.05）；不仅FOIS评分和FOIS评分变化率分别比对照组两项指标都高，而且FOIS评分变化率与电疗组相比，差异具有显著性意义（P<0.05）。结论：针对脑卒中后咽相吞咽障碍患者，采用低频调制中频电，连接一次性针灸针刺激二腹肌前腹运动点，能够有效上抬舌骨，减少喉渗透及误吸风险，改善咽相吞咽障碍患者进食能力，该方法安全可行，有临床应用前景。

Effects of digastric muscle low frequency modulated medium frequency electroacupuncture therapy on dysphagia in post-stroke patients with vertical and anterior displacements of hyoid bone and thyroid cartilage

AbstractObjective: To investigate effects of digastric muscle low frequency modulated medium frequency electro-acupuncture therapy on dysphagia in post-stroke patients with vertical and anterior displacements of hyoid bone and thyroid cartilage.Method: Forty-five patients with hyoid raise disorder post-stroke from Dec.2012 to Jun.2014 were selected and divided, into the electro-acupuncture(EA) group, the electro therapy group and the control group randomly, each 15 cases. In EA group patients were connected to low-frequency modulated medium frequency electroacupuncture needles for stimulating the movement points of digastric muscle combined with manual therapy. In electrotherapy group, the patients received low-frequency modulated medium frequency electrotherapy with the swallowing therapy instrument combined with manual therapy. Both EA as well as electrotherapy and manual therapy were administered 20min respectively, while the control group, only 40min. All the treatments were performed once a day for 4 weeks. Barium swallow examination was used to show the magnitude of vertical and anterior displacements of hyoid bone and thyroid cartilage before and after treatment, and the collected data were analyzed statistically.Result: After 4 weeks of treatment, the barium swallow examination showed in EA group and electro therapy group the vertical and anterior displacements of hyoid bone and thyroid cartilage were elevated compared with before treatment, the difference was statistically significant (P<0.05), EA group and electrotherapy group compared with control group, the difference was statistically significant(P<0.05). In EA group after treatment FOIS score improved significantly(P<0.05). FOIS score and change rats of FOIS score in EA group and electrotherapy group were higher than those in control group, and in EA group the change rate of FOIS score compared with that in electro therapy the difference was statistically significant(P<0.05).Conclusion: For the pharyngeal phase of dysphagia in post-stroke patients, low-frequency modulatied medium frequency electrieity, connected with acupuncture needles to stimulate digastric muscle movement points, the vertical and anterior displacements of hyoid bone and thyroid cartilage could be effectively elevated, and the risk of laryngeal penetration and aspiration reduced the pharynx patients' swallowing ability improved. This treatment is feasible and safe in clinical application.