针刺治疗脑梗死后吞咽障碍方案的初步优选

目的对针刺治疗脑梗死后吞咽障碍的治疗方案进行初步优选。方法将63例脑梗死后吞咽障碍患者为研究对象,以才藤荣一7级评价法为观察指标,采用正交设计,研究针刺时机(A因素,A1为1~10 d,A2为11~20 d,A3为21~40 d)、选穴配伍(B因素,B1为项穴,B2为项穴+舌咽穴,B3为项穴+舌咽穴+辨证取穴)、针刺深度(C因素,C1为浅刺,C2为中刺,C3为深刺)、疗程(D因素,D1为治疗2个疗程,D2为4个疗程,D3为6个疗程)4因素3水平的不同搭配组合方案,对脑梗死假性延髓麻痹吞咽障碍患者的影响,初步确定脑梗死吞咽障碍针刺治疗优选方案。结果 4因素3水平的最佳水平及搭配方案(直观分析)为A1(或A2)B3C3D2,即在病程20 d内,选用颈项部、舌咽部穴位,配合辨证选穴,采用深刺法,治疗4个疗程能取得最好的效果。4因素的作用主次比较(方差分析)显示,因素A、C为显著因素(P0.05),因素B、D为不显著因素(P0.05)。显著因素A、C不同水平间的优劣比较(多重比较)显示,A1或A2优于A3(P0.05),C3优于C2、C1(P0.05),C2优于C1(P0.05)。结论对直观分析、方差分析、多重比较结论结合临床实际情况进行综合分析,认为在病程1~20 d内(A1或A2),采用项部穴(B1)为主,或结合舌咽穴(B2),或配合辨证取穴(B3),行深刺法(C3),治疗4~6个疗程(D3),为脑梗死假性延髓麻痹吞咽障碍患者的针刺治疗优选方案。

Preliminary Optimization of Acupuncture Treatment Protocols for Dysphagia after Cerebral Infarction

Objective To preliminarily optimize acupuncture treatment protocols for dysphagia after cerebral infarction.Methods Sixty Sixty-three patients with dysphasia after cerebral infarction were enrolled as the subjects.Eiichi Saito seven-grade assessment was taked as an observation index.An orthogonal design was used to study the protocols of different combinations of four factors and three levels：acupuncture time （factor A：A1,1-10 d; A2,11-20 d; A3,21-40 d）,point combination （factor B：B 1,neck points; B2,neck points ＋ glossopharyngeal points; B3：neck points ＋ glossopharyngeal points ＋ points selected by syndrome differentiation）,needle insertion depth （factor C：C1,shallow insertion; C2,moderate insertion; C3,deep insertion） and course of treatment （factor D：D1,2 courses; D2,4 courses; D3,6 courses）,and their effects on pseudobulbar palsy dysphagia after cerebral infarction for preliminary determination of an optimal acupuncture treatment protocol for dysphagia after cerebral infarction.Results The optimal combination protocol of four factors and three levels （intuitionistic analysis） was composed of A1 （or A2）,B3,C3 and D2,that is,the best effect was produced by treatment given within 20 days of disease duration,selection of neck and glossopharyngeal points and syndrome differentiation-based selection of acupoints,deep insertion of needles,and administration of four treatment courses.A comparison of the effects of the four factors （variance analysis） showed that factors A and C were significant factors （P＜ 0.05） and factors B and D,nonsignificant factors （P＞0.05）.A comparison of different levels of significant factors A and C （multiple comparison） showed that A1 or A2 was better than A3 （P＜0.05）,C3 was better than C2 and C1 （P＜0.05）,and C2 was better than C1 （P＜0.05）.Conclusion By intuitionistic analysis,variance analysis and multiple comparison in combination with clinical practice,it is considered that treatment given within 1-20 days o