| 姚路路
，梁伟
，杜鑫
，黄小波.针灸治疗对脑卒中患者吞咽障碍远期预后的影响[J].神经损伤功能重建,2022,17(知网首发): |
| 针灸治疗对脑卒中患者吞咽障碍远期预后的影响 |
| Effect of Acupuncture on Long-term Outcomes in Patients with Post-stroke Dysphagia |
| |
| DOI： |
| 中文关键词: 针灸 吞咽障碍 吞咽功能 卒中 神经调控 |
| 英文关键词: acupuncture dysphagia swallowing function stroke neuroregulation |
| 基金项目:国家自然科学基金
青年项目（No. 820
04443） |
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| 摘要点击次数: 1060 |
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| 中文摘要: |
| 目的：观察针灸治疗对脑卒中后吞咽障碍患者的远期疗效。方法：从2020年6月至2021年10月在首
都医科大学宣武医院和北京中医医院的住院患者中选取符合标准的研究对象。根据患者接受的治疗方法，
分为对照组（接受常规治疗）和针灸组（在对照组基础上增加针灸治疗）。提取患者的一般信息，通过6个月
的随访，获得患者吞咽功能恢复所需的时间和相关临床数据。主要结局指标定义为吞咽障碍量表（FILS）评
分提高3分所需的时间，通过构建Cox风险模型评价针灸治疗和吞咽功能恢复之间的关系。结果：在研究
期间共纳入375例患者，经倾向性评分匹配法处理后2组各入组129例患者。针灸组患者吞咽功能达到临
床改善所需的中位时间为 97 d（95%CI 93-124），对照组为 119 d（95%CI 108-145），2 组存在统计学差异
（HR=1.48；95%CI 1.14-1.92；P＜0.05）。针灸组 118 例（91.47%）吞咽功能达到临床改善，对照组 107 例 （82.95%）达到临床改善（RR=1.10；95% CI 1.05-1.22；P＜0.05）。6个月时，针灸组有78例（60.5%）达到功能
独立，对照组有 61 例（47.3%）达到功能独立（RR=1.279；95%CI 1.019-1.616；P＜0.05）。针灸组有 106 例 （82.2%）达到功能良好，对照组有91例（70.5%）达到功能良好（RR=1.165；95%CI 1.017-1.346；P＜0.05）。针
灸组中治疗时间＞1个月亚组（76例）的患者吞咽功能达到临床改善的中位时间为87.5 d（95%CI 84-95），治
疗时间＜1个月亚组（53例）为109 d（95%CI 94-123），差异有统计学意义（P＜0.05）。纳入多变量调整Cox
回归模型后2组患者吞咽功能恢复的时间仍存在差异（HR=1.79，95%CI 1.34-2.39）。针灸组最常见的不良
事件是疼痛（36例，27.9%），2组基础治疗相关不良事件、肺部感染和卒中复发的发生率无统计学差异（P＞ 0.05）。结论：针灸治疗可促进脑卒中吞咽障碍患者吞咽功能恢复，减轻残障程度，改善患者的远期生存质
量。 |
| 英文摘要: |
| This study involves an analysis investigating the association of receiving acupuncture
with long-term clinical outcomes of patients with post-stroke dysphagia. Methods: From June, 2020 to October, 2021, recruited patients from Xuanwu Hospital Capital Medical University and Beijing Hospital of Traditional Chinese Medicine who met the inclusion criteria. The patients in acupuncture group received acupuncture
treatment, and the patients who did not receive acupuncture treatment in the same period were selected as the
control group. The general information of patients was extracted, and the time required for the recovery of swallowing function and related clinical data were obtained through 6 months follow-up. The main outcome index is
defined as the time required for clinical improvement of swallowing function (FILS score increased by 3 points).
Cox risk model was established to evaluate the relationship between acupuncture treatment and swallowing function recovery. Results: During the study period, a total of 375 patients were included, and 129 patients in each
group were enrolled after being treated by propensity score matching method. It took 97 days (95%CI 93-124)
for patients in acupuncture group and 119 days (95%CI 108-145) for patients in control group to achieve clinical
improvement, and there was a statistical difference between the two groups (HR=1.48; 95% CI 1.14-1.92; P< 0.05). 118 patients in acupuncture treatment group achieved clinical improvement (91.47%), while 107 patients
(82.95% ) in control group achieved clinical improvement (RR=1.10; 95% CI 1.05-1.22; P<0.05). At 6 months,
78 patients (60.5% ) in the acupuncture treatment group achieved functional independence, while 61 patients
(47.3%) in the control group (RR=1.279; 95%CI 1.019-1.616; P<0.05). 106 patients (82.2%) in the acupuncture
treatment group had good function, and 91 patients (70.5% ) in the control group (RR=1.165; 95% CI 1.017-1.346; P<0.05). In the acupuncture group, the clinical improvement time of patients with acupuncture
treatment time longer than one month was 87.5 days (95%CI 84-95), and the treatment time less than one month
was 109 days (95%CI 94-123), the difference was statistically significant (P<0.05). There is still a difference in
the recovery time of swallowing function between the two groups after the variable-adjusted Cox regression
model is included (HR=1.79, 95% CI 1.34-2.39). The most common adverse event in acupuncture group was
pain (36 cases, 27.9%). There was no significant difference in the incidence of adverse events related to basic treatment, pulmonary infection and stroke recurrence between the two groups (P>0.05). Conclusion: Acupuncture can promote the recovery of swallowing function
in stroke patients with dysphagia; it can reduce the degree of disability and improve the long-term quality of life. |
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