Objective: To compare the effect among ultrasound-guided electroacupuncture (EA) at suprahyoid muscle group, conventional acupuncture and conventional EA at suprahyoid muscle group on pharyngeal dysphagia after stroke, and to explore its biomechanical mechanism.
Methods: A total of 120 patients with pharyngeal dysphagia after stroke were randomly divided into an observation group, a control-1 group and a control-2 group, 40 cases in each group. The patients in the observation group were treated with ultrasound-guided EA at suprahyoid muscle group; the patients in the control-1 group were treated with EA at Lianquan (CV 23), Wangu (GB 12) and Fengchi (GB 20), etc.; the patients in the control-2 group were treated with EA at suprahyoid muscle group according to anatomical location. The EA in the three groups were discontinuous wave, with frequency of 5 Hz and current intensity of 1 mA. The EA was given for 30 minutes, once a day, 6 times were taken as a course of treatment, and 4 courses of treatment were provided. The video floroscopic swallowing study (VFSS) was performed before and after treatment. The Rosenbek penetration-aspiration scale (PAS) score, the forward and upward movement distance of hyoid bone and thyroid cartilage, Ichiro Fujima ingestion-swallowing function score were recorded in the three groups, and the incidences of subcutaneous hematoma were recorded after treatment.
Results: Compared before treatment, the PAS scores were reduced and the Ichiro Fujima ingestion-swallowing function scores were increased after treatment in the three groups (P<0.05); the PAS scores in the observation group were lower than those in the control-1 group and the control-2 group, and the Ichiro Fujima ingestion-swallowing function scores in the observation group were higher than those in the control-1 group and the control-2 group (P<0.05). After treatment, the forward and upward movement distance of hyoid bone and thyroid cartilage in the observation group and the control-2 group was increased (P<0.05), and the forward and upward movement distance of hyoid bone was increased in the control-1 group (P<0.05); the forward and upward movement distance of hyoid bone and thyroid cartilage in the observation group was longer than that in the control-1 group and the control-2 group (P<0.05). The incidence of subcutaneous hematoma in the observation group was 0% (0/40), which was lower than 20.0% (8/40) in the control-1 group and 47.5% (19/40) in the control-2 group (P<0.05).
Conclusion: Ultrasound-guided EA at suprahyoid muscle group could improve the swallowing function in patients with pharyngeal dysphagia after stroke by increasing the motion of hyoid laryngeal complex. Its effect and safety are better than conventional acupuncture and conventional EA at suprahyoid muscle group.
目的：比较超声引导下舌骨上肌群电针与常规针刺、常规舌骨上肌群电针对脑卒中后咽期吞咽障碍的影响，并探讨其生物力学机制。方法：将120例脑卒中后咽期吞咽障碍患者随机分为观察组、对照1组和对照2组，每组40例。观察组予超声引导下舌骨上肌群电针治疗，对照1组予常规取穴（廉泉、完骨、风池等）电针治疗，对照2组根据解剖定位予舌骨上肌群电针治疗。3组均予断续波，频率5 Hz，电流强度1 mA，每次30 min，每天1次，6次为一疗程，治疗4个疗程。分别于治疗前后行视频吞咽造影（VFSS）检查，观察3组患者Rosenbek渗透-误吸量表（PAS）评分，舌骨、甲状软骨上移和前移距离，藤岛一郎摄食-吞咽功能等级评分，并于治疗后记录3组患者皮下血肿发生率。结果：治疗后，3组患者PAS评分较治疗前降低、藤岛一郎摄食-吞咽功能等级评分较治疗前升高（P<0.05）；观察组患者PAS评分低于对照1组及对照2组、藤岛一郎摄食-吞咽功能等级评分高于对照1组及对照2组（P<0.05）。治疗后，观察组及对照2组患者舌骨、甲状软骨上移和前移距离均较治疗前增加（P<0.05），对照1组患者舌骨上移和前移距离较治疗前增加（P<0.05）；观察组患者舌骨、甲状软骨上移和前移距离大于对照1组及对照2组（P<0.05）。观察组皮下血肿发生率为0%（0/40），低于对照1组的20.0%（8/40）和对照2组的47.5%（19/40，P<0.05）。结论：超声引导下舌骨上肌群电针可通过增加舌骨喉复合体运动度改善脑卒中后咽期吞咽障碍患者的吞咽功能，其效果及安全性优于常规针刺、常规舌骨上肌群电针。.
Keywords: dysphagia, pharyngeal phase; electroacupuncture (EA); stroke; suprahyoid muscle group; ultrasound.