针刺治疗中风慢性期中重度吞咽障碍机理的探讨.docVIP

针刺治疗中风慢性期中重度吞咽障碍机理的探讨 　　［摘要］目的：探讨针刺风府、人迎、廉泉、百劳治疗中风吞咽障碍的机理。方法：测定针刺前、后5分钟和疗前、疗后的吞咽相关肌肉肌电图和脑干诱发电位。结果：真性球麻痹患者疗后环甲肌振幅、时限及舌肌时限较疗前降低。假性球麻痹患者疗前、疗后各项指标变化差异无显著意义。结论：对于假性球麻痹吞咽障碍，针刺主要是调节皮质和脑干网状结构当中的吞咽中枢对于吞咽反射的控制作用，协调吞咽诸肌的运动；而对于真性球麻痹障碍， 针刺的作用主要是直接促使损伤的周围神经恢复，从而起到治疗效应。 　　［主题词］吞咽障碍/针灸疗法；中风/针灸疗法 　　Study on Mechanisms of Acupuncture Treatment for Moderate-Severe Dysphagia at Chronic Stage of Apoplexy 　　Zhang Wei, Liu Zhishun, Sun Shuchen, et al. (Guang＇anmen Hospital of China Academy of TCM, Beijing 100053, China) 　　［Abstract］PurposeTo study on mechanisms of acupuncture treatment for dysphagia due to apoplexy. Methods Electromyogram of swallowing-related muscles and evoked potentials in brainstem were determined before and after acupuncture treatment. Results Amplitude and time limit of cricothyroid muscle, and time limit of muscles of tongue in the patient of true bulbar paralysis after treatment decreased as compared with that before treatment respectively. There was no significant difference before and after treatment in the indexes in the patient of false bulbar paralysis. Conclusion For swallowing disturbance due to false bulbar paralysis, acupuncture regulates mainly the cortex and the swallowing center of the reticular structure of brain stem to control swallowing reflection and coordinate motor of swallowing-related muscles; and for swallowing disturbance due to the true bulbar paralysis, acupuncture improves directly recovery of injuried peripheral nerves, resulting in therapeutic effects. 　　［Keywords］Deglutition Disorders/acup ther;Stroke/acup ther 　　针刺治疗中风后中重度吞咽障碍是一种行之有效的方法，但有关的机理研究很少。我们通过测定吞咽相关肌肉肌电图和脑干诱发电位，试图探讨针刺人迎、廉泉、风府、百劳治疗中风后中重度吞咽障碍可能的机理和作用途径，现报道如下。 　　 　　1临床资料 　　 　　30例入选病例均系我院1998～2000年住院患者，其中男16例，女14例；年龄45～72岁，平均年龄61.2岁。其中真性球麻痹8例，假性球麻痹22例。诊断标准和入选标准见参考文献［1］。 　　 　　2方法 　　 　　所有病例均用针刺治疗，取穴：风府、人迎 (双侧)、廉泉、百劳 (双侧)。风府用2寸毫针针尖朝向喉结方向进针1.2寸，局部有酸胀感即可；人迎：喉结尖旁开1.5寸，颈总动脉内侧缘取穴，2寸毫针直刺1.8寸，局部有窒息样针感；廉泉用3寸毫针行合谷刺法；百劳用2寸毫针直刺1.5寸，局部有酸胀针感。四穴均平补平泻，得气后即出针。 　　采用DANTEC高速肌电和诱发电位系统