Objective: To observe the effect of nape cluster acupuncture on swallowing function and respiratory function in patients with post-stroke dysphagia, and to explore its relationship to cerebral arterial flow and neurotrophic factors.
Methods: A total of 120 patients with post-stroke dysphagia were randomized into an observation group and a control group, 60 patients in each one. The conventional swallowing rehabilitation therapy and respiratory function training were adopted in the control group. On the basis of treatment in the control group, nape cluster acupuncture was applied at Fengchi (GB 20), Tianzhu (BL 10), Wangu (GB 12), Lianquan (CV 23), Panglianquan (Extra), once a day; pricking blood was applied at Jinjin (EX-HN 12) and Yuye (EX-HN 13), once every 2 days. Both groups were treated for 2 weeks. The therapeutic efficacy was compared between the two groups, and the swallowing function (scores of Kubota water swallowing test, standardized swallowing assessment [SSA] and video fluoroscopic swallowing study [VFSS]), the respiratory function indexes (forced vital capacity [FVC], maximal voluntary ventilation [MVV] and maximal expiratory time), the bilateral cerebral arterial hemodynamics parameters (systolic peak velocity [Vs], mean flow velocity [Vm] and vascular resistance index [RI]) and the serology indexes (brain-derived neurotrophic factor [BDNF], nerve growth factor [NGF] and insulin-like growth factors-1 [IGF-1]) before and after treatment were observed in the both groups.
Results: The total effective rate was 80.0% (48/60) in the observation group, which was superior to 60.0% (36/60) in the control group (P<0.05). After treatment, the scores of Kubota water swallowing test and SSA in the observation group were lower than the control group (P<0.05), the VFSS score, FVC, MVV and maximal expiratory time were higher than the control group (P<0.05). After treatment, the Vs and Vm of bilateral cerebral artery and serum levels of BDNF, NGF and IGF-1 in the observation group were higher than the control group (P<0.05), the RI of bilateral cerebral artery was lower than the control group (P<0.05).
Conclusion: On the basis of the conventional rehabilitation training, nape cluster acupuncture can effectively improve the swallowing function and respiratory function in patients with post-stroke dysphagia, its mechanism may be related to the improvement of cerebral hemodynamics and the regulation of neurotrophic factors.
目的：观察项丛刺疗法对脑卒中后吞咽障碍患者吞咽功能及呼吸功能的影响，并探讨其与大脑动脉血流和神经营养因子的关系。方法：将120例脑卒中后吞咽障碍患者随机分为观察组和对照组，每组60例。对照组行常规吞咽康复治疗及呼吸功能训练，观察组在对照组基础上予项丛刺疗法，取风池、天柱、完骨、廉泉、旁廉泉穴针刺，每日1次，并于金津、玉液点刺放血，隔日1次，两组均治疗2周。比较两组临床疗效，观察两组患者治疗前后吞咽功能[洼田饮水试验评分、标准吞咽功能评价量表（SSA）评分、电视透视吞咽功能检查（VFSS）评分]、呼吸功能指标[用力呼气容积（FVC）、最大通气量（MVV）、最长呼气时间]、双侧大脑动脉血流动力学参数[最大峰值流速（Vs）、平均流速（Vm）、血管阻力指数（RI）]及血清学指标[脑源性神经营养因子（BDNF）、神经生长因子（NGF）及胰岛素样生长因子-1（IGF-1）]。结果：观察组总有效率为80.0%（48/60），高于对照组的60.0%（36/60，P<0.05）。治疗后，观察组洼田饮水试验评分、SSA评分低于对照组（P<0.05），VFSS评分、FVC、MVV、最长呼气时间均高于对照组（P<0.05）。治疗后，双侧大脑动脉Vs、Vm及血清BDNF、NGF、IGF-1水平均高于对照组（P<0.05），双侧大脑动脉RI低于对照组（P<0.05）。结论：在常规康复训练基础上，项丛刺疗法能有效改善脑卒中后吞咽障碍患者吞咽功能及呼吸功能，其机制可能与改善脑血流动力学、调节神经营养因子水平有关。.
Keywords: dysphagia; nape cluster acupuncture; respiratory function; stroke; swallowing function.