舌三針結(jié)合醒腦開竅法治療假性球麻痹構(gòu)音障礙的臨床探討

1、舌三針結(jié)合醒腦開竅法治療假性球麻痹構(gòu)音障礙的臨床探一、中文摘要目的：客觀綜合地評價兩種不同治療方法（舌三針結(jié)合 醒腦開竅法、常規(guī)針刺法）對假性球麻痹構(gòu)音障礙的臨床療效，探討 舌三針結(jié)合醒腦開竅法治療假性球麻痹構(gòu)音障礙的臨床有效性及實 用性。方法：將60例合格受試者隨機分為兩組，其中研究組進行舌三針結(jié) 合醒腦開竅法治療；對照組進行常規(guī)針刺法治療。一個療程為14天， 共治療兩個療程，釆用frenchay構(gòu)音障礙評估量表對治療前、治療 一個療程、治療結(jié)束后分別進行評分，并對兩組患者治療前與治療后 的低切全血粘度和血漿粘度指標進行比較，再進行臨床療效的評定。結(jié)果：1 與治療前相比，治療一個療程及治療后

2、兩組frenchay構(gòu)音 障礙評估量表評分均有所增高（pv0.01）,治療一個療程后，研究組 評分高于對照組（p&lt;0. 05）；治療結(jié)束后兩組評分無明顯差異（p>0. 05）；2在血液流變學(xué)方面，兩組治療后，低切和高切全血粘度指標均比 治療前改善明顯（pv0.01）,研究組改善情況好于對照組（p&lt;0. 05）； 治療后，兩組血漿粘度指標比治療前有所改善（pv0.05）,研究組與 對照組指標無差異（p>0. 05）；3臨床療效方面，一個療程結(jié)束后，研究組總有效率為70%,對照 組總有效率為40%,兩組療效比較，差異具有統(tǒng)計學(xué)意義（p<0. 05）；

3、治療結(jié)束后，研究組總有效率為86. 6%,對照組的總有效率為73%, 兩組療效比較，差異無統(tǒng)計學(xué)意義（p>0.05）,研究組痊愈率為36. 6%, 對照組痊愈率為20%,兩組比較，差異顯著（pv0.05）,具有統(tǒng)計學(xué) 意義。結(jié)論：1舌三針結(jié)合醒腦開竅法（研究組）和常規(guī)針刺法（對照組） 對假性球麻痹構(gòu)音障礙均有良好的療效；2. 舌三針結(jié)合醒腦開竅法比常規(guī)針刺治療更能有效地 改善假性球麻痹構(gòu)音障礙的臨床癥狀，見起效比常規(guī)針刺治療起效快;3. 舌三針結(jié)合醒腦開竅法治療假性球麻痹構(gòu)音障礙具有操作簡便，安全有效，起效快等優(yōu)點，臨床上值得推廣和研究。關(guān)鍵詞：假性球麻痹；構(gòu)音障礙；舌三針；醒腦開竅法；

4、針刺療法、abstractobjective: objective evaluation of two different treatment methods (tri-tongue-acus with brain-activating and orifice-opcning acupuncture/conventional acupuncture)on the effect of dysarthria of supranuclear paralysis discuss the clinical validity and practicality of tri-tongue-acus with

5、 brain-activating and orifice-opening acupuncture therapytreating dysarthria of supranuclear paralysismethods: 60 patients with qualified subjects were randomly divided into two groups, the research group was given tri-tongue-acus with brain-activating and orifice-opening acupuncture therapy; contro

6、l group was given conventional acupuncture therapy. a period of treatment is 14 days, a total is two periods observe the treatment of dysarthria symptom, score of frenchay assessment scale before treatment, treatment after a period and after treatment compare two groups low shear blood viscosity and

7、 pv before treatment and after all treatment.resuits: 1. after a period of treatment and after all treatment, frenchay assessment scale scores of two groups were be higher (p &it; 0.01) than before and after a period of treatment the research scores was higher than the control group scores but a

8、fter all treatment the research group and control group comparison had no significant difference (p &gt; 0.05);2. on blood rheology, after all treatment the two groups' indexes of high and low shear blood viscosity were lower (p &it; 0. 01) than before, and the indexes of research was lo

9、wer (p &lt: 0. 05) than the control group after all treatment the two groups5 indexes of pv were lower (p &it; 0.05) than before, but the research group and control group comparison had no significant difference (p &gt; 0.05);3. after a period of treatment, compare clinical curative effe

10、ct between the research group and control group the research group? s total effective rate on clinical curative effect was 70% , control groupj s total effective rate was 40% two groups of curative effect comparison of curative effect difference were statistically significant (p &it; 0.05). the

11、result shows that after a period of treatment, the clinical efficacy of research group was obviously superior to control group. after all the treatment, the research group the total effective rate was 100%, and the control group the total effective rate was 73% compare clinical curative effect betwe

12、en two groups, there were no statistically significant difference (p &gt: 0. 05). the result shows that the two groups? clinical curative effect were similar after all the treatment, the research group the cure rate was 36.6%, and the control group the cure rate was 20% compare two groups, there

13、 was statistically signified nt difference (p &lt: 0. 05). the result shows that the research groups cure rate was better than control group.conclusion: 1. tri一tongueacus with brain-activating and orifice-opening acupuncture therapy (research group), conventional acupuncture therapy (control gro

14、up) have good clinical efficacy in treating dysarthria of supranuclear paralysis.2. tri-tongue-acus with brain-activating and orifice-opening acupuncture therapy was better than conventional acupuncture in improving dysarthria of supra nuclear paralysis and has fast effective.3. the therapy of tri-t

15、ongue-acus with brainactivating and orificeopening acupuncture in treating dysarthria of supranuclear paralysis is simply, safety and fast effective, deserves depth research and wide spreading in clinical application.key words:supranuclear paralysis; dysarthria;tri-tongue-acus; brain-activating and

16、orifice-opening acupuncture; acupuncture3.5.2對照設(shè)計的依據(jù)對照組穴位的選擇參考高等中醫(yī)藥院校的教材5,選取穴位 肩犧、曲池、合谷、外關(guān)、陽陵泉、足三里、啞門、通里。合谷、曲 池、肩聽、足三里均為陽明經(jīng)的穴位，陽明經(jīng)為多氣多血之經(jīng)，陽明 經(jīng)氣血通暢，正氣旺盛則有利于機體的康復(fù)；足三里為足陽明胃經(jīng)的 要穴之一，具有調(diào)節(jié)機體免疫，補中益氣，通絡(luò)化濕，扶正祛邪的功 效；外關(guān)穴屬于手少陽三焦經(jīng)的穴位，為八脈交會穴之一，通陽維脈， 陽維脈維系各陽經(jīng)，具有溢蓄氣血的作用，針灸外關(guān)穴具有疏通經(jīng)絡(luò), 活血化瘀的功效；通里為手少陰心經(jīng)的絡(luò)穴，心開竅于舌，心經(jīng)的絡(luò) 穴通

17、里系于舌根，對舌部及言語疾患具有遠治的作用；啞門為督脈穴 之一，督脈具有總督一身陽氣之功，早在針灸甲乙經(jīng)就有記載啞 門治“舌緩，喑不能言?！搬槾虇￠T具有改善腦部供血，開竅醒腦, 促進言語功能恢復(fù)的作用。諸穴合用，共奏疏經(jīng)活絡(luò)，活血化瘀，調(diào) 整陰陽氣血，開竅醒腦的功效。3.5.3療效指標的選擇frenchay構(gòu)音障礙評定法是常用的構(gòu)音障礙評定法。評定內(nèi) 容包括反射、呼吸、舌、唇、頜、軟腭、喉、言語可理解度等8大項 目，29個分測驗，每個分測驗都設(shè)立了 5個級別的評分標準。河北 省人民醫(yī)院康復(fù)中心在frenchay相關(guān)項目構(gòu)音障礙評價法的基礎(chǔ)上, 做了增補和修改，重新編制了 frenchay構(gòu)音障

18、礙構(gòu)音評價量表，其 中痙攣性構(gòu)音障礙主要涉及到發(fā)音時間音調(diào)、音量及言語等項目。劉 若琳53等研究frenchay構(gòu)音障礙評定量表對于我國腦卒中患者的 評定效度，對腦卒中患者和正常人各39例分別由同一評定者用 frenchay構(gòu)音障礙評定量表進行評定，結(jié)果發(fā)現(xiàn)腦卒中組的 frenchay量表與barthel的相關(guān)系數(shù)為0. 727 (p&lt;0. 001)，腦卒 中組的各項得分和總分均低于正常組(p&lt;0.01),說明frenchay 構(gòu)音障礙評定量表對于我國腦卒中患者具有適用性。血液流變學(xué)是一門新興的生物力學(xué)及生物流變學(xué)分支，是研 究血液宏觀流動性質(zhì)，人體內(nèi)血液流動和細胞

19、變形，以及血液與血管、 心臟之間相互作用的學(xué)科。檢查項目包括包括全血粘度（高切全血粘 度、低切全血粘度），全血還原粘度（全血高切還原粘度、全血低切 還原粘度）、全血相對粘度（全血高切相對粘度、全血低切相對粘度）、 血漿粘度、紅細胞壓積、紅細胞沉降率、血沉方程k值。血流變的指 標對血液粘稠度具有提示意義。血液的高凝狀態(tài)則極易形成血栓，是 腦卒中發(fā)病的重要因素，因此血液流變學(xué)為腦卒中治療療效觀察的重 要指標。全血低切流變是指在低切變率時血液的粘度。低切變率時, 血液形成紅細胞聚集體，紅細胞聚集體越多，紅細胞聚集性越強，血 液粘度越高。因此低切全血粘度可以反映紅細胞的聚集程度。本研究 中低切全血粘度

20、切變率選擇為1s-1,此時紅細胞的聚集度能夠得到 完全及真實的體現(xiàn)。高切全血粘度為在高切變率下血液粘度，反映了 紅細胞的變形能力，高切全血粘度高時，紅細胞變形力差，高切粘度 低時，紅細胞變形好。根據(jù)基礎(chǔ)研究表明，在切變率達到180-1s時， 紅細胞開始出現(xiàn)拉破的現(xiàn)象，因此本研究中高切全血粘度切變率選擇 為loos-lo血漿粘度是影響全血粘度的重要指標之一，血漿粘度的 升高則全血粘度必然升高，主要取決于血漿蛋白，尤其是纖維蛋白原, 脂蛋口和球蛋口的粘度。3.6結(jié)果分析3. 6. 1臨床療效分析假性球麻痹是由雙側(cè)上運動神經(jīng)元受損(主要是運動皮質(zhì)及其發(fā) 出的皮質(zhì)腦干束)使延髓運動性顱神經(jīng)核-疑核以及

21、腦橋三叉神經(jīng)運 動核失去了上運動神經(jīng)元的支配而發(fā)生中樞性癱瘓所致。而針刺對于 腦部血液的供給具有改善作用，對于腦部言語區(qū)的修復(fù)有一定的治療 作用。從治療的結(jié)果可以看出，不管是常規(guī)針刺法還是舌三針結(jié)合醒腦開 竅法對假性球麻痹構(gòu)音障礙患者癥狀改善上都有良好的療效。但舌三 針結(jié)合醒腦開竅法在治療一個療程后，frenchay構(gòu)音障礙評定量表 的分數(shù)顯著高于常規(guī)針刺組(p&lt;o. 05),說明舌三針結(jié)合醒腦開竅 法的治療起效快于常規(guī)針刺法。在總體治療效果上，舌三針結(jié)合醒腦開竅法的痊愈率為36. 6%,總 有效率為86. 6%；常規(guī)針刺法的痊愈率為20%,總有效率為73% o經(jīng) 比較兩組總有效率無顯著差異(p&gt;0. 05),但舌三針結(jié)合醒腦開竅 法治療的痊愈率與常規(guī)針刺組具有顯著差異(p&lt;0. 05),說明舌三 針結(jié)合醒腦開竅法的療效更加完全。血流變學(xué)的觀察的觀察結(jié)果顯示，舌三針結(jié)合醒腦開竅法與常規(guī)針 刺組在治療后，對患者血流變均有一定的改善作用(p&lt;0.01),在 高切