目的: 探讨辣椒素冰棉签刺激联合穴位贴敷对风痰瘀阻证型脑卒中吞咽障碍的影响及临床意义。方法: 收集2022年10月—2024年3月我院收治的116例风痰瘀阻证型脑卒中吞咽障碍患者,按随机数字表法将其分为对照组与观察组,各58例。对照组给予常规+穴位贴敷治疗,观察组在对照组基础上采取辣椒素冰棉签刺激治疗。治疗2个月后随访。评估治疗前后两组临床疗效、中医证候积分和吞咽功能、血清辣椒素受体（transient receptor potential vanilloid 1,TRPV1）、降钙素基因相关肽（calcitonin gene related peptide,CGRP）、白细胞介素（interleukin,IL-6）水平、吞咽造影检查（videofluoroscopic swallowing study,VFSS）、美国国立卫生院神经功能缺损评分（national institutes of health stroke scale,NIHSS）、吞咽障碍特异性生活质量量表（swallowing-quality of life,SWAL-QOL）评分等相关指标变化,记录并发症发生情况。结果: 观察组总有效率高于对照组（96.55% vs 82.76%）。相比对照组：观察组治疗后主症、次症、舌脉象、总分均明显更低;观察组治疗后洼田饮水试验（WST）评分、吞咽功能启动时间（swallowing initiation time,STT）和口腔运送时间（oral transit time,OTT）更低,通过环咽肌时间间隔时间（cricopharyngeal passage interval,DT）更高;观察组治疗后TRPV1、IL-6水平均更低,CGRP水平更高;观察组治疗后VFSS、SWAL-QOL评分均更高,NIHSS评分更低。治疗后观察组并发症发生率与对照组比较（13.79% vs 8.62%）,差异无统计学意义。结论: 辣椒素冰棉签刺激联合穴位贴敷有助于改善风痰瘀阻证型脑卒中吞咽障碍患者的症状,降低机体炎症,促进神经功能恢复,提高生活质量。
Abstract
Objective This study aimed to investigate the effects and clinical significance of capsaicin cold cotton swab stimulation combined with acupoint application in treating swallowing disorders in stroke patients with Wind-Phlegm and Blood Stasis Syndrome. Methods A total of 116 patients diagnosed with swallowing disorders associated with Wind-Phlegm and Blood Stasis Syndrome admitted to our hospital between October 2022 and March 2024 were randomly assigned into two groups: the control group (58 cases) and the observation group (58 cases). The control group received conventional treatment combined with acupoint application, while the observation group was additionally treated with capsaicin cold cotton swab stimulation. Both groups were followed up after two months of treatment. Clinical efficacy, traditional chinese medicine syndrome scores, swallowing function, serum biomarkers, videofluoroscopic swallowing study (VFSS), National Institutes of Health Stroke Scale (NIHSS) scores, and Swallowing-Quality of Life (SWAL-QOL) scores were assessed before and after treatment. Complication rates were recorded. Results The total effective rate was significantly higher in the observation group compared to the control group (96.55% vs 82.76%). Post-treatment, the observation group demonstrated significantly lower scores for primary symptoms, secondary symptoms, tongue and pulse conditions, and overall traditional chinese medicine syndrome scores. Swallowing metrics, including WST scores, swallowing initiation time (STT), and oral transit time (OTT), were reduced, while the cricopharyngeal passage interval (DT) was prolonged in the observation group. Serum levels of transient receptor potential vanilloid 1 (TRPV1) and interleukin-6 (IL-6) were lower, while calcitonin gene-related peptide (CGRP) levels were higher in the observation group post-treatment. VFSS and SWAL-QOL scores improved significantly, and NIHSS scores decreased in the observation group compared to the control group. The complication rate did not differ significantly between the two groups (13.79% vs 8.62%). Conclusion Capsaicin cold cotton swab stimulation combined with acupoint application effectively alleviates swallowing disorders in stroke patients with Wind-Phlegm and Blood Stasis Syndrome. The treatment reduces inflammation, enhances neurological recovery, and improves quality of life.
关键词
辣椒素冰棉签刺激 /
穴位贴敷 /
风痰瘀阻证 /
脑卒中 /
吞咽障碍
Key words
capsaicin cold cotton swab stimulation /
acupoint application /
wind-phlegm and blood stasis syndrome /
stroke /
swallowing disorders
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参考文献
[1] 朱穆朗玛, 陈珂, 钟兆怡, 等. 中西医结合分期辨证治疗缺血性脑卒中研究进展[J]. 西部中医药, 2022, 35(7): 135-140.
[2] 曹丽萍, 姚娟娟. 针刺结合重复经颅磁刺激对缺血性脑卒中吞咽功能障碍的临床观察[J]. 中医康复, 2024, 1(9): 11-15.
[3] SMAOUI S, PELADEAU-PIGEON M, MANCOPES R, et al.Tongue Pressure Resistance Training for Post-Stroke Dysphagia: A Case Study[J]. Folia Phoniatr Logop, 2024, 76(6): 577-587.
[4] 支建梅, 卜秀焕, 刘更, 等. 舌针结合利咽组方穴位贴敷治疗中风后吞咽困难临床研究[J]. 针灸临床杂志, 2018, 34(5): 18-22.
[5] 施聪聪, 赵家君, 孙雪峰, 等. 辣椒素改善吞咽功能障碍的研究进展[J]. 护理学报, 2022, 29(16): 32-36.
[6] 历广招, 杨丽娟, 李长安. 辣椒素在神经源性吞咽障碍患者中的应用进展[J]. 中国康复, 2023, 38(7): 442-445.
[7] 柏慧华, 祝晓娟, 张成欢, 等. GUSS量表用于颅脑损伤患者吞咽功能风险评估的信效度分析[J]. 护理学杂志, 2017, 32(18): 36-39.
[8] 中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国急性缺血性脑卒中诊治指南2018[J]. 中华神经科杂志, 2018, 51(9): 666-682.
[9] 中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国脑出血诊治指南 (2019)[J]. 中华神经科杂志, 2019, 52(12): 994-1005.
[10] 中国吞咽障碍康复评估与治疗专家共识组. 中国吞咽障碍评估与治疗专家共识 (2017年版) 第一部分评估篇[J]. 中华物理医学与康复杂志, 2017, 39(12): 881-892.
[11] 郑筱萸. 中药新药临床研究指导原则: 试行[M]. 北京: 中国医药科技出版社, 2002: 99-104.
[12] 侯东哲, 张颖, 巫嘉陵, 等. 中文版美国国立卫生院脑卒中量表的信度与效度研究[J]. 中华物理医学与康复杂志, 2012, 34(5): 372-374.
[13] 中国康复医学会康复护理专业委员会. 吞咽障碍康复护理专家共识[J]. 护理学杂志, 2021, 36(15): 1-4.
[14] 窦祖林. 吞咽障碍评估与治疗[M]. 北京: 人民卫生版社, 2009: 87-88.
[15] 刘国菊, 丁芸, 程阅凤, 等. 洼田饮水试验联合吞咽训练对脑梗死吞咽障碍患者治疗效果的影响[J]. 实用临床医药杂志, 2018, 22(2): 5-8.
[16] CUI Q, WEI B, HE Y, et al.Findings of a videofluoroscopic swallowing study in patients with dysphagia[J]. Front Neurol, 2023, 4(14): 1213-1219.
[17] HEDSTROM J, JOHANSSON M, OLSSON C, et al.Quality of care in dysphagia patients: adaptation and validation of the Swedish SWAL-CARE questionnaire[J]. Health Qual Life Outcomes, 2020, 18(1): 316-318.
[18] 骆立虎, 付高勇, 余秀芳, 等. 电针与神经肌肉促进技术联合用于脑卒中后吞咽障碍患者对总体康复效果及安全性的影响[J]. 中医康复, 2024, 1(9): 16-19.
[19] 王付启, 秦合伟, 王媛. 丁苯酞联合会厌逐瘀方穴位贴敷治疗急性脑梗死后吞咽障碍的临床疗效[J]. 中西医结合心脑血管病杂志, 2023, 21(20): 3827-3830.
[20] 董晓莹, 张影. 肌电生物反馈联合吞咽训练及低频电刺激对卒中后并发吞咽障碍者康复效果及舌骨喉复合体动度的影响[J]. 湖南师范大学学报 (医学版), 2021, 18(5): 116-120.
[21] 王光清. 历代膏药作用的统计与现代膏药创新的进展[J]. 陕西中医, 2005, 26(1): 77.
[22] PASIERSKI M, SZULCZYK B.Beneficial Effects of Capsaicin in Disorders of the Central Nervous System[J]. Molecules, 2022, 27(8): 2484-2487.
[23] YUAN S, QIU B, LIANG Y, et al.Role of TRPV1 in electroacupuncture-mediated signal to the primary sensory cortex during regulation of the swallowing function[J]. CNS Neurosci Ther, 2024, 30(3): 1445-1447.
[24] 程婷, 郝文杰, 李祥, 等. 电刺激联合吞咽功能训练治疗肝豆状核变性吞咽障碍的临床观察[J]. 中国康复, 2022, 37(8): 451-455.
[25] TOMSEN N, ORTEGA O, NASCIMENTO W, et al.Oropharyngeal Dysphagia in Older People is Associated with Reduced Pharyngeal Sensitivity and Low Substance P and CGRP Concentration in Saliva[J]. Dysphagia, 2022, 37(1): 48-57.
[26] CUI F, YIN Q, WU C, et al.Capsaicin combined with ice stimulation improves swallowing function in patients with dysphagia after stroke: A randomised controlled trial[J]. J Oral Rehabil, 2020, 47(10): 1297-1303.
[27] KITTIPANYA-NGAM P, BENJAPORNLERT P, RATTANAKANOKCHAI S, et al.Effect of TRP-Stimulating Compounds to Reduce Swallowing Response Time in the Elderly: A Systematic Review[J]. Dysphagia, 2021, 36(4): 614-622.
基金
广西壮族自治区中医药管理局青年基金“辣椒素联合穴位贴敷治疗脑卒中吞咽障碍的疗效观察”（GXZYA20220255）;广西壮族自治区医疗卫生重点学科建设项目（桂卫科教发[2022]4号）
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