针灸并构音训练脑卒中后构音障碍:文献计量分析及临床治疗结果验证
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摘要
背景:卒中后构音障碍目前在治疗上尚缺乏能明显奏效的药物,单纯的康复训练效果不是很显著,传统中医针灸治疗在临床上取得了不错的效果。目的:应用文献计量学方法分析卒中后构音障碍的研究重点及趋势;并观察针灸合并构音训练治疗卒中后构音障碍的效果。方法:(1)应用计算机检索中国知网CNKI数据库2004年1月至2018年12月收录的与卒中后构音障碍相关文献,利用知网的分组分层次浏览功能及可视化工具分析文献的发表年度趋势,作者、机构及基金分布情况等;阅读文题和摘要,排除综述文章及护理影像类文献,筛选针灸相关的文章,总结分析针灸治疗卒中后构音障碍的方法;(2)纳入2013年6月至2015年8月在沈阳市第一人民医院治疗的卒中后构音障碍患者96例,按治疗方式不同分为2组,对照组48例进行构音训练,治疗组48例进行构音训练+针灸(舌针、项针)治疗,每个患者接受2个疗程共40 d治疗,应用改良Frenchay构音障碍评价法评估临床疗效,并记录不良反应。结果与结论:(1)共检索到卒中后构音障碍相关的中文文献121篇,从2004年发表1篇至2018年14篇,整体呈上升趋势;发表卒中后构音障碍相关文章最多的是成都中医药大学附属医院(5篇),均为胡卡明团队发表,发表文章最多前10个单位及前8位作者中有60%来自中医药大学或中医药大学附属医院;121篇中有72篇包含针灸治疗,其中单纯舌针治疗的7篇,舌针+项针治疗的8篇,舌针+头针治疗的7篇,针灸+电刺激治疗的12篇,针灸+高压氧治疗的3篇,针灸+康复训练的35篇;(2)在沈阳市第一人民医院治疗的卒中后构音障碍患者96例的临床治疗结果显示:治疗组总有效率92%,明显高于对照组总有效率54%,组间比较差异有显著性意义(P <0.05)。提示:在中国,目前研究卒中后构音障碍治疗最多的是中医药大学及相应的附属医院,中医方法尤其针灸是治疗卒中后构音障碍的重要手段,最常用的是舌针及项针。临床治疗结果显示,项针、舌针联合构音训练治疗脑卒中后构音障碍疗效满意。
BACKGROUND: There is a lack of effective drug for post-stroke dysarthria. Effect of single rehabilitation training is insignificant, and traditional acupuncture and moxibustion therapy obtains good treatment outcomes. OBJECTIVE: To analyze the research focus and prospects of post-stroke dysarthria by bibliometrics, and to explore the treatment efficacy of acupuncture and moxibustion combined with speech-language training for post-stroke dysarthria. METHODS:(1) A computer-based online research of CNKI database for the articles addressing post-stroke dysarthria from January 2004 to December 2018. The distribution of publication year, author, affiliation and funding in the literature was analyzed by group-level browsing and visualization tool. After reading the title and abstract, the review and the articles about nursing and radiography were excluded, and the articles concerning acupuncture and moxibustion were included to summarize acupuncture and moxibustion in the treatment of post-stroke dysarthria.(2) Ninety-six patients with post-stroke dysarthria admitted at the First People's Hospital of Shenyang between June 2013 and August 2015 were enrolled, and then divided into control and treatment groups(n=48 per group). The control group underwent speech-language training, and the treatment group received speech-language training and acupuncture and moxibustion(acupuncture at tongue and neck), for two courses and 40 days in total. The clinical efficacy was evaluated by advanced Frenchay dysarthria assessment, and the adverse reactions were recorded. RESULTS AND CONCLUSION:(1) One hundred and twenty-one Chinese articles were retrieved. There was 1 article published in 2004, total 14 articles by the end of 2018. The articles(n=5) are mainly form Chengdu University of Traditional Chinese Medicine by Hu Kaming team. Sixty percent of the first ten affiliations and the first eight authors were form the Chinese Medicine Universities or their affiliated hospitals. Of them, 72 articles addressed acupuncture and moxibustion, including 7 in acupuncture at tongue, 8 in acupuncture at tongue and neck, 7 in acupuncture at tongue and head, 12 in acupuncture and electrostimulation, 3 in acupuncture and hyperbaric oxygen therapy, and 35 in acupuncture and rehabilitation training.(2) The total effctiveness rate in the treatment group(92%) was significantly higher than that in the control group(54%)(P < 0.05). In summary, in China, studies on the treatment of post-stroke dysarthria are mainly from Chinese Medicine Universities and their affiliated hospitals. Chinese medicine, especially acupuncture and moxibustion(acupuncture at tongue and neck mostly used) is an important means in the treatment of post-stroke dysarthria. Clinical trial results suggest that post-stroke dysarthria treated by acupuncture at tongue and neck combined with speech-language training can obtain satisfactory outcomes.
BACKGROUND: There is a lack of effective drug for post-stroke dysarthria. Effect of single rehabilitation training is insignificant, and traditional acupuncture and moxibustion therapy obtains good treatment outcomes. OBJECTIVE: To analyze the research focus and prospects of post-stroke dysarthria by bibliometrics, and to explore the treatment efficacy of acupuncture and moxibustion combined with speech-language training for post-stroke dysarthria. METHODS:(1) A computer-based online research of CNKI database for the articles addressing post-stroke dysarthria from January 2004 to December 2018. The distribution of publication year, author, affiliation and funding in the literature was analyzed by group-level browsing and visualization tool. After reading the title and abstract, the review and the articles about nursing and radiography were excluded, and the articles concerning acupuncture and moxibustion were included to summarize acupuncture and moxibustion in the treatment of post-stroke dysarthria.(2) Ninety-six patients with post-stroke dysarthria admitted at the First People's Hospital of Shenyang between June 2013 and August 2015 were enrolled, and then divided into control and treatment groups(n=48 per group). The control group underwent speech-language training, and the treatment group received speech-language training and acupuncture and moxibustion(acupuncture at tongue and neck), for two courses and 40 days in total. The clinical efficacy was evaluated by advanced Frenchay dysarthria assessment, and the adverse reactions were recorded. RESULTS AND CONCLUSION:(1) One hundred and twenty-one Chinese articles were retrieved. There was 1 article published in 2004, total 14 articles by the end of 2018. The articles(n=5) are mainly form Chengdu University of Traditional Chinese Medicine by Hu Kaming team. Sixty percent of the first ten affiliations and the first eight authors were form the Chinese Medicine Universities or their affiliated hospitals. Of them, 72 articles addressed acupuncture and moxibustion, including 7 in acupuncture at tongue, 8 in acupuncture at tongue and neck, 7 in acupuncture at tongue and head, 12 in acupuncture and electrostimulation, 3 in acupuncture and hyperbaric oxygen therapy, and 35 in acupuncture and rehabilitation training.(2) The total effctiveness rate in the treatment group(92%) was significantly higher than that in the control group(54%)(P < 0.05). In summary, in China, studies on the treatment of post-stroke dysarthria are mainly from Chinese Medicine Universities and their affiliated hospitals. Chinese medicine, especially acupuncture and moxibustion(acupuncture at tongue and neck mostly used) is an important means in the treatment of post-stroke dysarthria. Clinical trial results suggest that post-stroke dysarthria treated by acupuncture at tongue and neck combined with speech-language training can obtain satisfactory outcomes.
引文
[1]Kwon YG,Do KH,Park SJ,et al.Effect of Repetitive Transcranial Magnetic Stimulation on Patients With Dysarthria After Subacute Stroke.Ann Rehabil Med.2015;39(5):793-799.
[2]Kim G,Min D,Lee EO,et al.Impact of Co-occurring Dysarthria and Aphasia on Functional Recovery in Post-stroke Patients.Ann Rehabil Med.2016;40(6):1010-1017.
[3]金梅,刘晓加.基底神经节的语言功能[J].中国行为医学科学,2003,12(04):119-121.
[4]Netsell R.Speech aeromechanics and the dysarthrias:implications for children with traumatic brain injury.J Head Trauma Rehabil.2001;16(5):415-425.
[5]Mackenzie C,Muir M,Allen C,et al.Non-speech oro-motor exercises in post-stroke dysarthria intervention:a randomized feasibility trial.Int J Lang Commun Disord.2014;49(5):602-617.
[6]Mackenzie C,Lowit A.Improved status following behavioural intervention in a case of severe dysarthria with stroke aetiology.Int J Speech Lang Pathol.2012;14(4):318-328.
[7]Mahler LA,Ramig LO.Intensive treatment of dysarthria secondary to stroke.Clin Linguist Phon.2012;26(8):681-694.
[8]梁猛军,蔡永亮.脑卒中后构音障碍治疗研究进展[J].中医药临床杂志,2011,23(12):1136-1137.
[9]杨孝芳,施杨婉琳,崔瑾,等.针刺结合康复训练对脑卒中后假性球麻痹患者构音障碍影响的研究[J].贵阳中医学院学报,2012,34(5):42-44.
[10]路飞,张连城.中医治疗脑卒中后构音障碍研究[J].长春中医药大学学报,2012,28(2):253-254.
[11]潘巍一,张捷洪,柯秀君,等.头部督脉穴联合舌三针改善脑卒中后构音障碍的临床症状及Frenchay评分情况观察[J].首都食品与医药,2016,(10):71-72.
[12]武志佳,胡卡明,郭耀光,等.针刺结合言语康复训练治疗脑卒中后痉挛性构音障碍:多中心随机对照研究(英文)[J].世界针灸杂志,2014,24(4):12-16.
[13]王雅青,刘芳,王晓芳,等.舌下放血合舌部操治疗脑卒中假性延髓麻痹构音障碍32例[J].福建中医药大学学报,2013,23(3):63-64.
[14]刘丽丽,董赟,郝盼富.针刺配合言语康复训练治疗脑卒中后构音障碍临床研究进展[J].中医药临床杂志,2013,25(11):1038-1039.
[15]贾力,白洁,刘东,等.舌体分区多针点刺配合言语训练治疗脑卒中后运动性构音障碍30例[J].中国中医药现代远程教育,2016,14(2):44-46.
[16]缪鸿石,朱镛连.脑卒中的康复评定和治疗[M].北京:华夏出版社,1996.
[17]缪鸿石.康复医学理论与实践(上册)[M].上海:上海科学技术出版社,2000.
[18]柳金英,常静玲.脑卒中后基底核构音障碍的脑机制研究进展[J].中国康复医学杂志,2014,29(10):987-990.
[19]王红,陈卓铭.脑卒中后遗构音障碍的诊断与治疗[J].新医学,2006,37(11):717-719,738.
[20]刘莉,邵伟波.脑卒中所致痉挛型构音障碍的康复训练方法及疗效[J].中国康复理论与实践,2008,14(10):925-926.
[2]Kim G,Min D,Lee EO,et al.Impact of Co-occurring Dysarthria and Aphasia on Functional Recovery in Post-stroke Patients.Ann Rehabil Med.2016;40(6):1010-1017.
[3]金梅,刘晓加.基底神经节的语言功能[J].中国行为医学科学,2003,12(04):119-121.
[4]Netsell R.Speech aeromechanics and the dysarthrias:implications for children with traumatic brain injury.J Head Trauma Rehabil.2001;16(5):415-425.
[5]Mackenzie C,Muir M,Allen C,et al.Non-speech oro-motor exercises in post-stroke dysarthria intervention:a randomized feasibility trial.Int J Lang Commun Disord.2014;49(5):602-617.
[6]Mackenzie C,Lowit A.Improved status following behavioural intervention in a case of severe dysarthria with stroke aetiology.Int J Speech Lang Pathol.2012;14(4):318-328.
[7]Mahler LA,Ramig LO.Intensive treatment of dysarthria secondary to stroke.Clin Linguist Phon.2012;26(8):681-694.
[8]梁猛军,蔡永亮.脑卒中后构音障碍治疗研究进展[J].中医药临床杂志,2011,23(12):1136-1137.
[9]杨孝芳,施杨婉琳,崔瑾,等.针刺结合康复训练对脑卒中后假性球麻痹患者构音障碍影响的研究[J].贵阳中医学院学报,2012,34(5):42-44.
[10]路飞,张连城.中医治疗脑卒中后构音障碍研究[J].长春中医药大学学报,2012,28(2):253-254.
[11]潘巍一,张捷洪,柯秀君,等.头部督脉穴联合舌三针改善脑卒中后构音障碍的临床症状及Frenchay评分情况观察[J].首都食品与医药,2016,(10):71-72.
[12]武志佳,胡卡明,郭耀光,等.针刺结合言语康复训练治疗脑卒中后痉挛性构音障碍:多中心随机对照研究(英文)[J].世界针灸杂志,2014,24(4):12-16.
[13]王雅青,刘芳,王晓芳,等.舌下放血合舌部操治疗脑卒中假性延髓麻痹构音障碍32例[J].福建中医药大学学报,2013,23(3):63-64.
[14]刘丽丽,董赟,郝盼富.针刺配合言语康复训练治疗脑卒中后构音障碍临床研究进展[J].中医药临床杂志,2013,25(11):1038-1039.
[15]贾力,白洁,刘东,等.舌体分区多针点刺配合言语训练治疗脑卒中后运动性构音障碍30例[J].中国中医药现代远程教育,2016,14(2):44-46.
[16]缪鸿石,朱镛连.脑卒中的康复评定和治疗[M].北京:华夏出版社,1996.
[17]缪鸿石.康复医学理论与实践(上册)[M].上海:上海科学技术出版社,2000.
[18]柳金英,常静玲.脑卒中后基底核构音障碍的脑机制研究进展[J].中国康复医学杂志,2014,29(10):987-990.
[19]王红,陈卓铭.脑卒中后遗构音障碍的诊断与治疗[J].新医学,2006,37(11):717-719,738.
[20]刘莉,邵伟波.脑卒中所致痉挛型构音障碍的康复训练方法及疗效[J].中国康复理论与实践,2008,14(10):925-926.
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