目的 探究针刺配合中药冰刺激在缺血性脑卒中吞咽障碍患者中的应用效果。方法 选择缺血性脑卒中吞咽障碍患者92例，采用随机数字表法随机分为对照组和观察组各46例，对照组患者给予包括吞咽康复训练、冰刺激、神经肌肉电刺激的常规治疗，在此基础上，观察组患者加以针刺配合中药冰刺激治疗，疗程4周。评估两组患者临床疗效、吞咽功能、脑血流动力学、表面肌电图结果，并进行安全性评价。结果 观察组治疗总有效率为89.13%，显著高于对照组的71.74%（P<0.05）；治疗后，两组患者吞咽功能（洼田饮水试验评级、标准吞咽功能评定量表（SSA）评分）、脑血流动力学（左右两侧椎动脉和基底动脉的平均血流速度（Vm）、搏动指数（PI））、表面肌电图（颏下肌群和舌骨下肌群的吞咽时限、最大波幅均明显改善）均较治疗前明显改善，且观察组治疗后的洼田饮水试验评级、SSA评分、PI水平、吞咽时限水平显著低于对照组（P<0.05），Vm、最大波幅水平显著高于对照组（P<0.05）；治疗期间，观察组吸入性肺炎发生率为6.52%，显著低于对照组的21.74%（P<0.05）。结论 针刺配合中药冰刺激治疗缺血性脑卒中吞咽障碍疗效确切，可改善患者吞咽功能、脑血流动力学，有助于重构吞咽反射，值得临床推广。

Objective To explore the application effect of acupuncture combined with traditional Chinese medicine ice stimulation on patients with dysphagia after ischemic stroke.Methods Ninety-two patients with dysphagia after ischemic stroke were selected and randomly divided into control group (46 cases) and observation group (46 cases) by the random number table method. The patients in the control group were given routine treatments such as swallowing rehabilitation training, ice stimulation and neuromuscular electrical stimulation, and on this basis. The patients in the observation group were treated with acupuncture combined with traditional Chinese medicine ice stimulation, and the two groups were treated for 4 weeks. The clinical efficacy, swallowing function, cerebral hemodynamics and surface electromyography results were evaluated in the two groups of patients, and safety evaluation was performed.Results The total effective rate of treatment in observation group was significantly higher than that in control group (89.13% vs 71.74%, P<0.05). After treatment, the swallowing function (water swallow test grading, Standardized Swallowing Assessment (SSA)), cerebral hemodynamics (mean blood flow velocity (Vm) and vascular pulse index (PI) of left and right vertebral arteries and basilar artery) and surface electromyography (swallowing time limit and maximum amplitude of submental muscles and subhyoid muscles) were significantly improved in the two groups of patients compared with those before treatment. The water swallow test grading, SSA score, PI level, and swallowing time limit of observation group after treatment were significantly lower than those of control group, while the Vm and maximum amplitude were significantly higher than those of control group (P<0.05). During treatment, the incidence rate of aspiration pneumonia was 6.52% in observation group, which was significantly lower than 21.74% in control group (P<0.05).Conclusion Acupuncture combined with traditional Chinese medicine ice stimulation has an exact efficacy in treating dysphagia after ischemic stroke. It can effectively improve the swallowing function and cerebral hemodynamics, and help reconstruct the swallowing reflex, thus it is worthy of clinical promotion.

湖北省科学技术厅2017年湖北省科技计划项目（2017ACA192）：中医康复常用技术标准及临床应用转化研究，负责人：赵焰。