| Objective:To observe and compare the effects of Gandouling decoction combined with neuromuscular electrical stimulation on cerebral WD with Phlegm-blood stasis syndrome and dysphagia,and evaluate its clinical efficacy.To explore the diagnostic and guiding significance of video fluoroscopic swallowing study in finding early cerebral WD complicated with dysphagia.Methods:(1)Sixty cerebral WD patients with phlegm-blood stasis syndrome and dysphagia meeting inclusion criteria were collected and randomly divided into the treatment group(n=30)and the control group(n=30).The course of disease,TCM classification,clinical manifestations and other data of the patients were recorded in detail.And Thirty healthy people were recruited as the normal group.(2)The control group was treated with basal copper drainage and neuromuscular electrical stimulation.The treatment group was additionally treated with Gandouling decoction on the basis of the treatment of the control group.7 days as a course of treatment,a total of 4 courses.The normal group did not have any drug intervention.(3)Subjects before treatment and after 4 courses of complete VFSS,when checked,the contrast of different characters use all four(No.1 contrast agent was pantogluamine injection,no.2 contrast agent was thin barium sulfate,no.3 contrast agent was mushy barium sulfate,and no.4 contrast agent was steamed bread or bread with barium sulfate)complete the swallow,observe the different character contrast agents respectively through the mouth and pharynx period of time.(4)Before the implementation of the program and at the end of the fourth course of treatment,the subjects’ TCM syndrome scores,drinking water test in depression fields,SSA and changes in 24 hours urinary copper were compared and analyzed.Results:(1)Comparison of VFSS results:Compared with the normal group,the time of contrast agents of four different characters through oral stage was significantly higher than that of the normal group(P<0.01).After 4 courses of treatment,the time of contrast agent passing through oral stage in the treatment group and the control group decreased(P<0.05),and the time of contrast agent passing through oral stage in the treatment group decreased significantly(P<0.05).When the other three contrast agents with different characters were used in oral stage,the time of contrast agents passing through oral stage in the two groups decreased significantly after 4 courses of treatment(P<0.01),and the decrease in the treatment group was more obvious than that in the control group(P<0.01).(2)Comparison of TCM syndrome scores:compared with before treatment,scores of both groups decreased after treatment(P<0.01);After treatment,the scores of treatment group decreased more obviously than that of control group(P<0.01).(3)Comparison of drinking water test in low-lying fields:compared with before treatment,scores of both groups increased after treatment,indicating that treatment was effective(P<0.01).After treatment,scores in the treatment group increased more obviously than those in the control group(P<0.01).(4)Comparison of SSA:Compared with before treatment,scores of both groups decreased after treatment(P<0.01);After treatment,the scores of treatment group decreased more obviously than that of control group(P<0.01).(5)Comparison of urine copper at 24 hours:compared with before treatment,urine copper in both groups increased after treatment(P<0.01);After treatment,urine copper in the treatment group increased more obviously than that in the control group(P<0.01).Conclusion:(1)It was found that patients with cerebral WD combined with dysphagia tended to have abnormalities in oral stage or pharyngeal stage during swallowing.Patients with early dysphagia were mainly in oral stage.When taking different forms of contrast agent,the passage time of contrast agent was longer than that of normal people,and the duration of contrast agent passing through oral stage or pharyngeal stage is related to the contrast agent character.For patients with early dysphagia,clinical symptoms may not be obvious,but VFSS can find that the passage time of contrast agent in the oral phase is prolonged,and at the same time,abnormal initiation of the oral swallowing reflex can be observed,which is conducive to the early symptomatic treatment,and improve the prognosis.(2)Gandouling decoction combined with NMES can improve the TCM syndrome score,low-land drinking water test score and SSA scale score of cerebral WD patients with dysphagia with phlegm-blood stasis syndrome,and it is conducive to the excretion of copper,which has certain clinical efficacy.(3)Compared with single NMES in the treatment of dysphagia with WD phlegm-blood stasis syndrome,the Gandouling Decoction combined with NMES has more obvious clinical efficacy and can significantly improve the function of deglutition in patients. |
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