| Objective1. To compare the therapeutic effects between acupuncture combined with rehabilitation therapy and simple rehabilitation training on post-stroke dysphagia.2. Using the patient-reported outcome (PRO),swallowing disorders efficacy evaluation which is used after stroke was observed whether it can evaluate stroke patients with dysphagia swallowing function improvement and improvement of physiological and psychological state of the patient, to provide a new method for the evaluation of post-stroke dysphagia and to offer new methods of curing apoplectic sequelae for clinicians’ reference.MethodsScreened patients with post-stroke dysphagia in Dongzhimen Hospital. Seventy four cases were collected into the study, which were randomly divided into an experimental group (n=39) and a control group (n=39). Experimental group shed one case and control groupshed four cases. The control group received conventional therapy of neurologic internal medicine and swallowing rehabilitation training, whereas the experimental group received conventional therapy of neurologic internal medicine, acupuncture (Including prick blood) and swallowing rehabilitation training.3 times a week, once every other day and total treatments was for 28 days. Acupoint selection:Fengchi(GB 20) Wangu(GB 12) Tianzhu(BL 10) Lianquan (RN 23) Neidaying Jinjin(EX-HN 12) Yuye(EX-HN 13). Inthe first day, the seventh day,the fourteenth day and the twenty-eighth day after entering the group, weassess the patients respectively, and 3 months after the end of treatment followed up. The level of Kubota water-swallowing test and the patient-reported outcome were used to evaluate swallowing function improvement, physiological function and psychological improvement and clinical efficacy of patients with post-stroke dysphagia.Results1.Basic information:Collected Seventy three cases with post-stroke dysphagia, thirty eight cases in the experimental group and thirty five cases in the control group. The ages of experimental group ranged from 40 to 75 years old, and the mean age of which was 62.21±10.30 years old. There were 21 cases of men whose mean age was 64.64±6.93 years old and 17 cases of women whose mean age was 59.24±12.98 years old. The control group ages 35-74 years old, and the average age of them was 61.97±10.43 years old. There were 24 cases of men whose mean age was 62.25±10.40 years old and 11 cases of women whose mean age was 61.36±10.98 years old. The other differences such as gender, height, weight, ethnic showed no significant difference (P>0.05). When two groups of subjects enrolled systolic and diastolic blood pressure, heart rate, body temperature, breathing, duration, type of stroke and other clinical data showed no significant difference (P> 0.05), too.2. From Kubota water-swallowing test scores changes, the experimental group:in the first day of Kubota water-swallowing test scores was 3.74(1.00), in the twenty-eighth day of Kubota water-swallowing test scores was 1.29(0.00), reduced 2.45(1.00). The control group: on the first day of Kubota water-swallowing test scores was 3.71(1.00), in twenty-eighth day of Kubota water-swallowing test scores was 1.86(1.00), reduced 1.86(0.00). Compared the first day, the seventh day, the fourteenth day and the twenty-eighth day of Kubota water-swallowing test scores between the experimental group and the control group, the first day of Kubota water-swallowing test scores was no significant differences (P>0.05), the seventh day, the fourteenth day and the twenty-eighth day of Kubota water-swallowing test scores were significant differences (P<0.01).3. From bucking rating changes in the patient-reported outcome, the experimental group:in the first day of bucking scores in the patient-reported outcome was 3.89(0.00), on the twenty-eighth day of bucking scores in the patient-reported outcome was 0.39(0.00), reduced 3.50(1.00). The control group:in the first day of bucking scores in the patient-reported outcome was 3.80(0.00), in the twenty-eighth day of bucking scores in the patient-reported outcome was 1.46(2.00), reduced 2.34(1.00). Compared the first day, the seventh day, the fourteenth day and the twenty-eighth day of bucking scores in the patient-reported outcome scores between the expe2rimental group and the control group, the first day of bucking scores was no significant differences (>P>0.05), the seventh day, the fourteenth day and the twenty-eighth day of bucking scores were significant differences (P<0.01).4. From physiological function scores changes in the patient-reported outcome, the experimental group:in the first day of physiological function scores in the patient-reported outcome was 54.55±15.01, on the twenty-eighth day of physiological function scores in the patient-reported outcome was 16.18±8.90, reduced 38.37±13.17. The control group:in the first day of physiological function scores in the patient-reported outcome was 51.11±12.20, on the twenty-eighth day of bucking scores in the patient-reported outcome was 26.94±11.17, reduced 24.17±7.39. Compared the first day, the seventh day, the fourteenth day and the twenty-eighth day of physiological function scores in the patient-reported outcome scores between the experimental group and the control group, the first day and the seventh day of physiological function scores was no significant differences (P> 0.05), the fourteenth day and the twenty-eighth day of physiological function scores were significant differences(P <0.01).5. From changes of psychological function scores in the patient-reported outcome, the experimental group:on the first day of psychological function scores in the patient-reported outcome was 12.03±5.84,inthe twenty-eighth day of psychological function scores in the patient-reported outcome was 6.74±4.35, reduced 5.29±3.57. The control group:inthe first day of psychological function scores in the patient-reported outcome was 12.23(9.00), on the twenty-eighth day of bucking scores in the patient-reported outcome was 10.09(9.00), reduced 2.14(2.00). Compared the first day, the seventh day, the fourteenth day and the twenty-eighth day of psychological function scores in the patient-reported outcome scores between the experimental group and the control group, the first day, the seventh day and the fourteenth day of psychological function scores was no significant differences (P>0.05), the twenty-eighth day of psychological function scores were significant differences (P<0.01).6. From the perspective of the clinical curative effect, the cure rate of the experimental groupwas78.9%, the improved rate is 21.1%, the cure rate of the control groupwas60.3%, the improved rate is 38.4%, inefficiency was 1.4%. The total effective rates of the experimental group and the control group were 100%and 97.1%respectively, with significant difference (P <0.01).Conclusions1. This is the first clinical study used the patient-reported outcome (PRO), evaluate the clinical efficacy of patients with post-stroke dysphagia, not only to improve the patients with post-stroke dysphagia swallowing function improving efficacy, but also to enriched the evaluation system of TCM clinical efficacy.2.Under the guidance of evidence-based medicine system, professors in accordance with internationally recognized PRO scale development guiding principle. They appropriate to join the content of the characteristics of traditional Chinese medicine, such as diet, urine, bitter mouth, languid et al, establishment conforms to Chinese conditions and characteristicsPRO scale.The scale is patient to measure themselves in all aspects of health, is the patient as the center, to combination of the patient’s subjective and objective examination index, is an objective evaluation of themself with clinical symptoms, physiology and psychology on theimprovement of their mental state, reflects the people-oriented concept of traditional Chinese medicine.3. Compared the experimental group and control group, acupuncture combined with rehabilitation therapy not only improve bucking, drooling and other clinical manifestations, but can be improved the physiological functions, psychological mental condition of the patients, but the condition of the improvement of physiological function is better than that of psychological function.4. Compared with pure rehabilitation therapy, acupuncture combined with rehabilitation therapy treatment of post-stroke dysphagia has higher cure rate and the long-term follow-up therapeutic evaluation has no change.
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