A Clinical Study Of Nape Cluster Acupuncture In The Treatment Of Patients With Dysphagia Due To Wind, Phlegm And Blood Stasis After Stroke

Purpose: 1.To compare the different therapeutic effect on dysphagia patients Of Windphlegm Obstructing Collaterals Type between the combined treatment with napealigned acupuncture and swallowing function training and ordinary swallowing function to explore immediate effect of puncturing nape-aligned acupunatecture.2.To explore immediate effect,known as the first part of the time-effect,and mechanism of puncturing nape-aligned acupunatecture and the main acupoint Fengchi by the examination of VFSS,s EMG and TCD.Methods: 1.Thesis 1: A total of 96 patients of dysphagia were randomly assigned into a control group and an observation group,each 48 cases.The swallowing function treatment was provided to both 2 groups.Additionally,nape-aligned acupuncture was used in the observation group.The following acupoints were selected to acupoint:Fengchi,Wangu,Tianzhu,Pang Lianquan of both sides and Lianquan.Acupuncture method: 0.35mm×40mm needles,first twirling puncture both Fengchi about 35 mm with the direcction to the throat.Secondly twirling puncture both Wangu and Tianzhu about 35 mm with the direcction to the throat.Then twirling puncture both Pang Lianquan and Lianquan about 35 mm with the direcction to the tougue.Each acupoint was given 15 seconds with the rotational speed of 100 r/min.The retention of needle was 30 minutes.Jinjin Yuye was given blood-letting therapy twice a week,given for about 2~3ml blood one time with the depth of 1~2mm.Both groups were treated 5 times a week,30 mins each time.The scores of water swallowing test(WST),the standardized swallowing assessment(SSA)and the Surface lectromyography(s EMG)of swallowing time and the average amplitude of submental and infrahyoid muscles were observed after 1 mouth,SPSS 20.0 was utilized to conduct statistics analysis to get the results.2.Thesis 2:42 patients of observation group were accepted both nape-aligned acupuncture and the main acupoint Fengchi to explore the time-effect of both acupuncture methods under this self-control study to under the examination of VFSS,s EMG,TCD.Oral transit time(OTT),pharyngeal transit time(PTT)and the maximum displacement of the hyoid bone(Hmax D)was measured by VFSS after puncturing Fengchi.The swallowing time and the average amplitude of submental and infrahyoid muscles were observed by s EMG after puncturing Fengchi and napealigned acupuncture during dry and wet swallowing(swallow 5ml water).The blood flow characteristics and spectral parameters change were showed by Transcranial Dopple(TCD)after puncturing Fengchi and nape-aligned acupuncture.SPSS 20.0 was utilized to conduct statistics analysis to get the results.Results: 1.Thesis 1:Before treatment,there were no significant differences in general clinical data,the swallowing ability of WST,SSA and the swallowing time and the average amplitude of submental and infrahyoid muscles(P>0.05).1.1 After the treatment,swallowing ability of WST were better than those before treatment(P<0.05).1.2 SSA scores of both 2 groups were lower than those before treatment(P<0.05).The above scores of observation group were better control group(P<0.05).1.3 s EMG showed the swallowing time was shorter than those before treatment(P< 0.05)and the average amplitude of submental and infrahyoid muscles were higher by than those before treatment(P<0.05).The above scores of observation group were better control group(P<0.05).2.Thesis 2: 2.1VFSS showed he immediate result of puncturing Fengchi could shorten OTT,PTT and increace the maximum displacement of the hyoid bone(Hmax D)(P<0.05).2.2 s EMG 2.2.1 s EMG showed immediate effect of puncturing Fengchi which could increase amplitude of the root mean square(RMS)and decrease swallowing time of both submental muscles and infrahyoid muscles(P<0.05)under dry and wet swallowing.2.2.2 s EMG also indicate immediate effect of puncturing nape-aligned acupuncture that the swallowing time was shorter than those after puncturing Fengchi(P<0.05)and the average amplitude of submental and infrahyoid muscles were higher than those after puncturing Fengchi(P<0.05).The above scores of nape-aligned acupuncture were better than puncturing Fengchi.(P<0.05).2.3 TCD results 2.3.1 For those with high blood speed,Vs?Vd?Vm of RMCA,Vs?Vm of LMCA and BA were lower after puncturing Fengchi(P<0.05).Vs?Vm of LMCA and Vs?Vd?Vm of BA were lower after nape-aligned acupuncture(P<0.05).2.3.2 For those with normal blood speed,there was no significant changes after puncturing Fengchi and nape-aligned acupuncture(P>0.05).2.3.3 For those with low blood speed,Vd of RMCA and Vs?Vd?Vm of LMCA were lower after puncturing Fengchi(P<0.05).PI of LMCA,Vs?Vm of BA anad LVA,Vs?Vd?Vm of RVA were higher after puncturing Fengchi(P<0.05).PI? RI of VA were lower after puncturing Fengchi(P<0.05).PI of RACA,Vm of LMCA were lower after nape-aligned acupuncture(P<0.05).Vs?Vd?Vm of BA,Vs?Vm of VA were higher after nape-aligned acupuncture(P<0.05).RI of BA,PI?RI of LVA were lower after nape-aligned acupuncture(P<0.05).Conclusion: 1.Nape-aligned acupuncture combined with swallowing function training has significant influence on dysphagia patients of wind-phlegm Obstructing collaterals type after stroke,which should be applied widely.2.Nape-aligned acupuncture can shorten the swallowing time and increase the average amplitude of submental and infrahyoid muscles by the application of s EMG.3.Both main acupoint Fengchi and nape-aligned acupuncture shorten the swallowing time,increase the average amplitude of submental and infrahyoid muscles and the maximum displacement of the hyoid bone(Hmax D),and the result of nape-aligned acupuncture was better than Fengchi.4.Nape--aligned acupuncture has no influence on people with normal blood flow,but shows two-ways regulation to patients with abnormal blood flow.5.Fengchi,as the main acupoint of nape-aligned acupuncture,has points specificity and immediate effect to dysphagia patients,which shows positive effect to dysphagia muscles and blood vessel system.6.Nape-aligned acupuncture has better immediate effect to dysphagia patients compared with puncturing Fengchi,which shows better acupoint compatibility.