| Objective:Based on the systematic review of acupuncture treatment of dysphagia after stroke,the effects of acupuncture exercise therapy and conventional acupuncture on swallowing function and quality of life of patients with dysphagia after stroke were compared,and the health economics analysis of the two treatment schemes was carried out to explore the mechanism of acupuncture exercise therapy in treating this disease,in order to provide acupuncture intervention scheme with good curative effect,low cost and high safety for clinic.Method:1.Efficacy of acupuncture for dysphagia after stroke :a systematic review and meta-analysisAll the included studies were randomized controlled studies.The intervention measures of patients with dysphagia after stroke were acupuncture and swallowing rehabilitation treatment.The clinical efficacy,grading of drinking water test,standardized swallowing assessment(SSA)score,Fujishima feeding-swallowing function grade score,SWAL-QOL score,video fluoroscopic swallowing study(VFSS),etc.Search with “stroke”,“cerebral infarction”,“cerebral hemorrhage”,“acupuncture”,“dysphagia”,and “random”as keywords.Chinese search databases include CNKI,Wanfang Data,VIP and Chinese Biology.English retrieval databases include Pub Med,Embase and other databases.The quality of the included literatures was evaluated by the improved Jadad scoring scale,and the extracted Meta were analyzed by Revman5.3Version 5.3 software.2.Clinical research(1)Patient selection: From February 2017 to January 2019,136 patients with dysphagia during stroke recovery period were hospitalized in rehabilitation and neurological ward of Jiangbin Hospital of Guangxi Zhuang Autonomous Region.(2)Grouping scheme: The patients were divided into treatment group and control group with 68 cases each.In the treatment group,5 cases were eliminated due to aggravation of illness,and 3 cases fell off due to intolerance to acupuncture.In the control group,3 cases were eliminated due to the change of illness,2 cases fell off due to intolerance to acupuncture,and 3 cases fell off due to discharge from hospital.Finally,60 cases in the treatment group and 60 cases in the control group were involved in statistical analysis.(3)Treatment plan: Both groups received the same basic medicine treatment in neurology,swallowing function training,routine body acupuncture and rehabilitation training for hemiplegic limbs.In the treatment group,acupoints were selected: Fengfu,Fengchi,Yifeng and Three-acupoint of tongue.After rapid needle insertion,the above acupoints were twisted in a small extent by the method of tonifying and relieving diarrhea.Keep the needle for 10 minutes,and twist it once during the period,and continue to do it for about 10 seconds at each point.During needle retention,the patient is instructed to do the following actions: draw a circle with the tip of the tongue close to the upper jaw,roll the tongue,stretch the tongue,and swallow saliva.After taking out of the needle,the routine acupuncture of hemiplegic limbs was performed.In the control group,conventional acupuncture was used,and the points were Lianquan,Wangu(double),Fengchi(double),Tongli(double),Zhaohai(double),Hegu(double)and Taichong(double).Hold the needle for 20 minutes.The two groups were treated five times a week,with three weeks as one course of treatment,with two courses of treatment in total.(4)Evaluation indicators: Watian drinking water test,SSA were used to evaluate swallowing function,SWAL-QOL was used to evaluate patients' quality of life,cost-effectiveness ratio and incremental cost-effectiveness ratio were used to evaluate health economic benefits,and the efficacy and safety were evaluated.Results:1.Results of systematic reviewA total of 3207 related literatures were obtained from the initial search,and 39 literatures were finally included after screening layer by layer,all of which were randomized controlled studies involving 3078 patients.By integrating the data in the literature,it is found that acupuncture combined with swallowing rehabilitation training can significantly improve the effective rate of patients compared with simple swallowing rehabilitation training.Wada drinking water test,SSA scale score,Fujishima feeding-swallowing function grade score and swallowing disorder specific quality of life scale score also reflect that the swallowing function of patients is significantly improved after acupuncture treatment.2.Clinical research results(1).Before treatment,the general baseline data of patients were analyzed,including gender composition,average age,average course of disease,stroke type and educational level.there was no statistical difference between the two groups(P>0.05),and the distribution was balanced and comparable.There is no significant difference between the two groups in water test grade,SSA score and SWAL-QOL score before treatment(P>0.05),which is comparable.It shows that the indexes of the two groups are evenly distributed.(2).Results of Watian drinking water test: Compared with before treatment,the difference between the experimental group after one course of treatment and after two courses of treatment was statistically significant(P<0.05).After one course of treatment and two courses of treatment in the control group,the difference was statistically significant(P<0.05).It shows that acupuncture exercise therapy and routine acupuncture can effectively improve the swallowing function of patients.Comparing between groups,after one course of treatment,there was no significant difference between the experimental group and the control group(P>0.05).After two courses of treatment,the effect of the experimental group was better than that of the control group,and the difference was statistically significant(P<0.05).It shows that there is no difference in curative effect between them after one course of treatment.After two courses of treatment,with the prolongation of treatment time,the therapeutic effect of acupuncture exercise therapy is better than that of conventional acupuncture,which indicates that the clinical effect of acupuncture exercise therapy needs a certain time of dose-effect accumulation process.From the trend chart,it can be seen that the score of the experimental group decreases more obviously than that of the control group,indicating that acupuncture exercise has better curative effect.(3).Results of SSA:Intra-group comparison: after two courses of treatment,the SSA score in the treatment group was significantly different from that before treatment(P<0.001),lower than that before treatment;The SSA score of the control group was significantly lower than that before treatment(P<0.001).The results indicated that SSA scores of both groups were lower than those before treatment,and acupuncture exercise therapy and routine acupuncture could significantly improve the symptoms of dysphagia after stroke.Comparison between groups: after two courses of treatment,the SSA score of the treatment group was significantly different from that of the control group(P<0.05),the SSA score of the treatment group was lower than that of the control group.It shows that after two courses of treatment,the SSA score of the treatment group is lower than that of the control group,and acupuncture exercise therapy is superior to conventional acupuncture in improving the symptoms of dysphagia after stroke.(4).Results of SWAL-QOL:(1)Total score comparisonIntra-group comparison: After two courses of treatment,the SWAL-QOL score in the treatment group was significantly higher than that before treatment(P<0.01).The score of SWAL-QOL in control group was significantly higher than that before treatment(P<0.01).After two courses of treatment,the SWAL-QOL scores of the two groups were improved,compared with those before treatment.Acupuncture and exercise therapy and conventional acupuncture can improve the swallowing function and quality of life of patients.Comparison between groups: After two courses of treatment,the SWAL-QOL score of the treatment group was significantly higher than that of the control group(P<0.01).It shows that both methods can improve the swallowing function of patients and improve their quality of life,but acupuncture exercise therapy is better than conventional acupuncture.(2)Comparison of scores of each itemIntra-group comparison: After two courses of treatment,the scores of each item in the treatment group were significantly higher than those before treatment(all P<0.05).In the control group,there was no significant difference between two courses of treatment and before treatment except "social interaction"(P>0.05),but there were significant differences between two courses of treatment and before treatment(all P<0.05),which were higher after treatment than before treatment.(5)Comparison of clinical efficacyAfter the course of treatment,compare the clinical curative effects: 30 cases in the observation group,2 cases cured,16 cases markedly effective,10 cases effective and 2 cases ineffective;In the control group,0 cases were cured,9 cases were markedly effective,13 cases were effective and 8 cases were ineffective.After statistical analysis,the difference was statistically significant(P<0.01).It shows that the clinical effect of acupuncture exercise therapy is better than that of routine acupuncture group.(6)Health economics evaluation(1)Watian drinking water test: Cost-effectiveness analysis: RMB 4103.02 yuan will be spent for every one point reduction in Wadi drinking water test in the treatment group;The control group spent RMB 5364.09 yuan for each reduction of one point in the depression test,indicating that the treatment group spent RMB 1261.07 yuan less than the control group for each reduction of one point in the depression test score.Incremental cost-effectiveness analysis: Compared with the control group,the patients in the control group spend 544 yuan more for each additional unit of treatment effect.(2)SSA: Cost-effectiveness analysis: RMB1334.06 will be spent for every one point reduction of SSA score in the treatment group;The SSA score of the control group decreased by 1 point,which cost RMB 2365.41,indicating that the SSA score of the treatment group decreased by 1 point,which cost RMB1031.35 less than that of the control group.Incremental cost-effectiveness analysis: Compared with the control group,the patients in the control group spend 101.58 yuan more for each additional unit of treatment effect.(3)SWAL-QOL: Cost-effectiveness analysis: For each additional score of Swal Qo L in the treatment group,it will cost RMB 193.72;Every increase in the control group's SWAL-QOL score will cost RMB 313.50,indicating that every increase in the treatment group's SWAL-QOL score will cost RMB 119.78 less.Incremental cost-effectiveness analysis: Compared with the control group,the patients in the control group spend 16.65 yuan more for each additional unit of treatment effect.(7)Safety evaluationIn the last two groups,120 patients were included in the statistics.During the treatment,there was no inhalation pneumonia,malnutrition,dizziness,hematoma,severe pain,arrhythmia and other adverse reactions.In the treatment group,there were 6cases of subcutaneous hemorrhage at Lianquan point,but it dissipated in about 5 days,without adverse consequences that seriously affected the vital signs of the patients,which indicated that the safety of the two groups was guaranteed and the compliance of the patients was good.Conclusion:1.The systematic evaluation of the clinical efficacy of acupuncture in treating dysphagia after stroke suggests that acupuncture combined with swallowing rehabilitation training can effectively improve the swallowing function of stroke patients.2.Through clinical research,it is found that acupuncture exercise therapy can significantly reduce the drinking water level of patients in the depression field,and improves the scores of SSA scale and dysphagia-specific quality of life scale,and its mechanism needs further study.3.According to the analysis of health economics,acupuncture exercise therapy is lower than conventional acupuncture in the cost of obtaining unit effect,and has the best cost-effectiveness ratio. |
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