【医药学论文】舌三针结合醒脑开窍法治疗假性球麻痹构音障碍的临床探讨

 一、 中文摘要

      目的：客观综合地评价两种不同治疗方法（舌三针结合醒脑开窍法、常规针刺法）对假性球麻痹构音障碍的临床疗效，探讨舌三针结合醒脑开窍法治疗假性球麻痹构音障碍的临床有效性及实用性。
结果：1.与治疗前相比，治疗一个疗程及治疗后两组Frenchay构音障碍评估量表评分均有所增高（P＜0.01），治疗一个疗程后，研究组评分高于对照组（P< 0.05）；治疗结束后两组评分无明显差异（P＞0.05）；
3.临床疗效方面，一个疗程结束后，研究组总有效率为70%，对照组总有效率为40%，两组疗效比较，差异具有统计学意义（P＜0.05）；治疗结束后，研究组总有效率为86.6%，对照组的总有效率为73%，两组疗效比较，差异无统计学意义（P＞0.05），研究组痊愈率为36.6%，对照组痊愈率为20%，两组比较，差异显著（P＜0.05），具有统计学意义。
      2.舌三针结合醒脑开窍法比常规针刺治疗更能有效地改善假性球麻痹构音障碍的临床症状，且起效比常规针刺治疗起效快；
关键词：假性球麻痹；构音障碍；舌三针；醒脑开窍法；针刺疗法
Objective: objective evaluation of two different treatment methods (tri-tongue-acus with brain-activating and orifice-opening acupuncture/conventional acupuncture)on the effect of dysarthria of supranuclear paralysis. Discuss the clinical validity and practicality of tri-tongue-acus with brain-activating and orifice-opening acupuncture therapy treating dysarthria of supranuclear paralysis.

Methods: 60 patients with qualified subjects were randomly divided into two groups, the research group was given tri-tongue-acus with brain-activating and orifice-opening acupuncture therapy; Control group was given conventional acupuncture therapy. A period of treatment is 14 days, a total is two periods. Observe the treatment of dysarthria symptom, score of Frenchay assessment scale before treatment, treatment after a period and after treatment. Compare two groups low shear blood viscosity and PV before treatment and after all treatment.

Results:1. After a period of treatment and after all treatment, Frenchay assessment scale scores of two groups were be higher (P < 0.01) than before. And after a period of treatment the research scores was higher than the control group scores. But after all treatment the research group and control group comparison had no significant difference (P > 0.05);
0.05);
0.05). the result shows that the two groups' clinical curative effect were similar. After all the treatment, the research group the cure rate was 36.6%, and the control group the cure rate was 20%. Compare two groups, there was statistically significant difference (P < 0.05). the result shows that the research groups cure rate was better than control group.
2. Tri-tongue-acus with brain-activating and orifice-opening acupuncture therapy was better than conventional acupuncture in improving dysarthria of supranuclear paralysis and has fast effective.

Key words: supranuclear paralysis; dysarthria; tri-tongue-acus; brain-activating and orifice-opening acupuncture; acupuncture.

3.5.2 对照设计的依据
3.5.3 疗效指标的选择
    血液流变学是一门新兴的生物力学及生物流变学分支，是研究血液宏观流动性质，人体内血液流动和细胞变形，以及血液与血管、心脏之间相互作用的学科。检查项目包括包括全血粘度（高切全血粘度、低切全血粘度），全血还原粘度（全血高切还原粘度、全血低切还原粘度）、全血相对粘度（全血高切相对粘度、全血低切相对粘度）、血浆粘度、红细胞压积、红细胞沉降率、血沉方程K值。血流变的指标对血液粘稠度具有提示意义。血液的高凝状态则极易形成血栓，是脑卒中发病的重要因素，因此血液流变学为脑卒中治疗疗效观察的重要指标。全血低切流变是指在低切变率时血液的粘度。低切变率时，血液形成红细胞聚集体，红细胞聚集体越多，红细胞聚集性越强，血液粘度越高。因此低切全血粘度可以反映红细胞的聚集程度。本研究中低切全血粘度切变率选择为1S-1，此时红细胞的聚集度能够得到完全及真实的体现。高切全血粘度为在高切变率下血液粘度，反映了红细胞的变形能力，高切全血粘度高时，红细胞变形力差，高切粘度低时，红细胞变形好。根据基础研究表明，在切变率达到180-1S时，红细胞开始出现拉破的现象，因此本研究中高切全血粘度切变率选择为100S-1。血浆粘度是影响全血粘度的重要指标之一，血浆粘度的升高则全血粘度必然升高，主要取决于血浆蛋白，尤其是纤维蛋白原，脂蛋白和球蛋白的粘度。

3.6 结果分析
 假性球麻痹是由双侧上运动神经元受损（主要是运动皮质及其发出的皮质脑干束）使延髓运动性颅神经核-疑核以及脑桥三叉神经运动核失去了上运动神经元的支配而发生中枢性瘫痪所致。而针刺对于脑部血液的供给具有改善作用，对于脑部言语区的修复有一定的治疗作用。
在总体治疗效果上，舌三针结合醒脑开窍法的痊愈率为36.6%，总有效率为86.6%；常规针刺法的痊愈率为20%，总有效率为73% 。经比较两组总有效率无显著差异（P>0.05），但舌三针结合醒脑开窍法治疗的痊愈率与常规针刺组具有显著差异（P< 0.05），说明舌三针结合醒脑开窍法的疗效更加完全。

4.结论
      2.舌三针结合醒脑开窍法比常规针刺治疗更能有效地改善假性球麻痹构音障碍的临床症状，且起效比常规针刺治疗起效快；

5. 问题与展望