Clinical Study on Treatment of Swallowing Dysfunction in Post-Stroke Patient with Cricopharyngeal Dysphagia with Ditan Decoction Combined with Midnight-Noon Ebb-Flow Acupuncture
Abstract: Objective: To observe the clinical effect of Ditan Decoction (DTD) combined with Midnight-Noon Ebb-Flow Acupuncture (MLA) on the treatment of swallowing dysfunction in post-stroke patients with cricopharyngeal dysphagia (CPD). Methods:A total of 84 post-stroke patients with CPD adimitted to Wenzhou Hospital of Traditional Chinese Medicine form January 2022 to January 2023 were randomly divided into the control group,the DTD group, the MLA group,and the DTD plus MLA (DTD+MLA) group,with 21 patients in each group. All four groups received basic treatment and standard swallowing rehabilitation therapy. The DTD group received nasogastric feeding of Ditan Decoction,the MLA group received Midnight-Noon Ebb-Flow Acupuncture for treatment,and the DTD+MLA group received both nasogastric feeding of Ditan Decoction and Midnight-Noon Ebb-Flow Acupuncture for treatment. All groups were treated for six weeks. The scores of Video Fluoroscopic Swallowing Study (VFSS),Simplified Swallowing Assessment( SSA) and Swallowing Quality of Life Questionnaire( SWAL-QOL),and surface electromyography( sEMG) signals of swallowing muscles were compared before and after treatment among the four groups. Adverse reactions were also compared. Results: After treatment, the VFSS scores in all four groups were increased (P<0.05), and the VFSS score in the MLA+DTD group was higher than that in the other three groups (P<0.05). At four and six weeks of treatment,the SSA scores in all four groups were decreased (P<0.05),and the SSA score in the MLA+DTD group was lower than that in the other three groups( P<0.05). After treatment,the average electromyography( AEMG) values during dry swallowing and swallowing of 5 mL of warm water were decreased in all four groups (P<0.05). The mean swallowing time during dry swallowing shortened in the MLA group,the DTD group,and the MLA+DTD group (P< 0.05),and the mean swallowing time when swallowing 5 mL of warm water shortened in the DTD group,the MLA+ DTD group,and the control group( P<0.05). The AEMG values during dry swallowing and swallowing of 5 mL of warm water in the MLA+DTD group were lower than those in the MLA group and the control group (P<0.05). The mean swallowing time during dry swallowing in the MLA+DTD group was shorter than that in the other three groups (P< 0.05),and the mean swallowing time when swallowing 5 mL of warm water in the MLA+DTD group was shorter than that in the MLA group and the control group (P<0.05). At four and six weeks of treatment, the SWAL-QOL scores were gradually increased in the MLA group,the DTD group,and the MLA+DTD group (P<0.05),and the scores in the MLA+DTD group were higher than those in the other three groups (P<0.05);the MLA group and DTD group had higher scores than the control group (P<0.05). There was no significant difference in the overall incidence of complications among the four groups (P>0.05). Conclusion: Ditan Decoction combined with Midnight-Noon Ebb- Flow Acupuncture can improve swallowing function and quality of life in post-stroke patients with CPD, with high safety.