目的 采用功能性近红外光谱成像技术(fNIRS)探讨幕下脑卒中吞咽障碍患者的皮质功能状态与吞咽功能的相关性，并观察舌三针对该类患者皮质活动的影响。 方法 选取幕下脑卒中吞咽障碍患者30例，按照随机数字表法将其分为假针刺组和舌三针组，每组15例。采用fNIRS采集两组患者在静息态、针刺态(假针刺组为假针刺态)、电针态(假针刺组为假电针态)、针刺后静息态(假针刺组为假针刺后静息态)下的氧和血红蛋白(HbO2)的相对浓度变化(ΔHbO2)。采用改良Rankin量表(mRS)、渗漏误吸评分(PAS)、功能性经口摄食量表(FOIS)评估两组患者的整体功能残疾水平和吞咽功能。 结果 静息态下，两组患者的左侧初级运动皮质(r＝0.550，P＝0.002)、左侧背外侧前额叶皮质(r＝0.585，P＝0.001)和左侧前运动皮质(r＝0.510，P＝0.004)区域的平均ΔHbO2浓度与PAS评分呈中度正相关。针刺态下，舌三针组患者的右侧额下回(F＝9.651，P＝0.004)和左侧颞中回(F＝3.343，P＝0.029)区域的ΔHbO2浓度显著增加(P<0.05)，左侧躯体感觉皮质(F＝4.948，P＝0.035)和左侧初级运动皮质(F＝4.742，P＝0.038)区域的ΔHbO2浓度显著降低(P<0.05)。 结论 舌三针可促使幕下脑卒中吞咽障碍患者的大脑皮质活动发生变化，这可能是改善吞咽障碍的潜在机制。 Objective To seek any correlation between cortical activity and the swallowing of dysphagia patients with infratentorial stroke, and to observe any effect of three-needle acupuncture of the tongue on such activity. Methods Thirty infratentorial stroke survivors with dysphagia were randomly divided into a tongue three-needle group and a sham acupuncture group, each of 15. Functional near-infrared spectroscopy was used to monitor changes in the concentration of oxygenated hemoglobin (ΔHbO2) at rest, during acupuncture (or sham acupuncture), during real or sham electro-acupuncture, and at rest after the acupuncture or sham acupuncture treatment. The Modified Rankin Scale, a Penetration-Aspiration Scale (PAS), and the Functional Oral Intake Scale were employed to assess overall functional disability and the swallowing of both groups. Results At rest the average ΔHbO 2 concentrations recorded in the left primary motor cortex, the left dorsolateral prefrontal cortex and the left premotor cortex in both groups were positively correlated with the PAS scores. During the acupuncture ΔHbO 2 concentration in the right inferior frontal gyrus and the left middle temporal gyrus increased significantly in the tongue three-needle group. It decreased significantly in the left somatosensory cortex and the left primary motor cortex. Conclusion Three-needle acupuncture of the tongue induces changes in cortical activity in infratentorial stroke survivors with dysphagia, suggesting a potential technique for improving disordered swallowing.
The effects of acupuncture of the tongue on the cortical activity of stroke survivors with dysphagia: A functional near-infrared spectroscopy study
Objective To seek any correlation between cortical activity and the swallowing of dysphagia patients with infratentorial stroke, and to observe any effect of three-needle acupuncture of the tongue on such activity. Methods Thirty infratentorial stroke survivors with dysphagia were randomly divided into a tongue three-needle group and a sham acupuncture group, each of 15. Functional near-infrared spectroscopy was used to monitor changes in the concentration of oxygenated hemoglobin (ΔHbO2) at rest, during acupuncture (or sham acupuncture), during real or sham electro-acupuncture, and at rest after the acupuncture or sham acupuncture treatment. The Modified Rankin Scale, a Penetration-Aspiration Scale (PAS), and the Functional Oral Intake Scale were employed to assess overall functional disability and the swallowing of both groups. Results At rest the average ΔHbO 2 concentrations recorded in the left primary motor cortex, the left dorsolateral prefrontal cortex and the left premotor cortex in both groups were positively correlated with the PAS scores. During the acupuncture ΔHbO 2 concentration in the right inferior frontal gyrus and the left middle temporal gyrus increased significantly in the tongue three-needle group. It decreased significantly in the left somatosensory cortex and the left primary motor cortex. Conclusion Three-needle acupuncture of the tongue induces changes in cortical activity in infratentorial stroke survivors with dysphagia, suggesting a potential technique for improving disordered swallowing.
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