【目的】 观察揿针联合重复经颅磁刺激（rTMS）治疗脑卒中后吞咽困难的临床疗效。【方法】 将 2022年 2月至 2024年 2月 中国人民解放军联勤保障部队第九〇八医院病房及门诊收治的120例脑卒中后吞咽困难患者按随机数字表法随机分为观察组 和对照组，每组各60例。2组患者均给予营养神经、改善循环等常规对症支持治疗，对照组给予高频rTMS治疗，观察组在 对照组治疗的基础上，联合揿针疗法进行治疗。连续治疗 4周。治疗 1个月后，评价 2组临床疗效，观察 2组患者治疗前后 中医证候积分、功能性经口摄食评价量表（FOIS）评分与标准吞咽功能评定量表（SSA）评分的变化情况，以及血清总蛋白 （TP）、血清白蛋白（ALB）、血红蛋白（Hb）的情况。比较2组患者治疗前后吞咽波幅、吞咽时程的变化情况。【结果】（1）研究 过程中，观察组无失访，对照组失访 8 例。最终观察组 64 例，对照组 56 例纳入疗效统计。（2）观察组的总有效率为 92.19% （59/64），对照组为76.79%（43/56），观察组疗效优于对照组，差异有统计学意义（P < 0.05）。（3）治疗后，2组患者中医证候积 分均明显改善（P < 0.05），且观察组在改善中医证候积分方面明显优于对照组，差异有统计学意义（P < 0.05）。（4）治疗后， 2 组患者的FOIS评分、SSA评分明显改善（P < 0.05），且观察组在改善FOIS评分、SSA评分方面明显优于对照组，差异有统 计学意义（P < 0.05）。（5）治疗后，2组患者的吞咽波幅、吞咽时程明显改善（P < 0.05），且观察组在改善吞咽波幅、吞咽时程 方面明显优于对照组，差异有统计学意义（P < 0.05）。（6）治疗后，2组患者的TP、ALB、Hb水平明显改善（P < 0.05），且观察 组在改善TP、ALB、Hb水平方面明显优于对照组，差异有统计学意义（P < 0.05）。【结论】 揿针联合重复经颅磁刺激治疗脑卒 中后吞咽困难，能明显缩短患者的吞咽时程，增大吞咽波幅，从而改善患者的吞咽功能，提高患者的生活质量，临床疗效显著。 关键词：揿针疗法；重复经颅磁刺激；脑卒中；吞咽障碍；康复效果；临床观察

Objective To observe the clinical efficacy of thumb-tack needling for subcutaneous embedding combined with repetitive transcranial magnetic stimulation（rTMS）in the treatment of post-stroke dysphagia. Methods A total of 120 cases of patients with post-stroke dysphagia admitted to the 908th Hospital of the Joint Logistics Support Force of the People 􀆳 s Liberation Army of China from February 2022 to February 2024 were randomly divided into the observation group and the control group according to random number table method，with 60 cases in each group. Both groups of patients were given conventional symptomatic supportive treatment，such as trophic nerve， improving circulation， etc.， and the control group was given high-frequency rTMS treatment， while the observation group was treated with thumb-tack needling for subcutaneous embedding therapy on the basis of the treatment in the control group. The course of treatment covered four weeks continuously. After one month of treatment，the clinical efficacy of the two groups was evaluated，and the changes in scores of traditional Chinese medicine （TCM） syndrome， Functional Oral Intake Scale （FOIS） and Standardized Swallowing Assessment （SSA），as well as levels of serum total protein（TP），serum albumin（ALB），and hemoglobin（Hb）before and after treatment were observed in the patients of the two groups. The changes in swallowing wave amplitude and swallowing duration before and after treatment were compared between the two groups of patients. Results（1）During the study，there were none in the observation group and eight cases in the control group were failed to follow-up. Finally，64 cases in the observation group and 56 cases in the control group were included in the efficacy statistics. （2）The total effective rate was 92.19%（59/64）in the observation group and 76.79%（43/56）in the control group， and the efficacy of the observation group was superior to that of the control group，the difference being statistically significant（P < 0.05）.（3）After treatment， the TCM syndrome scores of the patients in the two groups were significantly improved（P < 0.05），and the improvement in the observation group was significantly superior to that in the control group，with statistically significant differences（P < 0.05）.（4）After treatment，the FOIS score and SSA score of the patients in the two groups improved significantly（P < 0.05）， and the improvement in the observation group was significantly superior to that in the control group， the difference being statistically significant（P < 0.05）.（5）After treatment，the swallowing wave amplitude and swallowing duration of patients in the two groups improved significantly（P < 0.05），and the improvement in the observation group was significantly superior to that in the control group，the difference being statistically significant（P < 0.05）.（6）After treatment， the TP，ALB and Hb levels of patients in the two groups improved significantly（P < 0.05），and the improvement in the observation group was significantly superior to that in the control group， with statistically significant differences（P < 0.05）. Conclusion Thumb-tack needling for subcutaneous embedding combined with rTMS in the treatment of post-stroke dysphagia can significantly shorten the patients 􀆳 swallowing duration and enlarge the swallowing wave amplitude，thus improving their swallowing function and improving their quality of life.

R246.9

江西省中医药管理局科技计划资助项目（编号：2021B241）