【目的】 观察分期针刺联合双侧经颅直流电交替刺激治疗脑卒中后口咽期吞咽障碍的临床疗效。【方法】 选取2023年6月 至2024年6月于陕西省康复医院神经康复病区收治的60例明确诊断为脑卒中后口咽期吞咽障碍的患者为研究对象。按照随 机数字表将患者随机分为观察组和对照组，每组各30例。2组患者均给予常规吞咽功能训练。对照组给予双侧经颅直流电交 替刺激治疗，观察组在对照组治疗的基础上，给予分期针刺治疗。共治疗4周。治疗1个月后，评价2组临床疗效。观察2组患 者治疗前后洼田饮水试验分级评分（WST）和电视透视吞咽功能评分（VFSS）的变化情况，以及功能性经口摄食量表评分 （FOIS）和吞咽障碍生活质量评分（SWAL-QOL）的情况。比较2组患者治疗前后表面肌电图（sEMG）舌骨肌群波幅及吞咽时间 的变化情况。并评价 2 组的安全性及并发症的发生情况。【结果】（1）治疗后，2 组患者 WST、VFSS 评分均明显改善（P＜ 0.05），且观察组在改善 WST、VFSS 评分方面明显优于对照组，差异有统计学意义（P＜0.05）。（2）治疗后，2 组患者 FOIS、 SWAL-QOL 评分均明显改善（P＜0.05），且观察组在改善 FOIS、SWAL-QOL 评分方面明显优于对照组，差异有统计学意义 （P＜0.05）。（3）治疗后，2组患者的sEMG波幅及吞咽时间均明显改善（P＜0.05），且观察组在改善sEMG波幅及吞咽时间方面 明显优于对照组，差异有统计学意义（P＜0.05）。（4）观察组并发症发生率为16.67%（5/30），对照组为30.00%（9/30）。观察组 并发症发生率明显低于对照组，差异有统计学意义（P＜0.05）。（5）观察组总有效率为 93.34%（28/30），对照组为 76.67%（23/ 30）。观察组疗效优于对照组，差异有统计学意义（P＜0.05）。【结论】 分期针刺联合双侧经颅直流电交替刺激治疗脑卒中后口 咽期吞咽障碍患者，能显著改善患者的吞咽功能，从而提高患者的生活质量，降低并发症的发生率，疗效显著。

Objective To observe the clinical efficacy of staged acupuncture combined with alternating bilateral transcranial direct current stimulation （tDCS） in treating post-stroke oropharyngeal dysphagia. Methods Sixty patients diagnosed with oropharyngeal dysphagia after stroke，admitted to the Neurological Rehabilitation Ward of Shaanxi Kangfu Hospital from June 2023 to June 2024， were selected as the study subjects. Patients were randomly divided into an observation group and a control group using a random number table，with 30 patients in each group. Both groups received conventional swallowing function training. The control group received additional alternating bilateral tDCS， while the observation group received staged acupuncture in addition to the control group's treatment. The total treatment duration was 4 weeks. After one month of treatment，the clinical efficacy was evaluated in both groups. Changes in the Water Swallowing Test （WST） grade， Videofluoroscopic Swallowing Study （VFSS） score，Functional Oral Intake Scale （FOIS） score，and Swallowing-Quality of Life （SWAL-QOL）score were observed before and after treatment. Changes in the amplitude of hyoid muscle group surface electromyography （sEMG） and swallowing time were compared before and after treatment between the two groups. The safety and incidence of complications in both groups were also evaluated. Results （1） After treatment，WST and VFSS scores were significantly improved in both groups （P＜0.05），and the improvement in the observation group was significantly superior to that in the control group，with a statistically significant difference （P＜0.05）. （2） After treatment，FOIS and SWAL-QOL scores were significantly improved in both groups （P＜0.05），and the improvement in the observation group was significantly superior to that in the control group，with a statistically significant difference （P＜0.05）.（3） After treatment， sEMG amplitude and swallowing time were significantly improved in both groups （P＜0.05），and the improvement in the observation group was significantly superior to that in the control group， with a statistically significant difference （P＜0.05）.（4） The complication rate was 16.67% （5/30） in the observation group and 30.00% （9/30） in the control group. The complication rate in the observation group was significantly lower than that in the control group，with a statistically significant difference （P＜0.05）.（5） The total effective rate was 93.34% （28/30） in the observation group and 76.67% （23/30） in the control group. The efficacy in the observation group was superior to that in the control group，with a statistically significant difference （P＜0.05）. Conclusion Staged acupuncture combined with alternating bilateral tDCS for patients with post-stroke oropharyngeal dysphagia can significantly improve swallowing function， thereby enhancing the patient's quality of life， reducing the incidence of complications， and demonstrating significant therapeutic efficacy.

R246.9

陕西省重点研发计划资助项目（编号：2024SF-YBXM-686）；西安创新能力支撑计划-医学研究资助项目（编号：23YXYJ0139）