【目的】 观察“通关利窍”针刺法联合球囊扩张术治疗脑卒中后环咽肌失弛缓（CPD）所致吞咽障碍的临床疗效。【方法】 选取2022年8月至2024年4月绵阳市中心医院收治的82例明确诊断为脑卒中后CPD所致吞咽障碍的患者为研究对象。按随 机数字表将患者随机分为观察组和对照组，每组41例。2组患者均给予健康宣教及对症基础治疗。对照组在常规处理的基础 上，给予球囊扩张术治疗。观察组在对照组治疗的基础上，给予“通关利窍”针刺法治疗。连续治疗4周。治疗4周后，评 价2组临床疗效。观察2组患者治疗前后吞咽造影检查（VFSS）评分和藤岛一郎吞咽功能评分（FDS）的变化情况，以及Barthel 指数评分（BI）的情况。比较2组患者治疗前后症状积分的变化情况。并评价2组的安全性及不良反应的发生情况。【结果】（1） 观察组总有效率为90.24%（37/41），对照组为68.29%（28/41）。观察组疗效优于对照组，差异有统计学意义（P＜0.05）。（2）治 疗后，2组患者的 VFSS评分明显改善（P＜0.05），且观察组在改善 VFSS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FDS评分明显改善（P＜0.05），且观察组在改善FDS评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 Barthel评分明显改善（P＜0.05），且观察组在改善 Barthel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组患者的症状积分明显改善（P＜0.05），且观察组在改善症状积分方面明显优于 对照组，差异有统计学意义（P＜0.05）。（6）对照组不良反应发生率为9.76%（4/41），观察组为14.63%（6/41），2组患者的不良 反应发生率比较，差异无统计学意义（P＞0.05）。【结论】 通关利窍针刺法联合球囊扩张术治疗脑卒中后 CPD所致吞咽障碍， 可有效改善患者的临床症状，提高患者的吞咽功能，从而提高患者的生活质量，疗效显著。

Objective To observe the clinical efficacy of “Tongguan Liqiao” Acupuncture combined with balloon dilation in treating dysphagia caused by cricopharyngeal dysfunction （CPD） after cerebral stroke （CS）. Methods Eighty-two patients diagnosed with dysphagia caused by CPD after CS at Mianyang Central Hospital from August 2022 to April 2024 were selected as study subjects. Patients were randomly divided into an observation group and a control group using a random number table method，with 41 patients in each group. Both groups received health education and symptomatic basic treatment. The control group received additional balloon dilation therapy based on conventional treatment，while the observation group received “Tongguan Liqiao” Acupuncture in addition to the control group’s treatment. The treatment course for both groups was 4 weeks. After 4-week treatment，clinical efficacy was evaluated in both groups. Changes in Videofluoroscopic Swallowing Study （VFSS） scores，Fujishima Ichiro Dysphagia Scale （FDS） scores，and Barthel Index （BI） scores were observed before and after treatment in both groups. Changes in symptom scores were compared between the two groups before and after treatment. Safety and adverse reactions were also evaluated in both groups. Results （1） The total effective rate was 90.24% （37/41） in the observation group and 68.29% （28/41） 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）.（2） After treatment， 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）.（3）After treatment， FDS 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）.（4） After treatment，Barthel Index 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）.（5） After treatment， the symptom 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）.（6） The incidence of adverse reactions was 9.76%（4/41） in the control group and 14.63% （6/41） in the observation group， with no statistically significant difference between the two groups （P＞0.05）. Conclusion“Tongguan Liqiao” Acupuncture combined with balloon dilation effectively alleviates clinical symptoms and improves swallowing function in patients with dysphagia caused by CPD after stroke，thereby enhancing patients’ quality of life with notable therapeutic efficacy.

R246.9

四川省科技计划资助项目（编号：2022ZHYZ0015）