[Primary optimization of acupuncture program for dysphagia after cerebral infarction]

To optimize primarily acupuncture program for dysphagia after cerebral infarction.

Sixty-three patients with pseudobulbar palsy dysphasia after cerebral infarction were selected as the subjects. Water swallow test was adopted for observation index. Orthogonal design was used to study the different combinations of treatment programs among four factors and three levels, named acupuncture opportunity (factor A: A1: 1-10 d, A2: 11-20 d, A3: 21-40 d), point combination (factor B: B1: points in the neck, B2: points in the neck + points in the glossopharyngeal part, B3: points in the neck + points in the glossopharyngeal part + differentiating point), needling depth (factor C: C1: shallow puncture, C2: moderate puncture, C3: deep puncture), and treatment session (factor D: D1: 2 sessions, D2: 4 sessions, D3: 6 sessions); as well as the influences on pseudobulbar palsy dysphagia after cerebral infarction so as to determine primarily the optimized acupuncture program for dysphagia after cerebral infarction.

The direct analysis of orthogonal design indicated that the best level and the combination of four factors and three levels were A1 (or A2), B3, C3 and D3. It meant that for the patients less than 20 days for sickness, the points in the neck, points in the glossopharyngeal part and points selected according to syndrome differentiation were selected for deep puncture and the treatment lasted for 6 sessions. This program achieved the best improvement in water swallow test. The comparison between the primary effect and secondary effect among four factors (variance analysis) showed that factor A and C were the significant factors (P < 0.05), factor B and D were not significant (P > 0.05). It was suggested that acupuncture opportunity and needling depth played the significant roles in clinical efficacy. The comparison among different levels in terms of the significant factors A and C (multiple comparison) presented that A1 and A2 were superiorly significant than A3 (P < 0.001), A1 was not different in significance from A2 (P > 0.05). C3 was superiorly significant than C2 and C1 (P < 0.001, P < 0.01) and C2 was superiorly significant than C1 (P < 0.05).

By the comprehensive summarization of direct analysis, variance analysis and multiple comparison combined with actual clinical situation, the optimal program of acupuncture treatment for pseudobulbar palsy dysphasia after cerebral infarction is that in terms of the four factors and three levels, for the patients within 1 to 20 days for sickness, acupuncture is applied to the points in the neck or combined with points in the glossopbaryngeal part or the points se-i lected according to syndrome differentiation, with deep puncture, for 4 to 6 sessions of treatment.