电针联合表情肌功能训练操治疗重度贝尔面瘫临床研究
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摘要
目的:观察电针联合表情肌功能训练与单纯电针治疗重度贝尔面瘫的临床疗效差异及其对疗程的影响。方法:将≥21天仍未好转的120例重度贝尔面瘫患者,随机分为观察组(60例,脱落1例)和对照组(60例)。两组均口服甲钴胺、呋喃硫胺片药物治疗,对照组仅采用电针治疗;观察组电针治疗后进行早、晚各1次的表情肌训练。1周治疗3次,6次为一疗程,治疗4个疗程。比较两组患者治疗前、每个疗程结束后面神经功能(HBGS)评价分级和临床疗效,比较两组痊愈患者疗程差异,病程6个月时比较肌电图运动单位束颤波的发生率。结果:两组患者治疗后HBGS分级评价均较治疗前显著改善(均P <0. 01);与对照组比较,第1疗程结束时,HBGS分级差异无统计学意义(P> 0. 05);第2、3、4疗程结束时,HBGS分级差异有统计学意义,观察组优于对照组(均P <0. 05); 4个疗程结束后,观察组愈显率72. 88%(43/59),对照组48. 33%(29/60),差异有统计学意义(P <0. 01); 4个疗程后及病程6个月,这两个阶段痊愈患者疗程比较,观察组治疗天数均少于对照组(均P <0. 05);病程6月时肌电图运动单位束颤波的发生率,观察组3. 39%(2/59),对照组15%(9/60),差异有统计学意义(P <0. 05)。结论:与单纯电针相比,电针联合表情肌功能训练是治疗重度贝尔面瘫的有效方法,可提高愈显率,缩短治疗病程,且减少面瘫后遗症(面肌痉挛)的发生。
Objective: To observe the efficacy difference between electro-acupuncture combined with functional training of expression muscle and single electro-acupuncture in the treatment of severe Bell's palsy,and their influences to the treatment course. Methods: A total of 120 patients with severe Bell's palsy,who were not improved after 21 d,were randomized into the observation group( 60 cases with 1 dropout) and the control group( 60 cases). Both groups were treated with oral Mecobalamin and Fursultiamine tablets; on which basis,the observation group was also treated with functional training of expression muscle after electro-acupuncture treatment; whereas the control group was only treated with electro-acupuncture. The treatment was 3 times a week four 4 courses,and 6 times was taken as one course of treatment. The facial nerve function of House-Brackmann grading system( HBGS) and clinical efficacy were compared between the two groups before and after each course of the treatment. The difference in treatment course and the incidence of EMG motor unit fasciculation potentials were also compared at 6 th month of the duration between the two groups. Results: After the treatment,the HBGS evaluation was significantly improved in the both groups( P < 0. 01). There was no significant difference in HBGS after 1 st treatment course between the observation group and the control group( P > 0. 05);however the differences were seen after 2 nd,3 rd and 4 th treatment course between the two groups,in which the observation group was superior to the control group( P < 0. 05). After the treatment,the cured and markedly effective rate was 72. 88%( 43/59) in the observation group,which was significantly higher than 48. 33%( 29/60) in the control group( P < 0. 01). After 4 th course of the treatment and at 6 months of duration,the course of treatment for cured patients was compared. Days for the treatment in the observation group were all less than those in the control group( P < 0. 05). The incidence of EMG motor unit fasciculation potentials at 6 months of duration was 3. 39%( 2/59) in the observation group,which was greatly lower than 15%( 9/60) in the control group( P < 0. 05). Conclusion: Compared to single electro-acupuncture therapy,the electro-acupuncture combined with functional training of expression muscle has a better curative effect in the treatment of severe Bell's palsy,which can improve the cured and markedly effective rate,shorten the course of treatment,and reduce the occurrence of facial paralysis sequelae( hemifacial spasm).
Objective: To observe the efficacy difference between electro-acupuncture combined with functional training of expression muscle and single electro-acupuncture in the treatment of severe Bell's palsy,and their influences to the treatment course. Methods: A total of 120 patients with severe Bell's palsy,who were not improved after 21 d,were randomized into the observation group( 60 cases with 1 dropout) and the control group( 60 cases). Both groups were treated with oral Mecobalamin and Fursultiamine tablets; on which basis,the observation group was also treated with functional training of expression muscle after electro-acupuncture treatment; whereas the control group was only treated with electro-acupuncture. The treatment was 3 times a week four 4 courses,and 6 times was taken as one course of treatment. The facial nerve function of House-Brackmann grading system( HBGS) and clinical efficacy were compared between the two groups before and after each course of the treatment. The difference in treatment course and the incidence of EMG motor unit fasciculation potentials were also compared at 6 th month of the duration between the two groups. Results: After the treatment,the HBGS evaluation was significantly improved in the both groups( P < 0. 01). There was no significant difference in HBGS after 1 st treatment course between the observation group and the control group( P > 0. 05);however the differences were seen after 2 nd,3 rd and 4 th treatment course between the two groups,in which the observation group was superior to the control group( P < 0. 05). After the treatment,the cured and markedly effective rate was 72. 88%( 43/59) in the observation group,which was significantly higher than 48. 33%( 29/60) in the control group( P < 0. 01). After 4 th course of the treatment and at 6 months of duration,the course of treatment for cured patients was compared. Days for the treatment in the observation group were all less than those in the control group( P < 0. 05). The incidence of EMG motor unit fasciculation potentials at 6 months of duration was 3. 39%( 2/59) in the observation group,which was greatly lower than 15%( 9/60) in the control group( P < 0. 05). Conclusion: Compared to single electro-acupuncture therapy,the electro-acupuncture combined with functional training of expression muscle has a better curative effect in the treatment of severe Bell's palsy,which can improve the cured and markedly effective rate,shorten the course of treatment,and reduce the occurrence of facial paralysis sequelae( hemifacial spasm).
引文
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[13]胡琳娜,邵水金,刘延祥,等.电针治疗周围神经损伤的修复机制[J].中国组织工程研究与临床康复,2010,14(46):8662-8664.
[14]柏树令.系统解剖学[M]. 7版.北京:人民卫生出版社,2008:382-385.
[15]郭文海,王艳,裴飞.针刺结合康复训练治疗脑卒中后面瘫的疗效观察[J].针灸临床杂志,2013,29(3):26-27.
[16]郭俐宏,穆敬平,陈雄. Rood技术联合电针治疗周围性面瘫的临床研究[J].针灸临床杂志,2014,30(1):15-17.
[17]徐文玉,刘新,李阔.表情肌强化训练对特发性面神经麻痹的疗效[J].中国康复理论与实践,2014,20(5):474-476.
[2]陈生弟.神经病学[M]. 2版.北京:科学出版社,2011:248.
[3]高树中,杨毅.针灸治疗学[M]. 9版.北京:中国中医药出版社,2015:51.
[4]曹莲瑛,张伟,冷锋强,等.中药熏蒸配合电针治疗风寒型面瘫疗效观察[J].上海针灸杂志,2018,37(8):919-923.
[5]李予鲁,高志强,倪道凤.面神经功能分级现状[J].国外医学·耳鼻咽喉科学分册,2004,28(3):174-178.
[6]陶天遵.临床常见疾病诊疗标准[M].北京:北京医科大学中国协和医科大学联合出版社,2004:98.
[7]肖霞,丁有权,齐建国.周围神经损伤后慢性失神经及其对神经再生的影响[J].神经解剖学杂志,2016,32(3):412-416.
[8]张阳,曹江鹏,蔡兴慧,等.针刺通过调节神经营养因子修复神经损伤研究进展[J].安徽中医学院学报,2014,33(6):90-94.
[9] Shapira Y,Midha R. Shocking therapy:Brief electrical stimulation for delayed nerve repair[J]. Exp Neurol,2015,271:524-525.
[10] Gordon T. Electrical stimulation to enhance axon regeneration after peripheral nerve injuries in animal models and humans[J]. Neurotherapeutics,2016,13(2):295-310.
[11]惠莲,姜学钧,杨柠,等.去神经支配后运动终板区域超微结构及乙酰胆碱酯酶含量变化与面肌功能恢复神经损伤不同程度及损伤后不同时间的差异[J].中国临床康复,2005,9(21):71-73.
[12]杨绍安,靳安民,蔡宝塔,等.酸性成纤维细胞生长因子预防失神经支配肌运动终板退变及肌萎缩的实验研究[J].中华显微外科杂志,2006,29(3):213-214.
[13]胡琳娜,邵水金,刘延祥,等.电针治疗周围神经损伤的修复机制[J].中国组织工程研究与临床康复,2010,14(46):8662-8664.
[14]柏树令.系统解剖学[M]. 7版.北京:人民卫生出版社,2008:382-385.
[15]郭文海,王艳,裴飞.针刺结合康复训练治疗脑卒中后面瘫的疗效观察[J].针灸临床杂志,2013,29(3):26-27.
[16]郭俐宏,穆敬平,陈雄. Rood技术联合电针治疗周围性面瘫的临床研究[J].针灸临床杂志,2014,30(1):15-17.
[17]徐文玉,刘新,李阔.表情肌强化训练对特发性面神经麻痹的疗效[J].中国康复理论与实践,2014,20(5):474-476.