针刺患侧“反映点”治疗急性期周围性面瘫疗效对照观察
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摘要
目的:探讨急性期针刺患侧"反映点"治疗周围性面瘫的疗效。方法:将90例急性期周围性面瘫患者随机分为反映点组、常规针刺组和理疗组,每组30例。3组均予相同基础用药,反映点组急性期针刺患侧"反映点"和患侧面部局部穴位(地仓、颊车、颧髎、下关、阳白、太阳等),静止期加用电针,恢复期加足三里;常规针刺组急性期针刺患侧翳风和患侧面部局部穴位(地仓、颊车、颧髎、下关、阳白、太阳等),静止期加用电针,恢复期加足三里;理疗组急性期予患侧翳风以超短波治疗,静止期和恢复期治疗同常规针刺组。3组均每日治疗1次,5次为一疗程,共治疗4个疗程。在治疗前后分别采用House-Brackmann(H-B)面神经功能分级量表、面部残疾指数(FDI)量表、症状体征积分量表进行功能评定,并比较3组患者的临床疗效。结果:治疗后各组患者H-B面神经功能分级均优于治疗前(P<0.01),治疗后组间比较,差异无统计学意义(P>0.05);治疗后,反映点组痊愈患者所需的疗程较常规针刺组和理疗组短(P<0.01);3组患者治疗后躯体功能评分、社会功能评分均优于治疗前(P<0.01),治疗后组间比较,差异无统计学意义(P>0.05);3组患者治疗后症状体征积分均低于治疗前(P<0.01),治疗后组间比较,差异无统计学意义(P>0.05);H-B面神经功能分级量表和FDI量表作为疗效标准,反映点组痊愈率为66.7%(20/30),常规针刺组为50.0%(15/30),理疗组为46.7%(14/30),反映点组痊愈率优于其他两组(P<0.05),反映点组愈显率为83.3%(25/30),常规针刺组为70.0%(21/30),理疗组为63.3%(19/30),反映点组愈显率均优于其他两组(P<0.05);症状体征积分作为疗效评价标准,反映点组治愈率为66.7%(20/30),常规针刺组为50.0%(15/30),理疗组为46.7%(14/30),反映点组治愈率均优于其他两组(P<0.05)。结论:与常规针刺和理疗相比,急性期针刺患侧"反映点"治疗周围性面瘫能缩短疗程、提高疗效。
Objective To explore the effect of acupuncture at the "reflection points" of affected side on the peripheral facial paralysis in acute phase. Methods Ninety patients with peripheral facial paralysis in acute phase were randomly divided into a reflection group(group A), a conventional acupuncture group(group B) and a physiotherapy group(group C), 30 cases in each group. The same basic medication were given in all three groups. In the group A, acupuncture at "reflection points" of the affected side and local acupoints in acute phase, such as Dicang(ST 4), Jiache(ST 6), Quanliao(SI 18), Xiaguan(ST 7), Yangbai(GB 14), Taiyang(EX-HN 5), etc. were applied. The electroacupuncture was added in the stationary phase, and Zusanli(ST 36) was added in the recovery phase. In the group B, acupuncture at Yifeng(TE 17) of the affected side in acute phase and local acupoints, such as Dicang(ST 4), Jiache(ST 6), Quanliao(SI 18), Xiaguan(ST 7), Yangbai(GB 14), Taiyang(EX-HN 5), etc. were applied. The electroacupuncture was added in the stationary phase, and Zusanli(ST 36) was added in the recovery phase. In the group C, ultrashort wave on Yifeng(TE 17) of the affected side in acute phase was applied, and the treatment in the stationary phase and the recovery phase was the same as the group B. The treatment was given once every day, 5 times as one course for 4 courses. The House-Brackmann(H-B) grading scale, facial disability index scale, the symptom and physical score integral scale were used to score before and after treatment, and the clinical effects of the three groups were compared. Results After treatment, the functional grade of H-B facial nerve was better than that before treatment in the three groups(P<0.01). There was no significant difference among the three groups after treatment(P>0.05). After treatment, the course of treatment required to reflect the healing in the group A was shorter than that in the group B and the group C(P<0.01); the body function scores and social function scores in the three groups were better than those before treatment(P<0.01), there was no significant difference among the three groups after treatment(P>0.05).The scores of symptoms and signs in the three groups were lower than those before treatment(P<0.01), there was no significant difference among the three groups after treatment(P>0.05). H-B facial nerve function grading scale and facial disability index(FDI) scale were used as the evaluation criteria, the curative rate was 66.7%(20/30) in the group A, 50.0%(15/30) in the group B and 46.7%(14/30) in the group C, the curative rate in the group A was better than the other two groups(P<0.05). The curative and markedly effective rate in the group A was 83.3%(25/30), 70.0%(21/30) in the group B and 63.3%(19/30) in the group C, the curative and markedly effective rate in the group A was better than the other two groups(P<0.05). The scores of symptoms and signs were used as the evaluation criteria, the curative rate was 66.7%(20/30) in the group A, 50.0%(15/30) in the group B, and 46.7%(14/30) in the group C. The curative rate in the group A was better than the other two groups(P<0.05). Conclusion Compared with general acupuncture and physiotherapy, acupuncture at the "reflection points" of the affected side on the peripheral facial paralysis in acute phase could shorten the course of treatment and improve the curative effect.
Objective To explore the effect of acupuncture at the "reflection points" of affected side on the peripheral facial paralysis in acute phase. Methods Ninety patients with peripheral facial paralysis in acute phase were randomly divided into a reflection group(group A), a conventional acupuncture group(group B) and a physiotherapy group(group C), 30 cases in each group. The same basic medication were given in all three groups. In the group A, acupuncture at "reflection points" of the affected side and local acupoints in acute phase, such as Dicang(ST 4), Jiache(ST 6), Quanliao(SI 18), Xiaguan(ST 7), Yangbai(GB 14), Taiyang(EX-HN 5), etc. were applied. The electroacupuncture was added in the stationary phase, and Zusanli(ST 36) was added in the recovery phase. In the group B, acupuncture at Yifeng(TE 17) of the affected side in acute phase and local acupoints, such as Dicang(ST 4), Jiache(ST 6), Quanliao(SI 18), Xiaguan(ST 7), Yangbai(GB 14), Taiyang(EX-HN 5), etc. were applied. The electroacupuncture was added in the stationary phase, and Zusanli(ST 36) was added in the recovery phase. In the group C, ultrashort wave on Yifeng(TE 17) of the affected side in acute phase was applied, and the treatment in the stationary phase and the recovery phase was the same as the group B. The treatment was given once every day, 5 times as one course for 4 courses. The House-Brackmann(H-B) grading scale, facial disability index scale, the symptom and physical score integral scale were used to score before and after treatment, and the clinical effects of the three groups were compared. Results After treatment, the functional grade of H-B facial nerve was better than that before treatment in the three groups(P<0.01). There was no significant difference among the three groups after treatment(P>0.05). After treatment, the course of treatment required to reflect the healing in the group A was shorter than that in the group B and the group C(P<0.01); the body function scores and social function scores in the three groups were better than those before treatment(P<0.01), there was no significant difference among the three groups after treatment(P>0.05).The scores of symptoms and signs in the three groups were lower than those before treatment(P<0.01), there was no significant difference among the three groups after treatment(P>0.05). H-B facial nerve function grading scale and facial disability index(FDI) scale were used as the evaluation criteria, the curative rate was 66.7%(20/30) in the group A, 50.0%(15/30) in the group B and 46.7%(14/30) in the group C, the curative rate in the group A was better than the other two groups(P<0.05). The curative and markedly effective rate in the group A was 83.3%(25/30), 70.0%(21/30) in the group B and 63.3%(19/30) in the group C, the curative and markedly effective rate in the group A was better than the other two groups(P<0.05). The scores of symptoms and signs were used as the evaluation criteria, the curative rate was 66.7%(20/30) in the group A, 50.0%(15/30) in the group B, and 46.7%(14/30) in the group C. The curative rate in the group A was better than the other two groups(P<0.05). Conclusion Compared with general acupuncture and physiotherapy, acupuncture at the "reflection points" of the affected side on the peripheral facial paralysis in acute phase could shorten the course of treatment and improve the curative effect.
引文
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[9]李瑛,李妍,刘立安,等.针灸择期治疗周围性面瘫多中心大样本随机对照试验[J].中国针灸,2011,31(4):289-293.
[10]郑筱萸.中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社,2002:55-56.
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[12]邓永安,郭家奎,于金栋,等.面瘫临床评价方法的研究进展[J].中国康复理论与实践,2017,23(12):1407-1410.
[13]陈平雁,范建中.面部神经肌肉系统功能障碍的一种评价手段--面部残疾指数及其信度和效度[J].国外医学(物理医学与康复学分册),1997,17(4):173-176.
[14]谭铭,刘建平,劳力行.针灸研究中组间症状积分的定量比较与组内分级定性法利弊的探讨[J].中西医结合学报,2012,10(8):847-852.
[15]金观源.“继往圣,开来学”的反映点针灸(一)[J].中医药导报,2017,23(7):1-6.
[2]梁繁荣,赵吉平.针灸学[M].北京:人民卫生出版社,2013:262.
[3]金观源,相嘉嘉,金雷.临床针灸反射学[M].北京:北京科学技术出版社,2004:236-237.
[4]贾建平,陈生弟.神经病学[M].北京:人民卫生出版社,2013:340.
[5]高树中,杨骏.针灸治疗学[M].北京:中国中医药出版社,2012:51-52.
[6]House JW,Brackmann DE.Facial nerve grading system[J].Otolaryngol Head Neck Surg,1985,93(2):146-147.
[7]Van Swearingen JM,Brach JS.The facial disability index:reliability and validity of a disability instrument for disorders of the facial neuromuscular system[J].Phys Ther,1996,76(12):1288.
[8]王志国.急性期针刺风池、风府治疗周围性面瘫的临床观察[D].济南:山东中医药大学,2011:32-33.
[9]李瑛,李妍,刘立安,等.针灸择期治疗周围性面瘫多中心大样本随机对照试验[J].中国针灸,2011,31(4):289-293.
[10]郑筱萸.中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社,2002:55-56.
[11]中国针灸学会.循证针灸临床实践指南:贝尔面瘫(修订版)[M].北京:中国中医药出版社,2018:5.
[12]邓永安,郭家奎,于金栋,等.面瘫临床评价方法的研究进展[J].中国康复理论与实践,2017,23(12):1407-1410.
[13]陈平雁,范建中.面部神经肌肉系统功能障碍的一种评价手段--面部残疾指数及其信度和效度[J].国外医学(物理医学与康复学分册),1997,17(4):173-176.
[14]谭铭,刘建平,劳力行.针灸研究中组间症状积分的定量比较与组内分级定性法利弊的探讨[J].中西医结合学报,2012,10(8):847-852.
[15]金观源.“继往圣,开来学”的反映点针灸(一)[J].中医药导报,2017,23(7):1-6.