贝尔麻痹患者的面肌功能评分与预后(英文)

Study on the relationship between the assessment of facial muscle function and prognosis of Bell's palsy

背景:贝尔麻痹原因不明,且由于不同的病因和病程可导致病情轻重不同的结果,目前临床上对面肌功能测定和预后还没有取得一致的意见。目的:探讨贝尔麻痹的定位诊断、瞬目反射(Blinkreflex,BR)和神经电图(electroneurography,ENoG)测试结果与预后的关系,并进一步探讨治疗时机的选择。设计:前后对照研究。单位:广西壮族自治区北海市人民医院耳鼻咽喉科。对象:1989-01/1999-12北海市人民医院耳鼻咽喉科住院符合诊断标准的贝尔麻痹患者42例,其中把资料完整的36例进行统计分析。方法:对36例贝尔麻痹患者均进行定位诊断、BR和ENoG测试,并对面肌功能进行评分。结果:对定位诊断其病变在D段、面肌功能评分在11分以下者,BR和ENoG测试显示面肌功能差的患者,保守治疗效果亦差,而行面神经减压术后可望提高疗效,发病1个月内检查结果与预后一致(P>0.05)。在发病后40d手术的2例,均能完全恢复;2个月行2例,1例完全恢复,1例部分恢复;3个月与4个月分别各行1例,都能部分恢复。结论:对临床上定位诊断病变在D段以下,面肌功能评分在11分以上,发病后1个月内BR测试R1波存在,ENoG测试面肌纤维损失<90%的患者,保守治疗可完全恢复。反之,效果就差,对保守治疗无效者,必须行面神经减压术。

BACKGROUND: There has been no definite cause for Bell's palsy. Different kinds of causes and courses always lead to different outcomes.Up to now there has not been to accord on the relationship between assessment of facial muscle function and prognosis of Bell’s palsy. OBJECTIVE:To explore the relationship between level diagnosis, blink reflex(BR) ,electroneurography(ENoG)and prognosis in order to find the timing for treatment of Bell's palsy. DESIGN:A self control study. SETTING:Department of otolaryngology,Beihai People's Hospital, Guangxi Zhuang Autonomous Region. PARTICIPANTS:There were 42 cases of Bell's palsy that were in accordance with the diagnosis criteria and hospitalized in the Beihai People's Hospital from January 1989 to December 1999.Thirty six cases out of the 42 were well documented and thus were studied here. METHODS:Level diagnosis,BR and EnoG test as well as facial muscle assessment were conducted on thirty six patients with Bell's palsy. RESULTS:Patients with facial function score under 11 and with the lesion at D segment had poor results in BR and ENoG test.The outcome of conservative treatment for these patients was also bad. That would be improved by facial nerve decompression.The results of examination within one month after palsy onset were correlated with prognosis(P >0.05).Two cases received decompression on the 40th day onset and recovered completely.Two cases received decompression in the 2nd month,one recovered completely and the other partially.In the 3rd and 4th month there were two patients received decompression and recovered partially. CONCLUSION:Patients with the following manifestations may make complete recovery after conservative treatment:lesion distal to segment D,facial function over 11 marks,presence of R1 wave by BR test in the 1st month and fiber deprivation < 90%by ENoG.Facial nerve decompression should be taken for patients in a condition other than that.