巨刺法分期治疗周围性面瘫临床观察

Opposing Needling Technique in the Staged Treatment of Peripheral Facial Palsy

目的比较周围性面瘫巨刺法、分期巨刺法和患侧针刺法的临床疗效差异,为针灸治疗周围性面瘫提供临床依据。方法将98例患者按随机数字表法随机分为A组(巨刺法组)33例、B组(分期巨刺法组)33例、C组(患侧针刺组)32例,3组均予相同基础用药,针刺取穴阳白、四白、颧髎、颊车、地仓、翳风、合谷。A组针刺面部健侧穴位;B组急性期(发病1~7 d)面部取健侧穴位,静止期和恢复期(发病8 d以后)面部取患侧穴位;C组针刺面部患侧穴位;每周7次,连续治疗4周。应用House-Brackmann(H-B)面神经功能评价分级系统于治疗前后对3组患者面神经功能进行评分,并比较3组疗效。结果3组均能促进面神经功能恢复,总有效率均为100%(P>0.05),A组(60.606%)和B组(66.667%)痊愈率均优于C组(46.875%)(P<0.05);A组痊愈时间(20.55±4.763)d和B组(18.35±4.460)d优于C组(23.53±3.175)d(P<0.05);治疗后第7天、第14天、第21天A组和B组H-B评分均优于C组(P<0.05),治疗后第14天、第21天B组评分优于A组(P<0.05)。结论巨刺法和分期巨刺法能加速急性期周围性面瘫的恢复,并明显缩短疗程,疗效优于针刺面部患侧穴,且早期使用巨刺法联合中期针刺患侧的疗法优于持续使用巨刺法。

Objective To compare the clinical effects of opposing needling,staging opposing needling and affected side needling on peripheral facial paralysis,and to provide clinical basis for the treatment of peripheral facial paralysis by acupuncture and moxibustion.Methods 98 patients were randomly divided into group A(opposing needling group)of 33 cases,group B(staging opposing needling group)of 33 cases and group C(affected side needling group)of 32 cases.All three groups were given the same basic medication.Acupuncture points were Yangbai(GB 14),Sibai(ST 2),Quanliao(SI 18),Jiache(ST 6),Dicang(ST 4),Yifeng(TE 17)and Hegu(LI 4).Group A was treated with acupoints on the healthy side of the face.Group B was treated with acupoints on the healthy side of the face in the acute stage(1~7 days after morbidity)and on the affected side of resting and convalescent stage(8 days after morbidity).Group C was treated with acupoints on the affected side of the face,7 times a week for 4 weeks.Facial nerve function was evaluated by House-Brackmann(H-B)grading system before and after treatment in three groups,and the curative effects were compared.Results All three groups could promote the recovery of facial nerve function.The total effective rate was 100%(P>0.05).The recovery rate of group A(60.606%)and group B(66.667%)was better than that of group C(46.875%)(P<0.05).The recovery time of group A(20.55±4.763 days)and group B(18.35±4.460 days)was better than that of group C(23.53±3.175 days)(P<0.05).The H-B scores of group A and group B on the 7 th,14 th and 21 st day after treatment were better than those of group C(P<0.05),and the H-B scores of group B on the 14 th and 21 st day after treatment were better than of group A(P<0.05).Conclusion Opposing needling method and staging opposing needling method can accelerate the recovery of acute peripheral facial paralysis,and significantly shorten the course of treatment.The curative effect is better than needling the affected side of the face,and early use of gigantic needling method,mid-term acupuncture on the affected side is better than using gigantic needling method all the time.