影响针灸或针药合并治疗面神经炎患者疗效的多因素分析

Multiple Factors Analysis on Affecting Therapeutic Effects of Acupuncture and Moxibustion or Acupuncture Combined with Medicine in the Patient of Bell's Palsy

目的:寻找简单、经济、有效的并能客观地量化影响本病预后的重要因素。方法:采用前瞻性队列研究方法,通过对155例面神经炎患者治疗前后House-Brackmann面部功能分级变化观察,分析年龄、性别、面神经炎侧别、治疗前与期间是否充分休息、发病前是否有上呼吸道感染症状、发病前是否有吹冷风史、耳廓疱疹、耳周疼痛、发病10天时House-Brackmann面部功能分级、发病10天内是否有流泪、眼裂闭合情况、舌前2/3味觉是否存在、面部是否感觉疼痛、额纹皮皱是否能出现、能否鼓颊、食物塞在患侧面颊内是否需要借外力清除等16个因素对疾病预后的影响。结果:采用多元逐步回归统计得出“最优方程”:y=0.2504+0.0109x_1+0.2698x_2+0.4789x_3+0.1396x_4+0.4210x_5+1.3938x_6。结论:临床预后较差可能与年龄、发病前是否有上呼吸道感染症状、是否充分休息、耳周疼痛程度、耳廓疱疹出现、眼裂闭合情况等6个因素有正相关关系,即年龄越大、发病前有上呼吸道感染病史、不能充分休息、耳周疼痛程度越高、有耳廓疱疹及眼裂越大者恢复越差。

Objective: To find simple, economic and effective important factors which can objectively quantify the prcgnosis of Bell's palsy. Methods: Changes of the House-Brackmann facial function grades before and after treatment were investigated in 155 cases of Bell's palsy by prospective cohort study to analyze 16 items of affecting the prognosis of this disease, including age, sex, side of palsy, whether or not having a good rest before and during treatment, symptoms of upper respiratory tract infection before onset, cold-wind affected history before onset, herpes on the auricle, pain around ears, facial function grades on the 10th day after onset, whether having tearing within 10 days after onset, eyelid closing ability, taste on the front 2/3 of the tongue, facial pain, wrinkle, ability to blow out the cheek and to clear away food in the affected side, etc. Results: Using multiple stepwise regression to get the best equation: y=0. 2504 + 0.0109x_1 + 0.2698x_2 + 0.4789x_3 + 0.1396x_4 + 0.4210x_5 + 1. 3938x_6. Conclusion: Clinical therapeutic effects are correlated positively with 6 factors including age, sex, whether having symptoms of the upper respiratory tract infection before onset, a good rest, the extent of pain around ears, appearance of auricle herpes and eyelid closing ability. That is, for the older patients or the patients with upper respiratory tract infection history before onset, poor resting quality, more serious pain around ears, herpes on the auricle, bigger fissure of eyes, prognosis is poor.