三种不同方法治疗周围性面神经麻痹的疗效比较

Effectiveness of three different treatments for peripheral facial paralysis

目的:探讨星状神经节阻滞,针灸,星状神经节阻滞加针灸三种不同方法治疗周围性面神经麻痹的疗效,并对患者颜面皮肤温度变化进行对比观察。方法:选择1999-03/2005-05北京医院疼痛门诊和2002-03/2005-05宣武医院耳鼻喉头颈外科门诊诊断为周围性面神经麻痹患者42例。随机分为3组,每组14例。①星状神经节阻滞组:单纯使用星状神经节阻滞进行治疗。②针灸组:单纯使用针灸进行治疗(针刺部位为患侧迎香、承浆、四白、地仓、大迎、颊车、下关、人中、阳白、攒竹、鱼腰、丝竹空、合谷、印堂、翳风,风池等穴位。进针方式为指切法、夹持法和提捏法)。③星状神经节阻滞加针灸组:联合应用以上两种方法进行治疗。各组治疗,1次/d,10次为1个疗程。治疗前后应用日本颜面神经麻痹部位评价法(柳原氏40点法)进行周围性面神经麻痹程度及疗效判断(患侧颜面总分累计在0～10分为重度麻痹;11～20分为中度麻痹;21分以上为轻度麻痹,正常满分为40分。疗效判定标准:36分以上为完全治愈;36分以下为不完全治愈,其中32～36分为有效,不满32分则为好转)。并于治疗前10min和治疗后10,20,30,40,50min测定三组不同方法治疗时的双侧颜面部位皮肤温度。结果:42例患者全部进入结果分析。①3组患者颜面神经麻痹程度评分和疗效比较:3组患者治疗后的颜面神经麻痹程度评分均高于初诊时(P<0.01)。治疗结束后星状神经节阻滞加针灸组患者的颜面神经麻痹评分明显高于星状神经节阻滞组和针灸组[(36.57±0.57),(34.14±1.16),(34.00±1.03)分,(P<0.01)]。星状神经节阻滞组总有效率为71.0%。针灸组总有效率为78.1%。星状神经节阻滞加针灸组总有效率为99.4%。②3种方法对患侧颜面皮肤温度的影响:星状神经阻滞组治疗后第20分钟开始上升(35.5±0.3)℃,治疗后第30钟时温度最高(35.4±0.2)℃;针灸组治疗后第30分钟开始皮温升高(34.9±0.4)℃,并持续到第50分钟无下降趋势;星状神经阻滞加针灸组治疗后第10分钟时患侧皮温开始升高(35.2±0.3)℃,并持续到第50分钟无下降趋势。星状神经节阻滞加针灸组治疗后第30～50分钟颜面皮肤温度变化明显高于其他两组(P<0.01)。结论:3种方法对周围性面神经麻痹都有治疗作用。同单纯应用星状神经节阻滞和针灸治疗比较,星状神经节阻滞加针灸联合应用具有疗效好,显效快,明显改善局部微循环障碍,无副作用等特点。

AIM： To discuss the effect of stellate ganglion block （SGB）, acupuncture, SGB combined with acupuncture for peripheral facial paralysis through comparison of facial skin temperature. METHODS： Forty-two patients diagnosed as having peripheral facial paralysis were recruited from the Pain Outpatients of Beijing Hospital from March 1999 to May 2005 and the Outpatient of Otorhinolaryngology-Neck, Xuanwu Hospital from March 2002 to May 2005. Patients were randomized into three groups with 14 in each group： SGB treatment in SGB group, acupuncture treatment in acupuncture group, and combination of SGB and acupuncture in combination group, once a day and ten days as a course. The Facial Movement Score （40 in all） was adopted to evaluate the effect on facial paralysis. Criteria of paralysis： 0-10 as severe paralysis, 11-20 as moderate paralysis, and 〉 21 as mild paralysis. Criteria of therapeutic effect： 〉 36 as cure, 32-36 as efficiency, and 〈 32 as improvement. Hitachi UY200M thermograph was used to assay the skin temperature of the patients＇ face. The data was recorded 10 minutes before treatment and 10, 20, 30, 40 and 50 minutes after treatment. RESULTS： All the 42 patients were involved in the result analysis. ① Comparison of the Facial Movement Score ：The scores after treatment were higher than that before treatment in all the three groups （P 〈 0.01）. After treatments, the scores in the combination group were higher than those in the SGB group and the acupuncture group（36.57±0.57,34.14±1.16, 34.00±1.03） （P 〈 0.01）. The total effective rate was 99.4% in the combination group, 71.0% in the SGB group and 78.1% in the acupuncture group. ② Effect on the facial skin temperature： The skin temperature of patients in the SGB group began to rise at 20 minutes after treatment[（35.5±0.3）℃], and then went up the highest level [（35.4±0.2）℃]. In the acupuncture group, the temperature began to rise at 30 minutes after treatment[（34.9±0.4）℃] and lasted until the 50th minute. In the combination group, the temperature began to rise at 10 minutes after treatment[（35.2±0.3） ℃] and lasted until the 50th minute. The facial skin temperature in the combination group was higher than that in the SGB and acupuncture groups during 20-30 minutes after treatment （P 〈 0.01）. CONCLUSION： All the three kinds of treatments have a therapeutic effect on peripheral facial paralysis. In comparison with single SGB and acupuncture, the combination therapy of SGB and acupuncture has a better curative effect and begins to operate more rapidly, can improve local circulatory disorder and has no adverse effects.