面神经功能评价对针刺治疗贝尔麻痹疗效评估的影响

Correlation between facial nerve functional evaluation and efficacy evaluation of acupuncture treatment for Bell's palsy

目的:在针灸治疗贝尔麻痹的过程中,依据面神经麻痹程度进行面神经功能障碍评价分级,并观察该分级与疗效、疗程的关系及在判断预后方面的作用。方法:以面瘫常用运动功能评价量表House-Brackmann量表为准,并对眼裂和唇角设定量标准,治疗前和治疗结束时,根据该量表评分对患者面部瘫痪程度进行面神经功能障碍评估分级,依次分为轻度、中度、中重度、重度功能障碍和完全麻痹5个级别。按患者疾病分期采用针刺对症治疗,不人为设定治疗时程,全程观察,以最终疗效为准。结果:68例病例中,治愈53例,总有效率为97%。5种不同面神经功能障碍之间的治疗效果差异有统计学意义(P<0.01);疗效与病情轻重相关,等级相关分析相关系数为0.423(P<0.01);其疗程也随着面神经功能障碍级别加重而延长(P<0.01)。结论:贝尔麻痹患者存在面神经功能障碍轻重的差别,针灸治疗的效果随着面神经功能障碍的加重而下降,不同级别面神经功能障碍患者治疗所需疗程不同。临床研究中非常有必要对患者进行评估分级后再做观察治疗,并依据病情轻重程度选择不同治疗方法。

OBJECTIVE： To assess and grade facial nerve dysfunction according to the extent of facial paralysis in the clinical course of acupuncture treatment for Bell＇s palsy, and to observe the interrelationship between the grade, the efficacy and the period of treatment, as well as the effect on prognosis. METHODS： The authors employed the House-Brackmann scale, a commonly used evaluation scale for facial paralysis motor function, and set standards for eye fissure and lips. According to the improved scale, the authors assessed and graded the degree of facial paralysis in terms of facial nerve dysfunction both before and after treatment. The grade was divided into five levels： mild, moderate, moderately severe, severe dysfunction and complete paralysis. The authors gave acupuncture treatment according to the state of the disease without artificially setting the treatment period. The observation was focused on the efficacy and the efficacy was evaluated throughout the entire treatment process. RESULTS： Fifty-three cases out of 68 patients with Bell＇s palsy were cured and the overall rate of efficacy was 97 %. Statistically significant differences （P〈0.01） were perceived among the efficacy of five levels of facial nerve dysfunction. Efficacy was correlated with the damage level of the disease （correlation coefficient r：0.423, P〈0.01）. The course of treatment also extended with the severity of facial nerve dysfunction （P〈0.01）. CONCLUSION= Differences exist in patients with Bell＇s palsy in terms of severity of facial nerve dysfunction. Efficacy is reduced in correlation with an increase in facial nerve dysfunction, and the period of treatment varies in need of different levels of facial nerve dysfunction. It is highly necessary to assess and grade patients before observation and treatment in clinical study, and choose corresponding treatment according to severity of damage of the disease.