不同刺激量针刺合谷穴治疗缺血性脑卒中后中枢性面瘫:随机对照研究

Different stimulation intensities of acupuncture at Hegu (LI 4) for central facial nerve paralysis after ischemic stroke:a randomized controlled trial

目的：观察针刺合谷穴治疗缺血性脑卒中后中枢性面瘫的临床疗效,探讨不同刺激量针刺合谷穴治疗中枢性面瘫的量效关系及其最优针刺方案。方法：将50例患者依据针刺时间和针刺方向构成的不同刺激量随机分为合谷1、2、3、4组和对照组,每组10例。合谷1～4组采用不同刺激量针刺合谷穴,并加迎香、地仓、颊车、颧髎四穴为面瘫针刺处方,同时取内关、水沟、三阴交为主穴的＂醒脑开窍＂针法为脑卒中针刺处方及结合中西药物治疗;对照组除不针刺合谷穴外,其他治疗同合谷针刺组,疗程14天。比较各组House-Brackmann面神经功能分级系统量表（H-B）、多伦多面神经分级系统量表（TFGS）、面神经麻痹程度分级量表（DFNP）和面部残疾指数问卷表（FDI）评分及临床疗效。结果：①合谷1～4组治疗后H-B评分、TFGS评分、DFNP评分、FDI躯体功能评分均较治疗前显著提高（均P〈0.05）,FDI社会功能评分在治疗前后无明显改善（均P〉0.05）,对照组治疗前后各量表评分改善均不明显（均P〉0.05）;②合谷1～4组H-B评分治疗前后差值、合谷2组TFGS评分治疗前后差值,合谷1组、合谷2组DFNP评分治疗前后差值均较对照组提高明显（均P〈0.05）,而合谷1～4组间各量表差值差异均无统计学意义（均P〉0.05）,其中合谷2组各量表评分差值改善最明显;③合谷1～4组总有效率分别为90.0%（9/10）、100.0%（10/10）、90.0%（9/10）、80.0%（8/10）,均显著高于对照组的60.0%（6/10,均P〈0.05）。结论：针刺合谷穴治疗缺血性脑卒中后中枢性面瘫临床疗效确切,并且采用逆经脉方向斜刺、捻转行针5s的针刺方案,临床疗效最佳。

Objective To observe the clinical efficacy of acupuncture at Hegu（LI 4）on central facial nerve paralysis after ischemic stroke,and explore dose-effect relationship among different stimulation intensities of acupuncture at Hegu（LI 4）as well as its optimal treatment plan.Methods According to different acupuncture stimulation intensities which were based on treatment time and needle insertion direction,fifty patients were randomly divided into a Hegu 1group,a Hegu 2group,a Hegu 3group,a Hegu 4group and a control group,ten cases in each one.Different stimulation intensities of acupuncture at Hegu（LI 4）combined with facial paralysis acupoints,including Yingxiang（LI 20）,Dicang（ST 4）,Jiache（ST 6）and Quanliao（SI 18）,were applied in Hegu 1to4groups;meanwhile acupuncture at stroke acupoints,including Neiguan（PC 6）,Shuigou（GV 26）and Sanyinjiao（SP 6）,and medication treatment were adopted.Except acupuncture at Hegu（LI 4）,the treatment of the control group was identical as Hegu groups.The treatment duration lasted for 14days.The House-Brackmann facial never grading systems（H-B）,Toronto facial grading system（TFGS）,degrees of facial never paralysis（DFNP）,facial disability index（FDI）and clinical efficacy were compared among groups.Results（1）Compared before the treatment,H-B,TFGS,DFNP and physical function score in FDI were all improved significantly in the Hegu 1to4groups（all P〈0.05）,but social function score in FDI was not obviously improved（all P〈0.05）;all the scores in the control group were not evidently changed（all P〈0.05）.（2）Compared with the control group,differences of H-B before and after treatment in the Hegu 1to 4groups,differences of TFGS in the Hegu 2group and differences of DFNP in the Hegu 1and Hegu 2group were significantly improved（all P〈0.05）.The differences of any scale among Hegu 1to 4groups were not significant（all P〈0.05）,in which the most evident change was found in Hegu 2group.（3）The total effective rate was 90.0%（9/10）,100.0%（10/10）,90.0%（9/10）and80.0%（8/10）in Hegu 1to 4groups,which were significantly higher than 60.0%（6/10）in the control group（all P〈0.05）.Conclusion Acupuncture at Hegu（LI 4）has affirmative clinical efficacy on central facial nerve paralysis after ischemic stroke,in which oblique insertion along the opposite direction of meridian for 5sof twirling manipulation has the best clinical effect.