影响周围性面神经麻痹预后的相关指标

Affecting prognosis factors of peripheral facial paralysis

目的探讨影响周围性面神经麻痹预后的相关指标。方法对109例周围性面神经麻痹患者行面神经病变定位、House-Brackmann（H-B）分级及神经电生理检查。随访半年,以H-B分级法评估预后,分为预后好组（1∽2级）及预后差组（3∽6级）,两组的临床及电生理指标行统计学处理。结果根据H-B分级法,将患者分为预后好组89例,预后差组20例。与预后好组比较,预后差组年龄及入院时H-B分级4级的比率显著升高,入院时H-B分级3级的比率显著降低（均P〈0.001）。预后好组及预后差组膝状神经节、面神经管镫骨神经以上、面神经管镫骨神经以下、茎乳孔以外病变比率依次增高和降低,且预后差组膝状神经节病变比率显著高于,茎乳孔以外病变显著低于预后好组（均P〈0.001）。预后差组患侧面神经复合动作电位（CMAP）潜伏期、波幅下降比及F波消失率显著高于,波幅显著低于预后好组（均P〈0.001）。年龄（OR=2.545,95%CI：1.155∽5.608,P〈0.05）、面神经病变部位（OR=0.178,95%CI：0.075∽0.426,P〈0.01）、患侧面神经CMAP潜伏期（OR=1.843,95%CI：1.574∽9.271,P〈0.05）及波幅下降比（OR=2.447,95%CI：0.577∽5.631,P〈0.05）是预后差的独立影响因素。结论年龄、面神经病变部位、患侧面神经CMAP潜伏期及波幅下降比是周围性面神经麻痹患者预后差的独立影响因素。

Objective To investigate the affecting prognosis factors of peripheral facial paralysis. Methods One hundred and nine patients were enrolled with peripheral facial paralysis whose lesion distribution,HouseBrackmann（ H-B） grading scale and nerve electrophysiological examination were checked. Those petients were divided into good prognosis group（ 1- 2 grade） and poor prognosis group（ 3- 6 grade） according to their H-B grading scale after a follow-up period of 6 months. Results According to H-B grading scale,patients were divided into good prognosis group（ 89 cases） and poor prognosis group（ 20 cases）. Compared with good prognosis group,age and rate of 4 grade of H-B grading on admission in poor prognosis group were significantly increased,and rate of3 grade of H-B grading on admission in poor prognosis group was significantly decreased（ all P〈0. 001）. The rates of lession in geniculate ganglion,above the nervus stapedius in facial nerve canal,below the nervus stapedius in facial nerve canal,outside stylomastoid foramen in good prognosis group and poor group were successively increased and decreased respectively. Compared with good prognosis group,the rate of lession in geniculate ganglion was significantly higher,and the rate of lession in outside stylomastoid foramen was significantly lower（ all P〈0. 001）.The latency of nerve compound muscle action potential（ CMAP）, amplitude decreased ratio and F wave disappearance rate in poor prognosis group were significantly higher,and the amplitude was significantly lower（ all P〈0. 001）. Age（ OR = 2. 545,95% CI： 1. 155- 5. 608,P〈0. 05）,location of the lesion（ OR = 0. 178,95% CI：0. 075- 0. 426,P〈0. 01）,latency（ OR = 1. 843,95% CI： 1. 574- 9. 271,P〈0. 05） and amplitude decreased ratio（ OR = 2. 447,95% CI： 0. 577- 5. 631,P〈0. 05） of CAMP in affected side decreased were independent influence factors of poor prognosis. Conclusion Age,location of the lesion,latency and amplitude decreased ratio of CAMP in affected side decreased are independent influence factors of poor prognosis.