热敏灸与隔姜灸治疗难治性周围性面瘫的疗效对比观察

Efficacy Comparison Between Heat-sensitive Moxibustion and Ginger-partition Moxibustion for Refractory Peripheral Facial Paralysis

【目的】观察热敏灸与隔姜灸治疗难治性周围性面瘫的效果。【方法】将55例难治性周围性面瘫患者随机分为热敏灸组28例和隔姜灸组27例(其中隔姜灸组中途退出2例,最终纳入25例)。2组均给予基础治疗(口服甲钴胺)和常规针刺治疗,热敏灸组同时接受热敏灸治疗,隔姜灸组同时接受隔姜灸治疗,每天1次,10次为1个疗程,共治疗6个疗程。采用40分法、House-Brackmann面神经功能评价分级系统及瞬目反射(BR)、肌电图和神经电图等电生理检查评价2组疗效。【结果】(1)治疗后,2组患者的症状积分均显著提高(P<0.01),且热敏灸组的改善作用优于隔姜灸组(P<0.01)。(2)热敏灸组和隔姜灸组的愈显率分别为75.00%和44.00%,热敏灸组的愈显率显著高于隔姜灸组(P<0.05)。(3)电生理检查结果显示:2组治疗后BR检查健患侧R1、R2、R2’潜伏期之差值均显著小于治疗前(P<0.01),热敏灸组治疗后肌电图异常率改善明显(P<0.01),而2组面神经电图患侧眼轮匝肌/口轮匝肌波幅下降比虽较治疗前稍下降,但差异均无统计学意义(P>0.05)。【结论】热敏灸治疗难治性周围性面瘫的疗效优于隔姜灸。

Objective To compare the effects of heat-sensitive moxibustion and ginger-partition moxibustion on refractory peripheral facial paralysis. Methods Fifty-five patients with refractory peripheral facial paralysis were randomized into heat-sensitive moxibustion group（N=28） and ginger-partition moxibustion group（N=27）. For two cases dropped out during the treatment, a total of 25 cases were finally enrolled into the ginger-partition moxibustion group. Two groups received oral use of mecobalamin tablets and conventional acupuncture, and heat-sensitive moxibustion group was given heat-sensitive moxibustion and ginger-partition moxibustion group was given ginger-partition moxibustion additionally. The moxibustion was performed once a day and ten times constituted one course, the treatment covered 6 courses. The clinical effect of the two groups was evaluated by 40-score method, House-Brackmann facial neurological function evaluation standard, blink reflex（BR）,electromyogram and electroneurography. Results（1） Symptoms integral was increased in both groups after treatment（P〈0.01）, and the scores of heat-sensitive moxibustion group were higher than those of ginger-partition moxibustion group（P〈0.01）.（2） The markedly effective rate of heat-sensitive moxibustion group was 75.00% and that of ginger-partition moxibustion group was 44.00%, and there was statistically significant difference between them（P〈0.05）.（3） The results of electrophysiological examination showed that the difference values of ipsilateral and contralateral BR R1, R2, R2＇ in both groups after treatment were less than those before treatment（P〈0.01）, and the abnormal rate of electromyography for heat-sensitive moxibustion group was improved obviously after treatment（P〈0.01）. The amplitude of compound muscle action potentials（CMAP） of orbicularis oculi/orbicularis oris at the affected side of both groups showed a decreasing trend, but the differences were insignificant between the two groups after treatment（P〈0.05）. Conclusion The curative effect of heat-sensitive moxibustion for the treatment of refractory peripheral facial paralysis is better than that of ginger-partition moxibustion.