神经肌肉电刺激联合牛痘免疫病毒疫苗接种家兔炎症皮肤提取液治疗周围性面神经麻痹的临床疗效研究

Neuromuscular electrical stimulation combined with analgecine injection for peripheral facial paralysis

目的周围性面神经麻痹是神经内科常见疾病,临床上主要运用药物治疗,采用神经肌肉电刺激(neuromuscular electrical stimulation,NMES)治疗周围性面神经麻痹的研究较少。文中旨在观察NMES联合牛痘免疫病毒疫苗接种家兔炎症皮肤提取液治疗周围性面神经麻痹的疗效。方法选取2015年1月至2016年3月在江苏大学附属金坛医院神经内科门诊及住院治疗的96例周围性面神经麻痹患者,随机分成3组:常规治疗组、试验用药组、联合治疗组,每组32例。3组患者均予以常规治疗和理疗,试验用药组在常规治疗的基础上加用牛痘免疫病毒疫苗接种家兔炎症皮肤提取液静脉滴注,联合治疗组在试验用药组的基础上加用NMES治疗。在患者治疗前、治疗7 d和14 d时采用Portmann简易评分法对3组患者进行评定,并在治疗14 d时予以临床疗效评定;3组患者分别在治疗前和治疗14 d检测面神经运动传导诱发电位(M波)的潜伏期与波幅。结果治疗7 d时,联合治疗组Portmann简易评分[(12.69±2.17)分]较常规治疗组、试验用药组[(10.31±2.74)分、(11.22±2.54)分]升高(P<0.05)。治疗14 d时,试验用药组、联合治疗组Portmann简易评分[(14.25±2.37)分、(16.94±1.97)分]较常规治疗组[(12.69±2.53)分]升高(P<0.01),联合治疗组Portmann简易评分较试验用药组升高(P<0.01)。3组患者Portmann简易评分随着时间的延长逐渐升高(P<0.01)。联合治疗组、试验用药组总有效率高于常规治疗组(P<0.05),联合治疗组总有效率高于试验用药组(P<0.05)。治疗14 d时,联合治疗组、试验用药组M波潜伏期较常规治疗组缩短,波幅明显增高;联合治疗组波幅较试验用药组明显增高[(1.03±0.21)m V vs(0.93±0.15)m V,P<0.05]。结论 NMES和牛痘免疫病毒疫苗接种家兔炎症皮肤提取液联合治疗周围性面神经麻痹,能促进面神经功能恢复,疗效显著且安全性好。

Objective Peripheral facial paralysis is a common disease in neurology,which is treated mainly by medication in clinical practice but rarely by neuromuscular electrical stimulation( NMES). This study was to observe the effect of NMES combined with analgecine in the treatment of peripheral facial paralysis. Methods A total of 96 patients with peripheral facial paralysis were randomly divided into three groups of equal number to receive conventional medication( CM),analgecine injection( CM + AI),and combined therapy( CM+AI+NMES),respectively. Portmann simple scores were obtained by trained professionals before and at 7 and14 days after treatment,and the clinical effects were evaluated at 14 days. The latency and amplitude of facial nerve motor evoked potentials( M wave) were also detected before and at 14 days after treatment. Results At 7 days after treatment,Portmann simple scores were significantly increased in the CM+AI+NMES group as compared with those in the CM and CM+AI groups( 12.69±2.17 vs10.31±2.74 and 11.22±2.54,P<0.05 and P<0.01),and at 14 days remarkably higher in the CM +AI and CM +AI+NMES groups than in the CM group( 14. 25 ± 2. 37 and 16. 94 ± 1. 97 vs 12. 69 ± 2. 53,P <0.01) and with statistically significant difference between the former two groups( P<0.01). Portmann simple scores were increased in all the three groups in a time-dependent manner( P<0.01). At 14 daysafter treatment,the M wave latency was significantly decreased,while the amplitude remarkably increased in the CM+AI+NMES and CM+AI groups as compared with the CM group( [1.03±0.21] and [0.82±0.18] vs [0.93±0.15] mV,P<0.05),even higher in the CM+AI+NMES than in the CM+AI group( P<0.05). Conclusion NMES combined analgecine is safe and effective for the treatment of peripheral facial paralysis by promoting facial nerve function recovery.