面部穴位注射联合神经阻滞治疗面肌痉挛的效果

Efficacy of facial acupoint injection combined with nerve block in treating hemifacial spasm

目的评价面部穴位注射联合神经阻滞治疗面肌痉挛的效果。 方法按照2014年面肌痉挛中国专家共识的诊断标准，选取2015年2月至2016年1月面肌痉挛患者54例，年龄26～73岁，性别不限，病程6个月～17年，术后随访1年。采用随机数字表法分为2组（n＝27）：面部穴位注射联合神经阻滞组（A组）和单纯神经阻滞组（B组）。A组行面部四白穴、夹承浆穴、下关穴和翳风穴注射混合药液（2%盐酸利多卡因5 ml、复方倍他米松1 ml、甲钴胺溶液1 mg，生理盐水稀释至18 ml）2 ml，每5 d注射1次，共3次；经茎乳孔行面神经阻滞，药物同上（5 ml），每5 d阻滞1次，共3次；行星状神经节阻滞（1%利多卡因6 ml），每天阻滞1次，左右交替各5次。B组只行经茎乳孔面神经阻滞及星状神经节阻滞，不进行面部穴位注射。于治疗前、治疗后第10天、3个月和1年时记录Cohen分级和Shorr疗效，治疗后3月和1年时观察复发情况。 结果与B组比较，A组患者治疗后第10天、3月和1年时Cohen分级降低，有效率升高，治疗后3月和1年时复发率降低（P〈0.05）。 结论面部穴位注射联合神经阻滞治疗面肌痉挛的长期疗效优于单纯神经阻滞。

Objective To evaluate the efficacy of facial acupoint injection combined with nerve block in treating hemifacial spasm. Methods Fifty-four patients of both sexes, aged 26-73 yr, with the course of disease 6 months-17 yr from February 2015 to January 2016, were included in this study accord- ing to diagnostic criteria for hemifaeial spasm based on expert consensus in 2014. Patients were divided into 2 groups （n= 27 each） using a random number table： facial aeupoint injection combined with nerve block group （group A） and nerve block group （group B）. In group A, the mixed injection 2 ml （2% lidoeaine hydrochloride 5 ml, compound betamethasone 1 ml, mecobalamin 1 rag, diluted to 18 ml in normal sa- line） was given at facial Sibai, Jiachengjiang, Xiaguan and Yifeng acupoints once every 5 days, 3 times in total; facial nerve block was performed via the stylomastoid foramen with the mixed injection （ 5 ml） previously described once every 5 days, 3 times in total; stellate ganglion block was performed on the right and left side alternately once a day, 5 times on each side. In group B, patients received facial nerve block and stellate ganglion block, and no facial acupoint injection was applied. The Cohen rating and Shorr out- come were recorded before treatment and at 10th day, 3rd month and 1 yr after treatment, and the recur- rence was recorded at 3 months and 1 yr after treatment. Results Compared with group B, Cohen classifi- cation was significantly decreased, and the effective rate was increased at 10th day, 3rd month and 1 yr af- ter treatment, and the recurrence rate was decreased at 3 months and 1 yr after treatment in group A （P〈 0. 05）. Conclusion The facial acupoint injection combined with nerve block produces better long-term ef- ficacy in treating hemifacial spasm than nerve block alone.