激光散斑血流成像技术在周围性面瘫中的初步应用

Application of Laser Speckle Contrast Imaging in Assessing Peripheral Facial Paralysis

目的探讨激光散斑血流成像技术在检测周围性面瘫患者面部血流灌注方面的价值。建立周围性面瘫患者面部血流灌注的评估标准、阐明面部微循环状态与面神经功能之间的关系。材料与方法选取30例健康受试者和2015年4月至2016年12月在我科诊治的周围性面瘫患者87例,行面部激光散斑血流检测,选定四个检查区域,分别为眼周、面颊中0部、嘴角及鼻唇沟,测出监测区域血流灌注值(BP,Blood Perfusion),并通过公式计算(R=(BP患-BP健)/BP健)得出相应部位血流变化率。结果 1.通过对正常人面部血流差异性分析,发现眼周、脸颊以及鼻唇沟部位都可以作为面部血流灌注差异性分析的代表性监测部位。2.选定眼周部位与脸颊部位,亨特综合征组、贝尔面瘫组相比正常组血流变化率存在显著减少,但亨特综合征组和贝尔面瘫组之间差异无统计学意义。3.相比正常组,重度面瘫患者在整个发病时间内眼周部位的血流灌注变化率均存在显著减少,且发病时间超过2个月的面瘫患者较发病时间在1至2个月的患者眼周部位血流灌注变化率存在显著减少。4.发病时间在1个月至2个月的周围性面瘫患者较正常组脸颊部位的血流灌注变化率减少。5.在鼻唇沟部位,重度面瘫患者在发病1月内较正常组血流灌注变化率差异具有统计学意义,且在发病时间超过2个月后,鼻唇沟部位的血流灌注变化率较发病1个月之内升高。6.在眼周部位,中度面瘫组、重度面瘫组较正常组血流变化率均减少,重度面瘫组较中度面瘫组血流变化率减少。且周围性面瘫患者SunnyBrook评分越低,眼周血流变化率越小。结论眼周部位在周围性面瘫面部血流检测方面更加敏感、显著、稳定。周围性面瘫患者面部的确存在血流灌注的减少,且面神经损伤程度越重,患侧血流灌注越少,贝尔面瘫与亨特综合征这两种不同病因所致的周围性面瘫面部血流改变无明显差异。

Objective This study aimed to study the value of laser speckle contrast imaging(LSCI)in assessing facial perfusion and establish an evaluation criterion of microcirculation dysfunction among patients with peripheral facial paralysis,and to clarify the relationship between microcirculation and facial nerve recovery.Methods Thirty healthy subjects and eighty-seven patients with peripheral facial paralysis seen in our department from April 2015 to December 2016 were enrolled in the study.Laser speckle contrast imaging(PERIMED PeriCam PSI)was used to measure facial skin perfusion in all participants.Four different regions of interest(eyelid,middle cheek,mouth and nasolabial fold)were selected and blood perfusion of the corresponding regions was compared.The rate of blood perfusion change(R)was obtained.Results 1.Analysis of facial blood perfusion differences in normal subjects indicated that eyelid,middle cheek and nasolabial fold could be used as representative monitoring sites for analysis of facial blood perfusion variation.2.Compared with the normal group,R in the eyelid and middle cheek was significantly reduced in patients with Ramsay-Hunt syndrome and Bell’s palsy with no significant difference between the two disease conditions.3.R in the eyelid was significantly different during different disease courses compared with the normal group in patients with severe facial paralysis,and there was a significant difference between patients with facial paralysis of 1-2 months and those with facial paralysis of over 2 months.4.At the middle cheek,there was significant difference in R between the normal group and patients with peripheral facial paralysis of 1-2 months.5.In the nasolabial area,R was significantly different between the normal group and patients with peripheral facial paralysis of less than 1 month and increased significantly in patients with facial paralysis of over 2 months compared with those with facial paralysis of less than 1 month.6.R in the eyelid was lower in patients with severe or moderate facial paralysis than in the normal group,and lower in those with severe facial paralysis than in those with moderate facial paralysis.The lower the SunnyBrook score,the smaller R in the eyelid.Conclusion The eyelid region appears to yield more sensitive,prominent and consistent results for assessing facial blood flow in patients with peripheral facial,with the affected side showing lower perfusion than the normal side with correlations to the degree of facial nerve injury.