电针联合表情肌功能训练操治疗重度贝尔面瘫临床研究

Therapeutic Effect of Electro-Acupuncture Combined with Functional Training of Expression Muscle in the Treatment of Severe Bell’s Palsy

目的:观察电针联合表情肌功能训练与单纯电针治疗重度贝尔面瘫的临床疗效差异及其对疗程的影响。方法:将≥21天仍未好转的120例重度贝尔面瘫患者,随机分为观察组(60例,脱落1例)和对照组(60例)。两组均口服甲钴胺、呋喃硫胺片药物治疗,对照组仅采用电针治疗;观察组电针治疗后进行早、晚各1次的表情肌训练。1周治疗3次,6次为一疗程,治疗4个疗程。比较两组患者治疗前、每个疗程结束后面神经功能(HBGS)评价分级和临床疗效,比较两组痊愈患者疗程差异,病程6个月时比较肌电图运动单位束颤波的发生率。结果:两组患者治疗后HBGS分级评价均较治疗前显著改善(均P<0.01);与对照组比较,第1疗程结束时,HBGS分级差异无统计学意义(P>0.05);第2、3、4疗程结束时,HBGS分级差异有统计学意义,观察组优于对照组(均P<0.05);4个疗程结束后,观察组愈显率72.88%(43/59),对照组48.33%(29/60),差异有统计学意义(P<0.01);4个疗程后及病程6个月,这两个阶段痊愈患者疗程比较,观察组治疗天数均少于对照组(均P<0.05);病程6月时肌电图运动单位束颤波的发生率,观察组3.39%(2/59),对照组15%(9/60),差异有统计学意义(P<0.05)。结论:与单纯电针相比,电针联合表情肌功能训练是治疗重度贝尔面瘫的有效方法,可提高愈显率,缩短治疗病程,且减少面瘫后遗症(面肌痉挛)的发生。

Objective: To observe the efficacy difference between electro-acupuncture combined with functional training of expression muscle and single electro-acupuncture in the treatment of severe Bell's palsy, and their influences to the treatment course. Methods: A total of 120 patients with severe Bell's palsy, who were not improved after 21d, were randomized into the observation group(60 cases with 1 dropout) and the control group(60 cases). Both groups were treated with oral Mecobalamin and Fursultiamine tablets;on which basis, the observation group was also treated with functional training of expression muscle after electro-acupuncture treatment;whereas the control group was only treated with electro-acupuncture. The treatment was 3 times a week four 4 courses, and 6 times was taken as one course of treatment. The facial nerve function of House-Brackmann grading system(HBGS) and clinical efficacy were compared between the two groups before and after each course of the treatment. The difference in treatment course and the incidence of EMG motor unit fasciculation potentials were also compared at 6th month of the duration between the two groups. Results: After the treatment, the HBGS evaluation was significantly improved in the both groups( P <0.01). There was no significant difference in HBGS after 1st treatment course between the observation group and the control group( P >0.05);however the differences were seen after 2nd, 3rd and 4th treatment course between the two groups, in which the observation group was superior to the control group( P <0.05). After the treatment, the cured and markedly effective rate was 72.88%(43/59) in the observation group, which was significantly higher than 48.33%( 29/60 ) in the control group( P <0.01). After 4th course of the treatment and at 6 months of duration, the course of treatment for cured patients was compared. Days for the treatment in the observation group were all less than those in the control group( P <0.05). The incidence of EMG motor unit fasciculation potentials at 6 months of duration was 3.39%(2/59) in the observation group, which was greatly lower than 15%(9/60) in the control group( P <0.05). Conclusion: Compared to single electro-acupuncture therapy, the electro-acupuncture combined with functional training of expression muscle has a better curative effect in the treatment of severe Bell's palsy, which can improve the cured and markedly effective rate, shorten the course of treatment, and reduce the occurrence of facial paralysis sequelae(hemifacial spasm).