悬灸早期介入治疗急性期贝尔麻痹疗效评价

Early treatment of suspension moxibustion for Bell’s palsy in acute stage

目的:观察悬灸早期介入治疗急性期贝尔麻痹(BP)患者临床疗效及对预后的影响,探索悬灸早期介入治疗BP是否有不弱于激素的临床效果并且与激素联合使用是否有增效作用。方法:采用非随机方法将132例急性期BP患者按意愿分为使用激素组94例和不使用激素组38例,不使用激素组作为悬灸组;再将使用激素的患者随机分为激素组(46例)和悬灸+激素组(48例)。3组均给予针刺和口服甲钴胺胶囊作为基础治疗。针刺患侧阳白、四白、颧髎、地仓、颊车、翳风等穴,留针30 min,每日治疗1次,每周连续治疗5 d,休息2d,共治疗4周。口服甲钴胺胶囊,0.5mg/次,每日3次,连续服用4周。悬灸组在基础治疗的基础上,悬灸患侧阳白、四白、地仓、颊车、完骨、翳风,每穴灸约5 min,每日1次,每周连续治疗5 d,休息2d,共治疗4周。激素组在基础治疗的基础上,口服醋酸泼尼松片。悬灸+激素组在基础治疗的基础上,对患者患侧面部施灸(悬灸穴位及方法同悬灸组),同时嘱患者口服醋酸泼尼松片(服用方法同激素组),治疗4周。分别于治疗前、治疗2周后、4周后、随访4周4个时间点采用House-Brackmann面神经功能(H-B)分级、面部残疾指数量表(FDI)对患者进行疗效评价,观察3组临床疗效。结果:3组面瘫患者治疗2、4周后和随访4周H-B分级和FDI评分均优于治疗前(P<0.05);3组患者治疗2周后各指标组间比较差异无统计学意义(P>0.05);悬灸+激素组治疗4周后和随访4周H-B分级和FDI评分均优于悬灸组和激素组(P<0.05),而悬灸组和激素组比较差异无统计学意义(P>0.05)。随访结束悬灸+激素组痊愈率81.3%(39/48),优于悬灸组的68.4%(26/38)和激素组的60.9%(28/46,P<0.05),而悬灸组和激素组比较差异无统计学意义(P>0.05)。结论:3种治疗方法对急性期BP患者均安全有效,悬灸+激素组疗效要优于悬灸组和激素组,悬灸组和激素组疗效相当,早期悬灸介入治疗急性期BP安全有效,与激素联用有较好的协同作用。对于不能使用激素的患者,悬灸具有不弱于激素的临床疗效,可作为激素的替代疗法。

Objective To observe the efficacy of early treatment of suspension moxibustion for Bell’s palsy and its influence on the prognosis, and to explore whether the early treatment of suspension moxibustion has non-inferiority effect to hormone treatment and whether suspension moxibustion combined with hormone treatment has the synergistic effect. Methods A total of 132 patients with acute-stage Bell’s palsy were divided into a hormone group(94 cases) and a moxibustion group(38 cases) by non-random method, and the hormone group was further randomly divided into a hormone with moxibustion group(48 cases) and a hormone without moxibustion group(46 cases). The acupuncture and oral administration of mecobalamin capsule were used as basic treatment. Acupuncture was applied at Yangbai(GB 14), Sibai(ST 2), Quanliao(SI 18), Dicang(ST 4), Jiache(ST 6), Yifeng(TE 17), etc.,with the needles retained for 30 min, once a day, 5 consecutive days per week;there was an interval of 2 days between two weeks, and a total of 4-week treatment was given. The oral administration of mecobalamin capsule was given 0.5 mg each time, 3 times a day for 4 weeks. The patients in the moxibustion group, on the basis of basic treatment,were treated with the suspension moxibustion at Yangbai(GB 14), Sibai(ST 2), Dicang(ST 4), Jiache(ST 6), Wangu(GB 12), Yifeng(TE 17) of affected side, 5 min per acupoint, once a day, 5 consecutive days per week;there was an interval of 2 days between two weeks, and a total of 4-week treatment was given. The patients in the hormone without moxibustion group, on the basis of basic treatment, were treated with prednisone acetate tablets. The patients in the hormone with moxibustion group, on the basis of basic treatment, were treated with suspension moxibustion and prednisone acetate tablets. All the treatment was given for 4 weeks. The House-Brcackmann facial nerve grading(H-B) global score and facial disability index(FDI) scale were used to evaluate the curative effect in the three groups before treatment, 2 weeks and 4 weeks into treatment and 4 weeks after treatment;the efficacy was compared among the three groups. Results Compared before treatment, the H-B grading and FDI scores were significantly improved 2 weeks and 4 weeks into treatment and 4 weeks after treatment(P<0.05). The various indexs of each group 2 weeks into treatment were not statistically significant in the three groups(P>0.05);the H-B grading and FDI scores in the hormone with moxibustion group were superior to those in the moxibustion group and the hormone without moxibustion group 4 weeks into treatment and 4 weeks after treatment(P<0.05),while there was no significant difference between the moxibustion group and the hormone without moxibustion group(P>0.05). At the end of follow-up, the cured rate in the hormone with moxibustion group was 81.3%(39/48), which was superior to 68.4%(26/38) in the moxibustion group and 60.9%(28/46) in the hormone without moxibustion group(P<0.05). However, there was no significant difference between the moxibustion group and the hormone without moxibustion group(P>0.05). Conclusion The three treatment methods are all safe and effective for acute-stage Bell’s palsy. The suspension moxibustion combined with hormone therapy are superior to suspension moxibustion or hormone therapy alone. Early treatment of suspension moxibustion is safe and effective for Bell’s palsy, and has obvious synergistic effect with hormone. For the patients who cannot use hormone,suspension moxibustion could replace hormone, which is non-inferior to hormone.