神经电生理检查在急性面神经炎综合康复治疗预后评估中的应用价值

Value of neuroelectrophysiological examination in evaluation of prognosis of acute facial neuritis patients by comprehensive rehabilitation therapy

目的探讨神经电生理检查在急性面神经炎综合康复治疗预后评估中的应用价值。方法纳入74例急性面神经炎患者为研究对象,均在发病7~14 d时进行肌电图检测,包括瞬目反射(BR)和面神经电图(ENoG)检查,按照BR与ENoG检查结果分组。所有患者接受综合康复治疗,3个月时通过House-Brackmann分级法评估患者面神经功能的恢复情况,比较不同组别患者的康复治疗有效率。结果74例患者肌电图检查均出现BR的传出型异常,其中全出波35例、部分出波15例、全未出波24例,不同出波情况组间康复治疗有效率比较,差异无统计学意义(P>0.05)。ENoG检查患侧M波波幅与健侧比较均有下降,其中明显下降39例、中度下降23例、轻度下降12例,波幅明显下降组的康复治疗有效率显著低于轻度下降组、中度下降组(P<0.05)。结论神经电生理检查对急性面神经炎患者的诊治有指导意义,BR可作为早期诊断的敏感指标,但对治疗预后评估的价值不高,ENoG检测患侧M波波幅下降幅度与康复治疗有效率相关,可用于面神经炎综合康复治疗的疗效评估及预后判断。

Objective To explore value of neuroelectrophysiological examination in evaluation of prognosis of acute facial neuritis patients by comprehensive rehabilitation therapy.Methods A total of 74 patients with acute facial neuritis were selected as study subjects,and were performed electromyography,including blink reflex(BR)and electroneurography(ENoG)examination at 7 to 14 days after onset.They were divided into different groups according to the results of BR and ENoG examination.All patients were given comprehensive rehabilitation treatment.At 3 months,the recovery of facial nerve function was evaluated by House-Brackmann grading,and curative efficacy of different groups after rehabilitation treatment were compared.Results The electromyography findings of 74 patients showed BR efferent abnormalities,including 35 cases with whole wave,15 cases with partial wave and 24 cases with no wave.There were no significant differences in the effective rates of different groups with differed waves(P>0.05).ENoG examination showed that M-wave amplitude of the affected side decreased compared with the healthy side,including 39 cases with obvious decrease,23 cases with moderate decrease and 12 cases with mild decrease.The effective rate of obvious decreased wave group was significantly lower than that in the moderate decrease and the mild decrease groups(P<0.05).Conclusion Neuroelectrophysiological examinationis is of great significance in diagnosis and treatment.BR can be used as a sensitive index for early diagnosis,but has little value in evaluation of prognosis.The decrease of M-wave amplitude of ENoG is related to the effective rate of rehabilitation treatment,which can be used as a method in evaluation of prognosis and efficacy.