中药熏蒸联合针刺对中风后面瘫患者免疫及面神经功能的影响

Effect of Chinese herbal fumigation combined with acupuncture on immunity and facial nerve function of patients with post-stroke paralysis

目的观察中药熏蒸联合针刺对中风后面瘫患者免疫及面神经功能的影响。方法应用前瞻性随机对照方法将北京市鼓楼中医医院针灸科收治的107例脑梗死恢复期中枢性面瘫患者分为2组,对照组53例给予常规西医治疗、康复训练及针刺治疗,试验组54例在对照组治疗基础上给予中药熏蒸治疗,2组均治疗28 d。观察2组患者治疗前后House-Brackmann(H-B)面神经功能分级量表评分、面部残疾指数(FDI)评分、改良Barthel指数以及免疫球蛋白(IgA、IgG、IgM)、细胞免疫功能(CD3^+、CD4^+、CD8^+、CD4^+/CD8^+)变化情况,统计2组患者治疗28 d后的临床治疗效果。结果2组治疗后的H-B评分、FDI评分、改良Barthel指数均较治疗前显著改善(P均<0.05),试验组改善幅度均大于对照组(P均<0.05);2组治疗后IgA、IgG、IgM、CD8^+均较治疗前显著降低(P均<0.05),CD3^+、CD4^+、CD4^+/CD8^+均显著提高(P均<0.05),试验组改善幅度均大于对照组(P均<0.05)。试验组的临床总有效率为83.3%(45/54),对照组为64.2%(34/54),试验组明显高于对照组(P<0.05)。结论相较于常规及针刺治疗,加用中药熏蒸治疗中风后面瘫的疗效更显著,可以明显改善患者的面神经功能,增强日常生活能力;推测降低血清免疫球蛋白水平、提高免疫细胞功能是重要作用机制。

Objective It is to observe the effect of traditional Chinese medicine fumigation combined with acupuncture on the immune and facial nerve function of patients with post-stroke paralysis.Methods A prospective randomized controlled method was used to divide 107 patients with central facial palsy during recovery from cerebral infarction admitted to Gulou Hospital of Traditional Chinese Medicine from February 2018 to February 2019 into two groups.The control group(n=53)was given conventional western medicine treatment and rehabilitation,training and acupuncture treatment,the experimental group(n=54)was given traditional Chinese medicine fumigation treatment based on the treatment of the control group.Both groups were treated for 28 days.The changes of the scores of the House-Brackmann(HB)facial nerve function grading scale,facial disability index(FDI),modified Barthel index,and immunoglobulin(Ig A,Ig G,Ig M),cellular immune function(CD3^+,CD4^+,CD8^+,CD4^+/CD8^+)before and after treatment were observed in the two groups,and the clinical curative effect after treatment for 28 days were evaluated in the two groups.Results The scores of HB facial nerve function grading scale,FDI,and modified Barthel index of the two groups after treatment were significantly improved compared to before treatment(P<0.05).The improvements of these indexes of the experimental group were more significant than that of the control group(all P<0.05);IgA,IgG,IgM,CD8^+after treatment were significantly lower than those before treatment in the two groups(all P<0.05),CD3^+,CD4^+,CD4^+/CD8^+were significantly higher than those before treatment(all P<0.05),and the improvements of these indexes in the experimental group were more significant than those in the control group(all P<0.05).The total clinical effective rate of the experimental group was 83.3%(45/54),which was significantly higher than that 64.2%(34/54)of the control group(P<0.05).Conclusion Compared with normal therapy with acupuncture,traditional Chinese medicine fumigation combined with acupuncture is more effective in the treatment of post-stroke paralysis,which can significantly improve the facial nerve function and enhance the ability of daily living of patients.It is speculated that reducing serum immunoglobulin levels and improving immune cell function are its important mechanism.