镜像视觉反馈训练对周围性面瘫合并干眼综合征患者的效果观察

Effect of mirror visual feedback training for peripheral facial paralysis with dry eye syndrome patients

目的研究镜像视觉反馈训练对周围性面瘫合并干眼症患者的治疗效果。方法回顾性分析2019-03—2021-03湖南省脑科医院康复医学科治疗的50例周围性面瘫合并干眼症患者的临床资料,观察组25例,对照组25例。对照组给予常规药物治疗联合常规康复训练,药物醋酸泼尼松片、甲钴胺、维生素B1片,常规康复功能训练包括鼓腮、抬眉、上推双侧脸颊、闭眼训练等,动作重复15次,每次总康复训练时长约20 min,3次/d,连续训练2周。观察组在对照组的基础上加镜像视觉反馈训练,安排独立空间,放置50 cm×50 cm镜子,指导患者完成两侧面部提升、揉搓、闭眼、瞬目等训练,患者通过镜子集中观察自身运动呈现,将所见的健侧所呈现的动作提供视觉反馈,2次/d,20 min/次,共2周。治疗前及治疗后3 d、7 d、14 d分别采用眼表疾病指数(OSDI)、泪膜破裂时间(BUT)、泪液基础分泌试纸试验(SIt)、面神经功能分级(H-B)对患者进行康复评定。结果治疗前与治疗第3天时对照组与观察组OSDI评分、BUT评分、SIt未见明显差异(P<0.05);治疗第7天,与对照组相比,观察组OSDI评分下降,BUT评分提高,SIt增大,差异均有统计学意义(P<0.05);治疗第14天,2组OSDI评分均下降,且观察组较对照组下降明显(P<0.05),观察组BUT评分较对照组提高(P<0.05),SIt较对照组增加(P<0.05)。治疗前2组患者H-B神经功能分级均为Ⅳ级,差异无统计学意义(P>0.05);治疗后2组H-B面神经功能分级相比差异无统计学意义(P>0.05);观察组总有效96%,对照组为92%,2组比较差异无统计学意义(χ^(2)=0.60,P=0.55)。结论镜像视觉反馈训练能改善周围性面瘫合并干眼症患者的干眼症状,对面部神经功能改善不明显。

Objective To study the effect of mirror visual feedback training on peripheral facial paralysis combined with dry eye syndrome.Methods From March 2019 to March 2021,50 patients with peripheral facial paralysis complicated with dry eye syndrome were treated in our hospital as the research objects,and were divided into observation group(n=25)and control group(n=25).Control group was given routine drug treatment combined routine rehabilitation training,drug prednisone acetate,cobalt amine,vitamin B1 pills,function of conventional rehabilitation training for drum gills,carry on the eyebrows,pushing bilateral cheeks,close your eyes and training,action repeated 15 times,each time the total rehabilitation training time about 20 minutes,three times a day,training 2 weeks in a row.The observation group was given mirror visual feedback training on the basis of the control group.An independent space was arranged and a 50 cm×50 cm mirror was placed to guide the patients to complete the training of facial lifting,rubbing,eye closing and blink on both sides.The patients were observed their movement through the mirror and provided visual feedback on the movements on the healthy side,twice a day,20 min/time,2 weeks in total.Before treatment,3-day,7-day and 14-day after treatment respectively with ocular surface disease index(OSDI),it appears burst time(BUT),schirmer test(SIt),facial nerve function grading(House-Brackmann,H-B)were used to assess the rehabilitation of patients.Results Before treatment,there were no significant differences in OSDI,BUT,SIt scores between the control group and the observation group on the third day of treatment(P<0.05).On day 7 of treatment,compared with the control group,OSDI score decreased(P<0.05),BUT score increased(P<0.05),SIt increased(P<0.05),with statistical significance.On the 14th day of treatment,OSDI scores of both groups decreased,and the observation group decreased compared with the control group(P<0.05).The BUT score in the observation group was higher than that in the control group(P<0.05),and the SIt in the observation group were higher than those in the control group(P<0.05).Before treatment,the H-B neurological function grade of the two groups was grade Ⅳ,which was not statistically significant(P>0.05).There was no significant difference in H-B facial nerve function grade after treatment(P>0.05).The total effective rate was 96% in the observation group and 92% in the control group,there was no statistical significant difference(χ^(2)=0.60,P=0.55).Conclusion Mirror visual feedback training can improve the symptoms of dry eye in patients with peripheral facial paralysis combined with dry eye,BUT not the facial nerve function.