基于面部血流量信息的周围性面瘫客观评估及针刺疗效研究

A study on the objective evaluation of peripheral facial paralysis and therapeutic effect of acupuncture based on facial blood flow information

目的:通过计算不同面部区域的血流灌注量,探索激光散斑对比成像技术在针刺治疗周围性面瘫中的客观性及有效性。方法:对237例周围性面瘫患者进行针刺治疗,应用House-Brackmann面神经功能分级量表(House-Brackmann Facial Nerve Function Grading Scale,H-B)和运动神经传导速度(Motor Nerve Conduction Velocity,MCV)检测进行面神经功能的评价,同时收集同一时间点的激光散斑血流图像。通过计算血流比值,血流下降比值,眼轮匝肌、口轮匝肌波幅下降比等数值,评估面部血流灌注量与H-B评分、MCV参数的相关性,并计算针刺治疗前后的面部血流灌注量的变化,评估针刺疗效。结果:(1)病情评估:面部血流灌注量与基于神经电生理检测的面神经损伤分级呈负相关(r=-0.333);与基于H-B量表的面神经功能分级呈负相关(r=-0.402),差异均具有显著统计学意义(P<0.01);眼部血流灌注量与眼轮匝肌波幅下降比呈正相关(r=0.532),口部血流灌注量与口轮匝肌波幅下降比呈正相关(r=0.208),差异均具有显著统计学意义(P<0.01)。(2)针刺疗效评估:针刺治疗后全脸、眼部及口部区域的血流比值(Pr值)均有显著增高(P<0.01),差异具有显著统计学意义。结论:(1)初步证实面部血流灌注量可作为周围性面瘫针刺疗效评价的客观辅助指标,其中以眼部血流灌注量相关性最高;(2)针刺能有效改善面部血液循环,增强患侧局部血流灌注量,以达到治疗效果。

Objective:To explore the objectivity and effectiveness of laser speckle contrast analysis technology plus acupuncture on peripheral facial paralysis by calculating the blood flow perfusion in different facial areas.Methods:237 cases were treated by acupuncture,and their facial nerve functions were evaluated by H-B score and MCV.Results:(1)The objective evaluation:The facial blood perfusion volume was negatively correlated with the level of facial nerve injury based on nerve-electrophysiological test(r=-0.333),and facial blood perfusion volume based on the HB score was negatively correlated with the level of facial nerve function(r=-0.402),and the difference was both statistically significant(P<0.01).The ocular blood perfusion was positively correlated with amplitude decline ratio of orbicularis oculi muscle(r=0.532,P<0.01),and the oral blood perfusion was positively correlated with amplitude decline ratio of orbicularis oris muscle(r=0.208,P<0.01).(2)The therapeutic effect of acupuncture:There was significant difference in The Pr values of the full face,eyes and mouth area were significantly increased after acupuncture treatment,and the difference was statistically significant(P<0.01).Conclusion:(1)It is preliminarily confirmed that facial blood flow perfusion can be used as an objective auxiliary index for evaluating the clinical effects of acupuncture on facial nerve function,among which ocular blood perfusion shows the highest correlation.(2)Acupuncture cam effectively ameliorate the facial blood circulation,increase the regional blood flow perfusion of affected side,and then gain the therapeutic effect.