经筋刺法对难治性面瘫患者面神经功能的影响

Effect of Jingjin needling method on facial nerve function in patients with refractory facial paralysis

目的从多维度探讨经筋刺法治疗难治性周围性面瘫的临床疗效。方法选择2017年1月至2018年12月重庆市中医院针灸科门诊及住院部就诊的符合纳入标准的难治性面瘫患者110例,随机分为治疗组和对照组各55例。治疗组采用经筋刺法,对照组采用常规面部三线法,疗程4周。采用中医症状体征量表进行分级量化临床疗效判定,采用秩和检验比较2组治疗前及治疗后面神经功能分级(H-B分级)评分及临床疗效差异,并在治疗4周后采用卡方检验比较2组面瘫并发症发生率差异,同时对2组进行面神经电图(ENoG)检查。结果(1)治疗组和对照组治疗后H-B分级均低于治疗前,差异具有统计学意义(Z=-6.083、-2.089,P均<0.05);治疗组治疗后H-B分级明显低于照组,差异有统计学意义(Z=-3.580,P<0.05)。(2)治疗组与对照组组内不同H-B分级的患者之间疗效比较,差异均有统计学意义(χ^(2)=15.107、8.953,P均<0.05),治疗组VI级(完全麻痹)疗效高于对照组,差异有统计学意义(χ^(2)=0.025,P<0.05)。(3)治疗组治疗后中医症状评分为(7.85±3.26)分,较对照组[(12.57±4.18)分]明显降低,差异有统计学意义(t=-6.068,P<0.05)。(4)治疗组的面瘫合并症新发率(5.77%)较对照组(19.61%)明显降低(χ^(2)=4.471,P<0.05)。(5)治疗后2组患者ENoG患侧/健侧波幅比比较,差异无统计学意义(Z=-0.415,P>0.05)。结论针刺可明显改善难治性面瘫患者症状并降低面瘫合并症发生率,经筋刺法疗效优于常规面部针刺法。面神经电图对难治性面瘫的神经功能检测可能存在一定的滞后性,可能不适合作为难治性周围性面瘫患者疗效评估标准。

Objective To explore the clinical effect of Jingjin needling method in the treatment of refractory peripheral facial paralysis from multiple dimensions.Methods From January 2017 to December 2018,110 patients with intractable facial paralysis who met the inclusion criteria of this study were selected the outpatient and inpatient department of acupuncture and moxibustion department of Chongqing traditional Chinese medicine(TCM)hospital,and randomly divided into treatment group and control group,including 55 patients in each group.The treatment group were treated with Jingjin needling method,and the control group were treated with facial three-line needling.The course of treatment was 4 weeks.The TCM symptom and sign scale was used to evaluate the clinical efficacy.The rank sum test was used to compare House-Brackmann(H-B)facial nerve function grading(H-B grading)score and clinical efficacy between the two groups before and after treatment.The Chi-square test was used to compare the incidence of facial paralysis complications between the two groups after treatment for 4 weeks.At the same time,the two groups were examined by facial electroencephalogram(ENoG).Results(1)According to House-Brackmann scale both group had symptom improvement(Z=-6.083,-2.089,all P<0.05),and trial group was significant superior to control group(Z=-3.580,P<0.05).(2)There were significant differences between the treatment group and the control group in the efficacy of patients with different H-B grades(χ^(2)=15.107,8.953,all P<0.05),and the treatment group was significant superior to control group in the patients with level VI(χ^(2)=0.025,P<0.05).(3)After treatment,the score of TCM symptoms in the treatment group was(7.85±3.26),which was significantly lower than that in the control group(12.57±4.18)(t=-6.068,P<0.05).(4)The treatment group(5.77%)had less complications than control group(19.61%)(χ^(2)=4.471,P<0.05).(5)After treatment,two groups had no significant difference according to ENoG(Z=-0.415,P>0.05).Conclusions Acupuncture can obviously improve the symptoms of patients with refractory peripheral facial paralysis and reduce the incidence of facial paralysis complications.The Jingjin needling method curative effect is superior to facial three-line needling method.The ENoG by testing the neural function of refractory facial paralysis may have certain hysteresisand may not be suitable for the evaluation criteria of curative effect in patients with refractory peripheral facial paralysis.