揿针疗法联合经颅磁刺激与常规疗法治疗缺血性脑卒中后中枢性面瘫临床研究

Clinical Study on Thum-tack Needling for Subcutaneous Embedding Combined with Transcranial Magnetic Stimulation and Routine Therapy for Central Facial Palsy After Ischemic Stroke

目的:观察揿针疗法联合经颅磁刺激与常规疗法治疗缺血性脑卒中后中枢性面瘫的疗效。方法:回顾性分析202例缺血性脑卒中后中枢性面瘫患者的临床资料,按治疗方法分为A组78例、B组60例和C组64例。3组均采用药物治疗、康复训练等常规疗法,A组联合经颅磁刺激治疗,B组联合揿针疗法治疗,C组联合经颅磁刺激与揿针疗法治疗,3组均治疗4周。比较3组治疗前、治疗4周后的面神经功能分级(MHBN)情况、面神经残疾指数(FDI)评分、临床面部评价量表(FaCE)评分及患侧的瞬目反射R1、R2、R2’出波率、瞬目反射异常率。结果:治疗后,3组MHBN数据整体比较,差异有统计学意义(P<0.05);C组的面神经功能优于A组和B组(P<0.05),A组、B组MHBN数据比较,差异无统计学意义(P>0.05)。3组躯体功能评分、社会生活功能评分比较,差异均有统计学意义(P<0.05)。3组躯体功能评分均较治疗前升高,社会生活功能评分均较治疗前下降,差异均有统计学意义(P<0.05)。C组躯体功能评分均高于A组和B组,社会生活功能评分均低于A组和B组,差异均有统计学意义(P<0.05)。B组躯体功能评分高于A组,社会生活功能评分低于A组,差异均有统计学意义(P<0.05)。3组FaCE面部运动、面部感觉、口腔功能、眼睛感觉、泪液分泌评分比较,差异均有统计学意义(P<0.05)。3组面部运动、面部感觉、口腔功能、眼睛感觉、泪液分泌评分均较治疗前升高,差异均有统计学意义(P<0.05)。C组以上5项评分均高于A和B组(P<0.05),A组的各项评分与B组比较,差异均无统计学意义(P>0.05)。3组患侧瞬目反射R1出波率比较,差异无统计学意义(P>0.05),3组患侧瞬目反射R2、R2’出波率比较,差异均有统计学意义(P<0.05)。3组患侧瞬目反射R1、R2、R2’出波率均高于治疗前(P<0.05)。C组患侧瞬目反射R2、R2’出波率均高于A组和B组(P<0.05)。A组的患侧瞬目反射R2、R2’出波率与B组比较,差异均无统计学意义(P>0.05)。3组患侧瞬目反射异常率比较,差异有统计学意义(P<0.05)。3组患侧瞬目反射异常率均低于治疗前(P<0.05)。C组患侧瞬目反射异常率均低于A组和B组(P<0.05)。A组的患侧瞬目反射异常率与B组比较,差异无统计学意义(P>0.05)。结论:在常规疗法基础上加用揿针疗法联合经颅磁刺激治疗缺血性脑卒中后中枢性面瘫患者具有良好的临床效果,可有效减轻面神经损伤程度,改善面部功能和神经兴奋的传导,促进面神经功能的恢复,有效治疗面瘫。

Objective:To observe the curative effect of thum-tack needling for subcutaneous embedding combined with transcranial magnetic stimulation and routine therapy for central facial palsy after ischemic stroke.Methods:The clinical data of 202 patients with central facial palsy after ischemic stroke were given retrospective analysis,and divided into Group A,Group B and Group C according to their treatment methods,with 78,60 and 64 cases in each group respectively.All the three groups were treated with routine therapies such as medication and rehabilitation training;Group A was additionally treated with transcranial magnetic stimulation,Group B was additionally treated with thum-tack needling for subcutaneous embedding therapy,and Group C was additionally treated with transcranial magnetic stimulation and thumtack needling for subcutaneous embedding therapy.All the three groups were treated for 4 weeks.The Modified House-Brackmann(MHBN),Facial Disability Index(FDI)score,Facial Clinimetric Evaluation Scale(FaCE)score,transient reflexes R1,R2,R2'wave rate,and blink reflex abnormality rate of the affected side were compared among the three groups before treatment and after 4 weeks of treatmen.Results:After treatment,the overall comparison of MHBN data among the three groups showed significant difference(P<0.05);the facial nerve function in Group C was better than those in Group A and Group B(P<0.05),and there was no significant difference in MHBN data between Group A and Group B(P>0.05).The scores of physical function and social life function among the three groups showed significant differences(P<0.05).The physical function scores in all the three groups were increased when compared with those before treatment,and the social life function scores were decreased when compared with those before treatment,differences being significant(P<0.05).The physical function score in Group C was higher than those in Group A and Group B,and the social life function score was lower than those in Group A and Group B,differences being significant(P<0.05).The physical function score in Group B was higher than that in Group A,and the social life function score was lower than that in Group A,differences being significant(P<0.05).The scores of facial movement,facial sensation,oral function,eye sensation,and tear secretion of FaCE among the three groups showed significant differences(P<0.05).The scores of facial movement,facial sensation,oral function,eye sensation,and tear secretion in the three groups were all increased when compared with those before treatment,differences being significant(P<0.05).The above scores in Group C were higher than those in Group A and Group B(P<0.05),and there was no significant difference being found in the scores between Group A and Group B(P>0.05).There was no significant difference being found in the wave rates of blink reflex R1 of the affected side among the three groups(P>0.05).There were significant differences being found in the wave rates of blink reflex R2 and R2'of the affected side among the three groups(P>0.05).The wave rates of blink reflex R1,R2,and R2'of the affected side in the three groups were higher than those before treatment(P<0.05),and the wave rates of blink reflex R2 and R2'of the affected side in Group C were higher than those in Group A and Group B(P<0.05).There was no significant difference being found in the blink reflex R2 and R2'wave rates of the affected side between Group A and Group B(P>0.05).The abnormality rates of blink reflex among the three groups showed significant difference(P<0.05).The abnormality rates of blink reflex on the affected side in all the three groups were lower than those before treatment(P<0.05),and the abnormality rate of blink reflex on the affected side in Group C was lower than those in Group A and Group B(P<0.05).There was no significant difference being found in the abnormality rates of blink reflex between Group A and Group B(P>0.05).Conclusion:Thum-tack needling for subcutaneous embedding combined with transcranial magnetic stimulation and routine therapy has good clinical effects in treating patients with central facial palsy after ischemic stroke.It can effectively reduce the degree of facial nerve injury,improve facial function and nerve excitation conduction,promote the recovery of facial nerve function,and effectively treat facial paralysis.