针刺联合艾灸治疗急性期周围性面瘫的疗效观察

Observations on the efficacy of acupuncture plus moxibustion for acute peripheral facial paralysis

目的 观察针刺联合艾灸治疗急性期周围性面瘫的临床疗效。方法 将60例急性期周围性面瘫患者随机分为治疗组和对照组,每组30例。对照组采用针刺联合药物治疗,治疗组在此基础上采用按摩灸治疗。观察两组治疗前后面部House-Brackmann(H-B)面神经功能分级、肌电图、面部残疾指数(facial disability index,FDI)量表评分变化,比较两组治疗前后炎性因子[超敏C反应蛋白(hypersensitive C-reactive protein,hs-CRP)、白细胞(white blood cell, WBC)计数、中性粒细胞与淋巴细胞的比值(neutrophil-to-lymphocyte ratio, NLR)和血小板与淋巴细胞的比值(platelet-to-lymphoccyte ratio, PLR)]变化,并比较两组临床疗效。结果 治疗组总有效率为96.7%,对照组总有效率为86.7%,两组比较差异有统计学意义(P<0.01)。两组治疗后H-B面神经功能分级优于治疗前(P<0.05),且治疗组的H-B面神经功能分级优于对照组(P<0.05)。两组治疗后口轮匝肌、眼轮匝肌、额肌肌电图潜伏期明显低于治疗前(P<0.05),治疗组低于对照组(P<0.01)。两组治疗后口轮匝肌、眼轮匝肌、额肌患健侧肌电图波幅比值高于治疗前(P<0.01),治疗组高于对照组(P<0.01)。两组治疗后FDI躯体功能评分(facial disability index physical function,FDIP)和社会功能评分(facial disability index social function, FDIS)评分优于治疗前(P<0.01),治疗组优于对照组(P<0.01)。两组治疗后炎性因子水平低于治疗前(P<0.05),治疗组低于对照组(P<0.05)。结论 在药物治疗的基础上,针刺联合艾灸可有效促进急性期周围性面瘫患者面神经功能和社会功能的恢复,疗效优于单纯针刺治疗,其机制可能与改善急性期面神经炎症反应有关。

Objective To observe the clinical efficacy of acupuncture plus moxibustion for acute peripheral facial paralysis.Method Sixty patients with acute peripheral facial paralysis were randomized to treatment and control groups,with 30 cases in each group.The control group received acupuncture plus medication and the treatment group,massage moxibustion in addition.The House-Brackmann(H-B)facial nerve function grading,electromyogram and the Facial Disability Index(FDI)score were observed in the two groups before and after treatment.The inflammatory factors [Hypersensitive C-reactive protein (hs-CRP), white blood cell (WBC) count, neutrophil-to- lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR)] were compared between the two groups before and after treatment. The clinical therapeutic effects were also compared between the two groups. Result The total efficacy rate was 96.7% in the treatment group and 86.7% in the control group with a statistical significant difference between the two groups (P< 0.01). After treatment, the H-B facial nerve function grades were better in the two groups compared with before (P< 0.05) and in the treatment group than in the control group (P<0.05). After treatment, the electromyographic latencies of orbicularis oris, orbicularis oculi and frontalis muscle shortened significantly in the two groups compared with before (P<0.05) and were shorter in the treatment group than in the control group (P<0.01). After treatment, the affected and healthy sides of electromyographic wave amplitudes ratio of orbicularis oris, orbicularis oculi and frontalis muscle heightened in the two groups compared with before (P<0.01) and were hiigher in the treatment group than in the control group (P<0.01). After treatment, the FDI physical function (FDIP) and social function (FDIS) scores were better in the two groups compared with before (P<0.01) and in the treatment group than in the control group (P<0.01). After treatment, the inflammatory factor levels decreased in the two groups compared with before (P<0.05) and were lower in the treatment group than in the control group (P<0.05). Conclusion Acupuncture plus moxibustion based on medication can effectively promote the recovery of facial nerve function and social function and is more effective than acupuncture alone in treating patients with acute peripheral facial paralysis. Its mechanism may be related to reducing the acute-stage inflammatory reaction of facial nerves.