不同类型面部神经麻痹应用针药结合的治疗效果差异和原因探讨

Difference and Cause Analysis of Therapeutic Effect of Acupuncture Combined with TCM in Different Types of Facial Palsy

目的:分析针药结合在不同类型面部神经麻痹中的治疗作用并探讨效果差异产生原因。方法:将2016年6月—2018年5月间本院收治的符合研究标准的面部神经麻痹患者纳入研究,共80例。根据面部神经麻痹的类型分为中枢性面部神经麻痹组(即中枢组,27例)和周围性面部神经麻痹组(即周围组,53例),所有患者均采用针药结合进行治疗4周。比较两组的临床疗效,治疗前后肌电图(复合肌肉动作电位波幅和短潜伏期)变化及治疗前、治疗后1周、2周、3周和4周的面神经功能评分。结果:经治疗后,周围组临床总有效率为94. 34%(50/53),中枢组临床总有有效率为77. 78%,两组相比,差异显著,有统计学意义(χ~2=9. 013,P=0. 021)。治疗后第1周开始,周围组研究对象的面神经功能评分开始下降且差异有统计学意义(P <0. 05),而中枢组则是在治疗后第2周开始面神经功能评分开始下降且差异有统计学意义(P <0. 05)。数据结果显示,经治疗后,周围组各时间的神经功能评分均显著低于中枢组,P <0. 05。经治疗4周后,两组患者的CMAP波幅明显升高,R1潜伏期明显降低,P <0. 05。结论:针药结合能够显著缓解面神经麻痹患者临床症状、改善患者面部神经功能,升高CMAP波幅和降低R1潜伏期水平,发挥治疗作用,在周围性面神经麻痹的治疗效果优于中枢性面神经麻痹。

Objective:To analyze the therapeutic effect of acupuncture combined with TCM in different types of facial paralysis and explore the causes of the difference.Methods:A total of 80 patients with facial palsy who met the standard of study in our hospital from June 2016 to May 2018 were included in the study.According to the types of facial paralysis,the central facial paralysis group(the central group,27 cases)and the peripheral facial paralysis group(the periphera group,53 cases)were treated with acupuncture and TCM for 4 weeks.We compared the clinical efficacy of the two groups,changes of EMG(CMAP and short latency wave)before and after treatment,and the facial nerve function score of 1,2,3 and 4 weeks before and after treatment.Results:After treatment,the total clinical effective rate of peripheral group was 94.34%(50/53)and the central group had a total effective rate of 77.78%.The difference was significant(χ~2=9.013,P=0.021).One week after treatment,the facial nerve function scores of peripheral groups began to decrease and the difference was statistically significant(P<0.05),while the central group had a statistically significant difference(P<0.05)at the beginning of the 2 nd week after treatment.The results showed that after treatment the neurological function score of the peripheral group was significantly lower than that of the central group,P<0.05.After 4 weeks treatment,the average CMAP amplitude in both groups were significantly increased and R1 latency in both groups was significantly reduced.Conclusion:The combination of acupuncture and medicine can remarkably relieve the clinical symptoms,improve facial nerve function,rise the average CMAP amplitude and reduce R1 latency,playing a therapeutic role in the treatment of peripheral facial paralysis,which is better than that of central facial paralysis.