摘要
目的:观察电针穴位分型预测与面神经肌电图检查相结合,治疗周围性面神经麻痹的临床疗效。方法:选择2002-09/2005-02济南第四人民医院门诊及住院80例周围性面神经麻痹患者,按电针穴位分型法划分为一般型和顽固型,一般型为电针1组,顽固型分为电针2组、综合治疗组。电针1组、电针2组均都采用电针治疗:取穴阳白、太阳、地仓、下关、风池、翳风、迎香、攒竹、承浆。均取患侧。同时取健侧的合谷。针刺得气后采用电针治疗仪治疗,频率120～250次/min,每次留针30min,治疗1次/d,10次为1个疗程,休息两天,再行第2个疗程。综合治疗组:在常规电针治疗的同时,针刺时均采用中等手法刺激,同时加取双侧足三里穴,均采用补法,每10min行针1次,面部患侧采用特定电磁波照射,以下关、翳风穴为主进行局部照射,距离30～40cm,温度舒适为宜,每次电针加照射40min,1次/d,10次为1个疗程,休息两天再进行第2个疗程。所有患者均行面部面神经肌电图检查。结果:80例患者进入结果分析,无脱落者。①各组疗效的比较:电针1组43例中42例痊愈,占95%,顽固型37例仅痊愈15例,电针2组和综合治疗组分别占30%,53%,差异明显(P<0.05)。②各分型患者有效病例疗程长短比较:电针1组基本上在两个疗程内痊愈,电针2组,综合治疗组多在两三个疗程或3个疗程后好转,治疗时间较长。③不同分型患者面神经潜伏期M波比较:80例患侧面神经运动潜伏期有不同程度的延长,M波波幅降低,与健侧比较差异有极显著性(P<0.01)。其中患健侧M波波幅比值>50%35例、50%～30%32例,<30%13例,3个月后随访,M波波幅比值<30%中的5例仍有明显面瘫体征,>30%的67例中面瘫体征基本恢复。④按肌电图分型标准各型所占比例数比较:按肌电图分类的一般型43例中治愈41例,占95%,而顽固型中,按肌电图分类的轻中型31例中痊愈15例,占48%,无效的5例均提示为重度失神经性损害。虽然面神经肌电图,从面神经运动潜伏期是否延长及根据其失神经性损害进行分类,判断患者预后有一定的准确性,但同电针穴位分型两法合用,分型预测更直接明确。结论:电针分型可以预测该病的预后,对比面神经肌电图情况,判断其预后基本一致。同时根据分型,及时调整治疗方案,可减少后遗症的发生。
AIM： To observe the clinical curative effect of combination of electric acupuncture grouping anticipation and facial nervous electromyogram examination in the treatment of infranuclear facial palsy.
METHODS： Eighty inpatieuts and outpatients with infranuclear facial palsy of Jinan Fourth People＇s Hospital from September 2002 to Febuary 2005 were selected and divided into general type and stubborn type according to the acupoints of electric acupuncture. General type was taken as electric acupuncture group Ⅰ （group Ⅰ ）, stubborn type as electric acupuncture group Ⅱ （group Ⅱ ）, and combined therapic group. Patients in group Ⅰ and Ⅱ received electric acupuncture therapy： At point of Yangba/（GB 14）, Taiyang （Extra）, Dicang （ST 4）, Xiaguan （ST 7）, Fengchi （GB 20）, Yifeng （SJ 17）, Yingxiang （LI 20）, Cuanzhu （BL 2）, Chengjiang （RN 24） in the injured side. Meanwhile, uninjured side of connected valleys was treated with electric acupuncture therapic meter following acupuncture at the frequency of （120-250） times per minute, and needle was remained once a day for 30 minutes each time, One progress included 10 days, and there were an interval of 2 days between progresses. Combined therapic group： At the same time of routine electric acupuncture therapy, patients received moderate manoeuvre stimulation plus acupunture at Zusanli with supplementing method once every 10 minutes. Facial injured side was locally irradiated mainly at Xiaguan （ST 7）, Yifeng （SJ 17） with special electromagnetic waves from （30-40） cm in proper temperature. Treated with combination of electric acupuncture and irradiation once a clay for 40 minutes each time. One progress included 10 clays, and there were an interval of 2 days between progresses, Patients all received facial nervous eleetromyogram examination.
RESULTS： A total of 80 patients entered the final analysis, no one withdrew from the experiment. （1） Comparison of curative effect among groups： 43 patients in group Ⅰ and 42 patients in group Ⅱ recovered, which accounted for 95%, only 15 cases of 37 patients of stubborn type recovered, which accounted for 30% and 53% respectively in group IT and the combined therapic group, the differences were markedly （P〈0.05）.（2） Comparison of effective progress in patients of different types： Patients in group Ⅰ mainly recovered within two progresses; Patients in group IT and combined therapic group mainly tured better in the 2^ed and 3^rd progress even more than 3 progresses, of whom the curative time was much longer. （3） Comparion of M wave in facial neural latency in patients of different types： It was prolonged to different extend in 80 patients, and the wave amplitude of M wave was decreased. Compared with uninjured side, differences were significant （P〈0.01）. The wave amplitude ratios of M wave in the injured side and uninjured side in 35 patients 〉 50%, that of 32 patients between 50%＇and 30%, that of 13 patients 〈 30 %. Followp was done 3 months later, the wave amplitude ratios of M wave in 5 patients 〈 30% with obvious physical signs of facial paralysis, that of 67 patients 〈 30% with physical signs of facial paralysis mainly recovered, （4） Comparison of percentage according to the grouping standard of electromyogram： 41 ones in 43 patients of general type recovered, which accounted for 95%, 15 ones in 31 light of moderate patients of stubborn type recovered, which accounted for 48%, 5 patients with invalid effect indicated severe nervous lesion. Facial nervous electromyogram was clssified according to the prolonging of facial neurol motor latency and nervous lesion. In judging the prognosis of patients, although the classification is accurate to some extent, grouping anticipation was more direct and clearer in comparison with the combination of electric acupuncture and acupoint grouping.
CONCLUSION： Electric acupuncture grouping can anticipate the prognosis of disease and compare the status of facial nervous electromyogram, so as to judge whether the prognosis is coincident. Meanwhile, It can adjust the therapic approach and reduce the sequelaes according to the grouping.
出处
《中国临床康复》
CSCD
北大核心
2006年第3期21-23,共3页
Chinese Journal of Clinical Rehabilitation
