周围性面瘫针刺介入时机的临床对比研究

目的:观察患侧局部针刺介入时间对周围性面瘫急性期面神经损伤和面瘫疗效的影响.方法:将发病3天内的279例患者随机分为4组,即A组(74例)、B组(70例)、C组(74例)、对照组(61例).各组均于发病第3天开始西药醋酸泼尼松(强的松)治疗,A组、B组、C组在此基础上分别在发病第3、7、10天开始针刺治疗,穴取患侧风池、阳白、太阳、四白、迎香,双侧合谷等,耳面部穴位用浅刺法,不用行针手法,前4次不用电针,第5次起加用电针,远道取穴平补平泻,留针20 min,隔日1次,治疗25次.比较各组临床疗效、痊愈病人平均疗程及面神经电图(ENoG)指标变化.结果:A组、B组、C组、对照组临床总有效率分别为98.6%、95.7%、94.6%、72.1%,临床疗效比较差异有统计学意义(P＜0.05),痊愈病程长短按照A组、B组、C组和对照组的次序呈递增变化;各组间ENoG值第3天、第14天差异均无统计学意义(均P＞0.05).结论:面瘫急性期为针灸治疗最佳介入时间,针刺介入时间越早,疗效越好,疗程越短.

Clinical study on acupuncture intervention time for treatment of peripheral facial paralysis

Objective To observe effects of intervention time of local acupuncture at the affected side on the facial nerve injury and the therapeutic effect at acute stage of peripheral facial paralysis. Methods Two hundred and seventy-nine cases within 3 days of attack were randomly divided into 4 groups, group A (n=74), group B (n = 70), group C (n = 74) and control group (n=61). The 4 groups were treated with Prednisone on the third day after attack, and acupuncture was added in the group A, B and C, with Fengchi (GB 20), Yangbai (GB 14), Taiyang (EX-HN 5), Sibai (ST 2), Yingxiang (LI 20), etc. on the affected side and bilateral Hegu (LI 4) selected, and with superficial insertion method used for acupoints on the ear-face parts without manipulating the needles, and elec-troacupuncture was added from the fifth session of the treatment, and uniform reinforcing-reducing method was used for the distal acupoints selected. The needles were retained for 20 min and the treatment was given for 25 sessions, once other day. The therapeutic effects, the mean therapeutic courses for the cured patients and changes of electroneurography (ENoG) were compared among the groups. Results The clinical total effective rate was 98. 6% , 95. 7% , 94. 6% and 72. 1% in the group A, B, C and the control group, respectively, with a significant difference (P<0. 05), and the therapeutic course for the cured patients increased in the order of the group A, B, C and the control group; and there was no significant difference among the 4 groups in changes of ENoG at the third day and the fourteenth day (both P>0. 05). Conclusion Acute stage is the best opportunity for acupuncture treatment of peripheral facial paralysis, and the earlier the intervention time, the better the therapeutic effect and the shorter the therapeutic course.