银杏达莫治疗急性特发性面神经麻痹随机对照研究

目的：评价银杏达莫治疗急性特发性面神经麻痹的疗效。方法：62例急性特发性面神经麻痹患者随机分为银杏达莫组31例及对照组31例，分别应用银杏达莫25mL及丹参注射液20mL静脉滴注，每天1次，连续治疗14d，两组均同时使用相同剂量的泼尼松、抗病毒药及维生素B族治疗。治疗后1、3和4周采用House—Brackmann分级法进行疗效评估。结果：治疗后3周银杏达莫组患者痊愈率为48．38％（15／31），改善率为25．81％（8／31），总有效率74．19％；丹参组患者痊愈率为25．81％（8／31），改善率为16，13％（5／31），总有效率41．94％。治疗后4周，银杏达莫组痊愈率为74．19％（23／31），改善率为19．35％（6／31），总有效率93．55％；丹参组痊愈率为45．16％（14／31），改善率为22．58％（7／31），总有效率67．74％。两组间疗效差异有统计学意义（P〈0．05）。结论：银杏达莫治疗急性特发性面神经麻痹的疗效好于丹参。     

弥可保治疗急性特发性面神经麻痹的疗效观察

目的探讨弥可保治疗急性特发性面神经麻痹(单侧)的疗效。方法将80例治疗急性特发性面神经麻痹(单侧)患者随机分为2组:观察组(弥可保组)40例,在常规激素、抗病毒药物及理疗的基础上给予弥可保0.5 mg im qd。对照组40例,给予VitB120.5 mg im qd。分别在治疗前、治疗后4周采用2009年中国针灸《周围性面神经麻痹的临床评估及疗效判定标准方案》(修订案)[1]中面神经功能主观检测评分表进行面神经功能的测评,以评价疗效。结果弥可保组面神经功能评分提高高于对照组,总有效率高于对照组,2组比较差异有统计学意义(P<0.01)。结论弥可保及VitB12治疗急性特发性面神经麻痹(单侧)均有良好效果,前者疗效优于后者。     

特发性面神经麻痹治疗的探讨

目的　基于面神经营养血管痉挛参与特发性面神经麻痹发病机制的概念 ,将以改善微循环为主并用激素疗法与传统的单纯激素疗法进行对比研究 ,观察两种疗法疗效的差异。方法　将特发性面神经麻痹患者 1 1 2例分为 A、B组。A组 5 9例 ,为单纯激素疗法组 ;B组 5 3例 ,为以改善微循环为主并用小剂量激素疗法组。两组间性别、年龄相匹配。于治疗后 3 0 d分别统计两组的有效率、显效率、痊愈率、总有效率及无效率 ,并进行比较分析。结果　B组显效率、痊愈率和总有效率均显著高于 A组 ,无效率显著低于 A组。结论　提示以改善微循环为主并用激素疗法优于传统的单纯激素疗法 ,并有进一步研究意义。     

疏血通注射液治疗特发性面神经麻痹疗效观察

特发性面神经麻痹又称Bell麻痹,是茎乳孔内面神经非化脓性炎症所引起的周围性面神经麻痹,约30%患者预后不良,遗留后遗症,如面肌痉挛、病理性面肌联合运动、鳄鱼泪等[1],给患者造成巨大心理负担和生活影响。笔者应用疏血通注射液治疗本病取得较好疗效,现报告如下。     

电刺激法治疗特发性面神经麻痹的临床效果

目的探讨电刺激治疗特发性面神经麻痹的临床效果。方法收集我院确诊为特发性面神经麻痹的患者79例,随机分为试验组和对照组,对照组采用常规治疗,试验组采用常规治疗加电刺激治疗,记录治疗前后面神经功能等级评定变化,观察电刺激治疗的不良反应。结果试验组与对照组总有效率比较无显著差异(P0.05);但试验组患者的面神经功能恢复效果高于对照组,差异有统计学意义(P0.05)。结论电刺激治疗能提高特发性面神经麻痹的临床疗效。     

更昔洛韦联合强的松治疗急性特发性面神经麻痹临床观察

目的观察更昔洛韦联合强的松治疗急性特发性面神经麻痹的有效性和安全性。方法采用随机对照试验,选择发病3d内的急性面神经麻痹患者63例,随机分为治疗组32例(更昔洛韦联合强的松加基础治疗)及对照组31例(基础治疗),治疗前后定期对患者进行神经功能缺损评定,神经功能缺损评定采用改良Portmann简易评分法,以治疗第14天分值的改变作为主要疗效判断标准。结果治疗组痊愈率、总有效率与对照组比较,差异有统计学意义(P0.05),治疗组无明显不良反应。结论更昔洛韦联合强的松能有效改善急性特发性面神经麻痹的预后,无明显不良反应。     

依达拉奉治疗特发性面神经麻痹疗效观察

目的探讨依达拉奉在特发性面神经麻痹治疗中的疗效。方法将60例特发性面神经麻痹病人随机分为2组,对照组给予常规药物和康复治疗,治疗组在常规治疗的基础上加用依达拉奉静滴。治疗4周,于治疗前、4周后、3个月后分别用面神经功能临床简易评定量表评分,依据评分值变化评定疗效。结果经过4周治疗后,2组患者治疗前后面神经功能评分值均较治疗前增加,差异均有统计学意义(P0.001);但治疗组治疗4周后的评分值高于对照组(P0.05),治疗后3个月评分差异更明显(P0.01);3个月后的优良率分别为对照组80%、治疗组96.7%,差异明显(P0.01)。结论特发性面神经麻痹急性期应用抗自由基药物依达拉奉能明显改善面瘫患者的预后。     

三种方法治疗特发性面神经麻痹的对照研究

目的 观察中医、西医、中西医结合三种方法治疗特发性面神经麻痹患者的临床疗效.方法 169例特发性面神经麻痹患者随机分为3组,分别采用中医、西医、中西医结合方法治疗.结果 4周后3组评分均有所下降.中医组、西医组、中西医结合组总有效率分别达到84.48%、81.82%和98.21%.中西医结合组与其他2组比较有显著性差异(P＜0.05);中医组与西医组之间比较无统计学意义(P＞0.05).     

综合治疗急性特发性面神经麻痹92例疗效观察

目的 观察茎乳孔药物注射加上自我手法按摩和面肌功能锻炼对急性特发性面神经麻痹的临床疗效.方法 对确诊为急性特发性面神经麻痹的患者,跟踪随访180例,随机分成2组,进行疗效分析.治疗组92例,在门诊应用2%利多卡因2ml,甲钴胺250μg,ATP针40mg,地塞米松5mg进行茎乳孔注射,1次/d,连续7d;之后隔日1次,共7次;同时加上自我手法按摩和面肌功能锻炼.对照组88例,采用电针、自我手法按摩及面肌功能锻练.治疗前后按House-Brackmann(H-B)面神经分级标准进行评定.结果 治疗组的起效时间短于对照组(P<0.01),在Ⅰ级治愈方面也明显优于对照组(P<0.01).结论 采用茎乳孔药物注射治疗急性特发性面神经麻痹疗效确切,开始治疗的时间早,可以缩短治疗进程,经济简便,无后遗症,值得推广应用.     

注射用灯盏花素治疗特发性面神经麻痹

目的观察注射用灯盏花素对特发性面神经麻痹的治疗作用。方法选择特发性面神经麻痹患者共60例,随机分成治疗组和对照组,每组30例。2组均常规肌内注射维生素B1及B12。治疗组在常规肌内注射基础上,静滴注射用灯盏花素;对照组在常规肌内注射基础上,口服醋酸泼尼松片,2组用药均为1周。分别于治疗前、后进行House-Brackmann（H-B）分级评定,并监测不良反应。所得结果应用SPSS 16.0软件进行统计学处理。结果 2组患者的性别、年龄及治疗前H-B分级比较差异均无统计学意义（P〉0.05）;治疗组治疗前与治疗后7 d及28 d的H-B分级比较差异有统计学意义（P〈0.05）;对照组治疗前与治疗后28 d的H-B分级比较差异有统计学意义（P〈0.05）;对照组治疗前与治疗后7 d的H-B分级比较差异无统计学意义（P〉0.05）;2组治疗后7 d的H-B分级比较差异无统计学意义（P〉0.05）;2组治疗后28 d的H-B分级比较差异有统计学意义（P〈0.05）;2组未见严重不良反应发生。结论注射用灯盏花素对于特发性面神经麻痹具有较好的治疗作用。     

Neuroprotective treatment with Cerebrolysin in patients with acute stroke: a randomised controlled trial

Summary. Background and purpose. Cerebrolysin is a compound with neurotrophic and neuroprotective activity. It is produced by enzymatic breakdown of purified brain proteins and consists of low molecular weight peptides and amino acids. Cellular and animal models of cerebral ischaemia have shown that it is a potent neuroprotective agent. We explored the safety and preliminary outcome of Cerebrolysin treatment in patients with acute stroke. Methods. Randomised, placebo-controlled, parallel group trial. Patients with acute stroke were randomised within 24h of stroke onset to IV therapy with placebo or Cerebrolysin 50mL/day for 21 days. Both groups received concomitant treatment with ASA 250mg/day PO and pentoxifylline 300mg/day IV. Clinical examinations were performed on days 1, 3, 7, 21 and 90 post baseline. Outcome measures were the Canadian Neurological Scale, the Barthel Index, the Clinical Global Impressions, the Mini-Mental State Examination, and the Syndrome Short Test. Treatment emergent adverse events, lab tests, and vital signs were recorded to assess the safety of Cerebrolysin. Results. 146 patients were enrolled in two groups: 78 Cerebrolysin and 68 placebo. At baseline, no significant group differences were observed. Patients in the Cerebrolysin group had no significant improvement in the CNS score, the Barthel Index and the Clinical Global Impressions when compared to the placebo group. A significant improvement of cognitive function of the patients on Cerebrolysin was observed in the Syndrome Short Test when compared to the placebo group. Cerebrolysin was well tolerated and safe. Adverse events occurred with a similar frequency in both groups. Conclusion. The results demonstrate that neurotrophic treatment with Cerebrolysin is safe and well tolerated by patients with acute stroke. The findings, despite the small sample size, also indicate a potential treatment effect of Cerebrolysin in acute stroke. Larger studies, however, are needed to confirm and extend these findings.     

肌内效贴贴扎疗法治疗周围性面瘫的临床效果

目的研究肌内效贴贴扎疗法治疗周围性面瘫的临床效果。方法选取2013-09—2016-09于我院接受治疗的60例周围性面瘫患者为研究对象,按照入院顺序分为对照组与观察组各30例。对照组给予常规物理康复联合西药治疗,观察组在此基础上给予肌内效贴贴扎疗法,观察2组临床效果。结果治疗后,观察组评分提升至(16.83±3.14)分,明显高于对照组的(12.11±2.18)分,差异有统计学意义(P0.05);观察组总有效率为93.33%,明显高于对照组的70.00%。结论在周围性面瘫患者的临床治疗中,应用肌内效贴贴扎疗法,可缓解患者脸部疼痛感,促进肌肉力量的恢复,改善患者的临床症状,疗效显著,值得推广。     

早期激素治疗颅底骨折致迟发性面瘫的临床疗效

目的：观察颅底骨折致迟发性面瘫患者早期皮质激素治疗的疗效。方法回顾性分析颅底骨折致迟发性面瘫患者38例,早期（人院后立即给予）激素治疗20例,发现面瘫后给予激素治疗18例。治疗时间均1～2周,其他治疗相同。结果38例患者经保守治疗后均好转恢复,早期激素治疗的患者有效率95.0％（19/20）,恢复时间快;发现面瘫后给予激素治疗的有效率77.8％（14/18）,恢复时间慢。结论颅底骨折致迟发性面瘫患者早期激素治疗,可以明显提高迟发性面瘫患者的临床疗效。     

小儿周围性面神经麻痹的临床分析

目的探讨小儿周围性面神经麻痹的病因、临床特点及治疗方法。方法回顾性分析2000—2009年周围性面神经麻痹患儿8例,8例患儿头颈部影像学检查均为阴性,8例患儿均接受糖皮质激素和营养神经药物治疗。结果经过3个月的随访,8例患儿均治愈且无复发。结论小儿周围性面神经麻痹病因与临床表现常不典型,糖皮质激素治疗具有很好的疗效。     

Cerebrolysin in Alzheimer's disease: a randomized,double-blind,placebo-controlled trial with a neurotrophic agent

Summary. Summary. Cerebrolysin (Cere) is a compound with neurotrophic activity. It has been shown to be effective in the treatment of Alzheimer's disease (AD) in earlier trials. In this multicenter, randomized, double-blind, placebo-controlled, parallel-group study, patients were injected intravenously with placebo or 30 mL Cere five days per week for four weeks. Effects on cognition and global function were evaluated with the Alzheimer Disease Assessment Scale – Cognitive Subscale (ADAS-Cog) and the Clinicians Interview-based Impression of Change with Caregiver Input scale (CIBIC+) 4, 12, 24 weeks after the beginning of the injections. 192 patients were enrolled, 95 were randomized to placebo, and 97 to Cere. At baseline, there was a significant difference between groups for age, age of onset of dementia, and the number of patients with hallucinations. At week 12 there was a significant difference on the CIBIC+ (p = 0.033) in favor of Cere. The number of CIBIC+ responders (score ≤ 4), was significantly higher (p = 0.007), with 68 (76%) in the Cere group and 51 (57%) in the placebo group. Trends were noted in the Disability Assessment in Dementia scale and the Cornell Depression Scale. Adverse events were recorded in 73% of placebo and 64% of Cere patients. Most common adverse events were headaches, dizziness, weight loss and anxiety. Conclusions: Cere treatment was well tolerated and resulted in significant improvements in the global score two months after the end of active treatment. Received September 10, 2001; accepted November 15, 2001     

Contralateral reinnervation of midline muscles in facial paralysis.

We report on a patient with recovery of activity of the left orbicularis oris and nasalis muscles 3 months after a complete left facial palsy. Stimulation of the affected facial nerve evoked no responses, whereas contralateral facial nerve stimulation showed polyphasic responses with very long latencies in the nasalis and orbicularis oris muscles. Needle electromyography (EMG) revealed abnormal spontaneous activity in the left orbicularis oris muscle. The motor unit action potentials on the left side of the face could be recruited only during marked contraction of the corresponding muscles on the right and were of low voltage and polyphasic ("nascent potentials"). Contralateral reinnervation is probably due to sprouting of terminal branches crossing the midline of the face and innervating bundles of muscle fibers on the affected side. This phenomenon seems unfamiliar to most clinicians. Whether the activity is due to conduction along nerve fibers or muscle fibers crossing the midline is discussed.     

神经肌电图对特发性面瘫治疗及预后评估的研究

目的探讨神经肌电图(神经电图electroneurography,ENG和肌电图electromyography,EMG)在特发性面瘫治疗及预后评估中的价值。方法采用丹麦生产的keypointⅣ肌电图仪对96例确诊为特发性面瘫的患者进行患侧与健侧ENG、EMG检测,分别记录患侧面神经颞支、颧支、颊支的运动传导潜伏期、波幅以及所支配的额肌、眼轮匝肌、口轮匝肌的肌电图情况,并与自身健侧作对比。结果特发性面瘫患者患侧面神经运动传导潜伏期延长、M波波幅降低,与自身健侧相比,差异有统计学意义(P<0.05)。波幅下降<70%、NCV(神经传导速度)减慢<20%、EMG大致正常的轻度患者,3个月内面肌完全恢复,治愈率100%;波幅下降70%～90%、NCV减慢20%～50%、EMG呈部分神经源性损害的中度患者,3个月内大部分可完全恢复,治愈率87.8%;波幅下降>90%、NCV减慢>50%、EMG呈部分或完全神经源性损害的中重度患者,3个月内面肌完全恢复者为50%;诱发电位消失、NCV引不出、EMG呈完全神经源性损害的重度患者,3个月内面肌完全恢复者为25%。结论 ENG和EMG检测对特发性面瘫的神经损伤、面肌恢复等预后评估有重要价值,能对临床治疗提供客观依据。     

Values of blink reflex and electroneurography in diagnosis of facial paralysis

BACKGROUND: The electrophysiological test was mainly achieved by the reaction of nerve fiber to electrical stimulus, usually expressed by the amplitude and latency. Blink reflex and electroneurography (ENOG) are widely applied in facial paralysis, the amplitude would step down, and the latency would prolong when the facial nerve was injured. OBJECTIVE: To compare the value of blink reflex and ENOG in the diagnosis of facial paralysis (Bell's palsy). DESIGN: A controlled trial. SETTINGS: Affiliated Hospital, Chengdu University of Traditional Chinese Medicine; West China Hospital of Sichuan University; Mianyang Hospital of Traditional Chinese Medicine; Sichuan People's Hospital. PARTICIPANTS: The patients who had finished the tests of blink reflex (n =207) and ENOG (n =205) were selected from the Affiliated Hospital, Chengdu University of Traditional Chinese Medicine; West China Hospital of Sichuan University; Mianyang Hospital of Traditional Chinese Medicine; Sichuan People's Hospital from September 2001 to July 2003. After treatment for 4 weeks, the patients finished tests of blink reflex (n =207) and ENOG (n =205) were randomly divided into primary treatment group (n =68, 69), acupuncture group (n =71, 66) and comprehensive treatment group (n =68, 70), respectively. Approval was obtained from the ethic committee of hospital. METHODS: Patients in the primary treatment group and acupuncture group were treated with western medicine, acupuncture and moxibustion alone respectively, and those in the comprehensive treatment group were treated with acupuncture and moxibustion based on western medicine. The whole period of treatment was 4 weeks. The tests of blink reflex and ENOG were carried out using Japanese light and electricity MEB-2200 electromyogram/induced potential instrument for once before and after treatment respectively. The normal value of the latency period of wave R1 was within 13 ms, and the difference was 1–1.2 ms between the left and right sides. MAIN OUTCOME MEASURES: The latency of wave R1 of blink reflect and the latency and wave amplitude of ENOG on the affected and healthy sides before and after treatment were observed. RESULTS: Totally 207 and 205 patients received tests of blink reflex and ENOG, but 17 and 16 cases respectively did not finish the second measurement, finally 190 and 189 cases were involved in the analysis of results. The latencies of wave R1 on the affected side after treatment were significantly longer than those before treatment (t =–6.253, P < 0.01); The latencies of wave R1 on the normal side were in the normal range before and after treatment; The latencies of wave R1 before treatment on the affected side was significantly longer than that on the normal side (t =–5.896, P < 0.01), but there were no significant differences between the affected and normal sides after treatment (P > 0.05). It was indicated that the latencies of wave R1 on the affected side had restored normally, and the blink reflex was improved obviously after treatment. The latency of ENOG on the affected side before treatment was significantly prolonged as compared with that on the normal side (t =2.247, P < 0.01); After treatment, the difference between the affected and normal side became smaller, but remarkable significance still existed (t =10.810, P < 0.01). In spite of the obvious improvement of affected side before and after treatment, there were still significant differences (t =–8.110, P < 0.05). The wave amplitude on the affected side was decreased after treatment, which was not significantly different from that before treatment (P >0.05). CONCLUSION: After treatment of facial paralysis, blink reflect was greatly improved, there was an obvious hysteresis in the latency of ENOG. Therefore, blink reflect was better than ENOG in the early diagnosis, while ENOG was suitable for evaluating the prognosis. The ENOG examination was better than blink reflex at middle and late period.     

Peripheral facial paralysis and HIV infection: report of four African cases and review of the literature

Summary Four cases of infranuclear facial palsy associated with infection by the human immunodeficiency virus in young heterosexual African patients are reported. Two cases were healthy HIV carriers, one patient manifested AIDS-related complex, and one case fulfilled the CDC criteria for AIDS. Two patients had a typical Bell's palsy, one presented with manifest cephalic Herpes zoster infection and one, who suffered from facial diplegia, could be considered to have a cephalic form of Guillain-Barré syndrome. A review of the literature confirmed that peripheral facial palsy can occur at any stage of HIV infection and in various clinical contexts. In stages I and II of the HIV infection, patients may develop either Bell's palsy or Guillain-Barré syndrome. In stages III and IV, when the cellular immunity has begun to decline, Herpes zoster-related facial paralysis, seventh cranial nerve involvement secondary to meningeal lymphomatosis, and peripheral facial paralysis as one aspect of widespread chronic peripheral neuropathy may also occur.