External lid loading for the temporary treatment of paresis of the M. orbicularis oculi: a case report

Hesse S, Werner C, Melzer I, Waldner A, Bardeleben A. External lid loading for the temporary treatment of paresis of the M. orbicularis oculi: a case report.This clinical note re-introduces external lid loading with the help of a lead weight for the temporary treatment of lagophthalmos. Although simple and effective, the technique is rarely used. Instead of wearing a monoculus, the patient uses an individually tailored lead weight (0.8-mm thickness, 1.0–2.0g) stuck on the lid to enable its closure. Spontaneous ptosis indicates a too-heavy weight. With the musculus (M.) levator palpebrae intact, lid lifting is possible. The effect is gravity dependent; therefore, the patient has to wear the monoculus at night. To minimize the risk for lead intoxication, the surface of the weight is varnished. In the case of persistent M. orbicularis oculi paresis, internal lid loading can follow. Since 1997, a total of 152 lagophthalmos cases have been treated. All patients could close the lid immediately. Almost half the patients had to readjust the weight several times per day because of hooded eyelids. Compliance was high, and partial or complete restoration of M. orbicularis oculi function occurred in 60% of cases. In some subjects, restoration of the M. orbicularis oculi was faster than for the M. orbicularis orbis. External lid loading for the temporary treatment of lagophthalmos is simple and effective. Compared with a monoculus, vision is unimpaired and the aesthetic is more appropriate for most patients. Faster restoration of the M. orbicularis oculi hints at a potentially facilitatory effect of the weight.     

近年来针刺治疗Bell麻痹探析

通过对近年来针刺为主治疗Bell麻痹的综述,进一步明确了针刺治疗该病在医学界的地位,但至今却没有被大家普遍认同的针刺综合治疗方案,希望借此引起同行的重视,并能以点带面,推动针灸学的国际化发展。     

针刺配合按摩耳穴治疗贝尔面瘫研究述评

目的：探讨针刺配合按摩耳穴治疗贝尔面瘫的临床价值。方法：通过收集、整理、分析相关文献,探讨现代临床治疗贝尔面瘫的治疗方法及其优缺点。结果：针刺配合按摩耳穴治疗贝尔面瘫安全性高,痛苦小,操作简便,患者易于接受。结论：针刺配合按摩耳穴治疗贝尔面瘫疗效较好。     

黎凯教授缪刺法联合弥可保穴位注射治疗周围性面瘫后遗症

黎凯教授认为,面瘫后遗症发生或由于病情较重,或由于治疗不当,日久导致气虚血瘀,瘀阻脉络,弛缓不收而致。病机的关键在于血瘀,治宜补气活血,用缪刺法(留针20～30min,隔日1次,10次为1疗程)化瘀通络联合弥可保穴位注射(隔日1次,10次为1疗程。疗程间休息3日)。重视以补法为主,切忌泻法,免损伤正气。治疗期间嘱患者不再做热敷、运动患侧,防过度引起面瘫并发症;注意防寒,少去人较多的场所,以防感冒;治疗期间,少看电视、电脑等,减少对患侧刺激。     

分期针刺配合分期运动疗法治疗Bell麻痹临床观察

目的：观察分期针刺配合分期运动疗法治疗Bell麻痹临床疗效。方法：将100例Bell麻痹患者随机分为治疗组与对照组,治疗组采用分期针刺配合分期运动疗法,对照组采用针刺疗法,10d为一疗程,休息2d后行下一个疗程,连续治疗4个疗程,采用H—B分级法进行疗效对比,治疗后6个月对治疗患者进行随访,进行后遗症及并发症对比。结果：两组在总体疗效上无显著差异（P〉0．05）,但在治愈、显效、缩短病程及减少后遗症和并发症方面治疗组优于对照组（P〈0．05）。结论：分期针刺配合分期运动治疗Bell麻痹可以缩短病程、提高疗效、减少后遗症及并发症。     

小鼠病毒性面神经炎模型中面神经元凋亡的研究

目的 探讨1型单纯疱疹病毒（herpes simplex virus type 1,HSV-1）性面神经炎动物模型中面神经运动神经元（facial motor neurons,FMN）的凋亡情况以及凋亡相关基因bcl-2和bax的表达。方法 Balb/c小鼠84只,分别进行HSV-1接种和面神经切断处理。在操作后第1、3、7、10、15、20及30天分批处死动物,对面神经核进行HE染色、尼氏染色;采用原位末端转移酶标记（terminaldeoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling,TUNEL）技术检测FMN的凋亡;免疫组化染色检测凋亡相关基因bcl-2和bax在FMN中的表达。结果 面神经切断后,同侧FMN出现凋亡,在第10、15天达高峰,Bcl-2表达降低,Bax表达升高,Bcl-2/Bax比值下降;接种病毒后,同侧FMN没有明显的细胞凋亡,Bcl-2表达增高,在第15天达高峰,Bcl-2/Bax比值上升。结论 小鼠面神经接种HSV-1后FMN没有明显凋亡,可能与神经损伤程度轻以及HSV-1抑制宿主细胞凋亡有关,Bcl-2、Bax可能参与调控FMN的凋亡。     

鼠神经生长因子介入针刺治疗贝尔面瘫的分析

目的：观察鼠神经生长因子介入针刺治疗贝尔面瘫急性期的疗效分析。方法：将60例贝尔面瘫急性期患者分为治疗组（鼠神经因子介入组）和对照组（常规针刺方案组）,每组各30例。于治疗28d后进行疗效比较。结果：经28d治疗后,治疗组痊愈率63.33%,愈显率90.00%;而对照组痊愈率40.00%,愈显率66.67%。两组间痊愈率和愈显率比较均有统计学意义（P＜0.05）。H-B 量表分级情况中,两组均在治疗前后分级比较差异有统计学意义（P＜0.05）;而两组间在治疗结束后分级比较,治疗组优于对照组,差异有统计学意义（P＜0.05）。结论：建议贝尔面瘫急性期常规针刺治疗方案中迅速、短期介入鼠神经生长因子能明显提高疗效,有效缩短疗程,改善预后,减低费用负担,值得门诊推广。     

Infrared thermography and meridian-effect evidence and explanation in Bell’s palsy patients treated by moxibustion at the Hegu (LI4) acupoint Overall regulation or a specific target?

Subjects with Bell’s palsy and healthy individuals were treated with moxibustion thermal stimulation on the Hegu (LI4) acupoint; an infrared thermal imaging system was used to observe facial-temperature changes. Bell’s palsy patients developed low or high temperatures at the affected side, with poor symmetry. Healthy people showed high temperatures on the forehead, medial angle of the eye, nasal ala and around the lips, but low temperatures on bilateral cheeks, thus forming a "T-type hot area" in the face, with good temperature symmetry. Moxibustion treatment for 11 minutes significantly improved high asymmetry in temperature in the faces of Bell’s palsy patients. This evidence indicates that moxibustion treatment on Hegu enables increases in facial temperatures in healthy people and Bell’s palsy patients, especially around the lips. Moxibustion stimulation at the Hegu not only improves the global circulation but also has specific effects on the lips in Bell’s palsy patients, but the underlying mechanism needs further investigation.     

针刺对照激素治疗贝尔麻痹急性期疗效比较系统评价

目的：比较针刺与激素治疗贝尔麻痹急性期临床疗效及安全性。方法：检索PubMed、Cochrane图书馆、CBM数据库、CNKI数据库等收集针灸治疗贝尔麻痹急性期的临床随机对照试验,以Cochrane系统评价手册4.26结合Jadad进行质量评价,统计学分析采用RevMan 4.2.6。结果：4篇文献符合纳入标准,共316例患者。Meta分析显示针刺治疗贝尔麻痹急性期对照激素为主治疗,组间比较差异无统计学意义。合并RR[随机效应模型]=1.11,95%CI（0.99,1.25）,Z=1.80,P=0.07。结论：针刺较激素予贝尔麻痹急性期治疗治愈率尚无差异,但可能有缩短疗程的趋势,需要高质量的证据进一步证明。     

神经心理因素与贝尔麻痹针刺治疗疗效关系观察

目的研究神经心理因素对贝尔麻痹针刺治疗和总体预后的影响。方法选择贝尔麻痹患者50例,分为手法组和非手法组进行针刺治疗,采用针灸疗效主观感受量表、卡特尔人格因素测试、汉密尔顿焦虑量表(HAMA)进行评分,采用House-Brackmann分级标准评定治疗效果。结果通过House Brackmann评分,针刺治疗总有效率78.0%(39/50);且手法组疗效[89.2%(25/28)]优于非手法组[63.6%(14/22)],差异有统计学意义(P0.01);针刺得气感受进行视觉模拟评分结果显示,与非手法组比较,手法组患者得气分值及医者得气分值高于非手法组(P0.01);通过卡特尔人格因素测试(16PF)测试,乐群性、聪慧性、兴奋性、敢为性、独立性人群较为容易得气,且人格因素与疗效有明显相关性;通过HAMA评分,焦虑者占92.0%(46/50),且焦虑程度与疗效呈负相关(r=-0.9491,P0.05)。结论神经心理因素在贝尔麻痹的治疗中发挥着重要作用,应采取药物、针灸、心理干预及康复治疗等多种手段结合以改善预后。