Bell麻痹诊断与治疗时机的研讨

目的探讨Bell麻痹的最佳治疗决策.方法根据瞬目反射(Blink reflex,BR)和面神经电图(Elec-troneurography,ENoG)测试结果的关系,对36例Bell麻痹患者进行定位诊断,并对面肌功能进行评分.结果定位诊断病变在D段、评分在11分以下、BR和ENoG测试显示面肌功能差的患者,保守治疗效果亦差,而行面神经减压术后可望提高疗效.结论在临床上定位诊断病变在D段以下,面肌功能评分在11分以上,发病后一个月内BR测试R1波存在,ENoG测试面肌纤维损失＜90%的患者,保守治疗可完全恢复.反之,效果就差,对保守治疗无效者,必须行面神经减压术.

Clinical investigation on the strategic decision of treating procedure for Bell's palsy

Objective To investigate how making strategic decision of treating program for Bell's palsy based on the relationship between blink reflex (BR) and electroneurography (ENoG). Methods A scoring system was taken to evaluate the function of facial muscle according to the testing results of palsy level localization, BR and ENoG in 36 patients with this lesion. Results A conservative treating strategy resulted in poor therapeutic effect for those with palsy at D segment and scores under 11, while surgical procedure as facial nerve decompression might be helpful for them. Conclusion Conservative therapy will be effective for patients with scores of facial function more than 11, palsy location below D segment, wave R1 appearing in BR within one month after onset of lesion, and damaged facial fibers less than 90% based on ENoG. Facial nerve decompression should be taken for those once the conservative therapy failed to recover the function of facial nerve, or for those with scores less than 11.