重度神经损害的特发性面瘫42例临床与神经电生理分析

目的：分析重度神经损害的特发性面瘫患者的临床、神经电生理及其对预后的评价。方法：回顾性分析42例重度神经损害的特发性面瘫患者的临床资料，使用肌电图诱发电位仪对这些患者在发病重度神经损害的第1个月、3个月及6个月时分别进行肌电图与神经传导检查，并结合相应的临床疗效进行分析。结果：42例重度神经损害的特发性面瘫患者治疗前后临床神经功能的恢复无明显改善（P〉O．05）；患侧面神经复合肌动作电位潜伏期均延长，运动传导速度均明显减慢，所引出的M波波幅均低于正常的70％，患侧面神经所支配的肌肉均可见失神经电位，以上4个参数结果在治疗到第1个月、3个月、6个月时与正常值比较差异均有显著意义（P〈0．01），不同治疗时间后比较无显著改变（P〉0．05）。结论：重度神经损害的特发性面瘫患者经内科综合治疗无明显效果；神经传导与肌电图可以给重度神经损害的特发性面瘫患者的预后评估提供客观的依据，且内科综合治疗到第6个月后面神经功能在Ⅴ、Ⅵ级者，是否采取手术治疗以及手术治疗的时机选择与预后需作进一步探讨。

Study of clinic and electroneurophysiology in 42 patients with idiopathic facial palsy after severe nerve damage

Objective：To analyze the clinic, electroneurophysiology and prognosis evaluation in patients with idiopathic facial palsy（lFP） after severe nerve damage（SND）. Methods： Forty-two patients with SND were analyzed for clinical manifestations. Nerve conduction test and EMG examination were completed and it＇s results were compared with their clinical effectiveness in all cases the lst,3rd and 6th month respectively,the responding time of the clinical treatments were analyzed. Results： In the 42 patients with IFP after SND： there was no improvement in neural function recovery after therapy（P〉 0.05） ;Motor nerve conduction velocity slowed down, the latency was prolonged, the M wave amplitude decreased by 70% than that of normal person,and denervated potential within the muscles innervated by the facial nerve on the ill side was detected, the results of the above 4 parameters in the treatment of during the lst,3rd and 6th month compared with normal paramters had significant difference（P〈0.01）. But during the difference time before and after treatment had no significant change （P〉0.05）. Conclusion： For patients with IFP after SND, medical treatment appears to have no major effect and nerve conduction velocity and EMG can provide objective evidence for disease prognosis. Accordingto House-Braekrnann （H-B） facial nerve grading system 6th month after medical treatment：for those cases with H-B grade Ⅴ. Ⅵ , further exploration on the necessity of operative interference and the chance of operation should be made.