不同针灸方法分期治疗贝尔面瘫疗效观察

上海针灸杂志2014年7月第33卷第7期 ·613·文章编号:1005-0957(2014)07-0613-03 ·临床研究· 不同针灸方法分期治疗贝尔面瘫疗效观察

陈晓琴1,李瑛2,邙玲玲2

(1.彭州市中医医院,彭州 611930;2.成都中医药大学,成都 610075)

【摘要】 目的 观察不同分期针灸方法治疗成都地区380例贝尔面瘫患者的临床疗效。方法 采用临床随机对照试验方法将372例贝尔面瘫患者随机分为A组65例、B组78例、C组75例、D组71例和E组83例。A组采用分期针刺治疗,B组采用分期针灸治疗,C组采用分期电针治疗,D组采用分期经筋排刺治疗,E组采用不分期针刺治疗。治疗4个疗程后比较各组House-Brackmann(H-B)分级量表、面部残疾指数量表(FDI)、面神经麻痹程度分级评分表及WHOQLO-BREF量表评分,并评价各组疗效。结果 5组治疗后H-B分级量表、FDI、面神经麻痹程度分级评分表及WHOQLO-BREF量表评分比较,差异均无统计学意义(P＞0.05)。5组临床疗效比较,差异均无统计学意义(P＞0.05)。结论 5种治疗方案均对贝尔面瘫均有效。在医疗条件受限、医疗资源不足的情况下,治疗贝尔面瘫推荐使用单纯针刺治疗。

【关键词】 针灸疗法;电针;贝尔面瘫;面神经麻痹;排刺

【中图分类号】 R246.6 【文献标志码】 A

DOI:10.13460/j.issn.1005-0957.2014.07.0613

Observations on the Efficacies of Different Staged Acupuncture Methods in Treating Bell’s Palsy CHEN Xiao-qin1, LI Ying2, MANG Ling-ling2. 1.Pengzhou Hospital of Traditional Chinese Medicine,Pengzhou611930,China; 2.Chengdu University of Traditional Chinese Medicine,Chengdu 610075,China

[Abstract] Objective To investigate the clinical efficacies of different staged acupuncture methods in treating 380 Bell’s palsy patients in Chengdu area. Methods A clinical randomized controlled trial was carried out. Three hundred eighty patients with Bell’s palsy were randomly allocated to groups A, B, C, D and E, 76 cases each. Group A was treated with staged acupuncture; group B, with staged acupuncture and moxibustion; group C, with staged electroacupuncture; group D, by staged muscle-region alignment needling; group E, with non-staged acupuncture. The House-Brackmann grading scale scores, the Facial Disability Index (FDI) scores, the Classification Scale of Facial Paralysis scores and the WHOQOL-BREF scores were compared between the groups after four courses of treatment. The therapeutic effect was evaluated in every group. Results There were statistically significant differences in the House-Brackmann grading scale score, the FDI score, the Classification Scale of Facial Paralysis score and the WHOQOL-BREF score (P＞0.05) and in clinical therapeutic effect (P＞0.05) between the five groups. Conclusion All the five protocols are effective in treating Bell’s palsy. Under limited medical conditions and inadequate medical resources, using acupuncture alone is recommended for the treatment of Bell’s palsy.

[Key words]Cupuncture therapy; Electroacupuncture; Bell’s palsy; Facial paralysis; Alignment needling

贝尔面瘫临床以病侧面部表情肌瘫痪为主,表现为眼睑闭合不全,或(和)泪液分泌减少;皱额、蹙眉均不能或不全;鼻唇沟平坦,口角下垂或张口时被牵向健侧;病侧角膜反射消失;示齿、鼓腮、噘嘴、吹哨任意一项不能或不全;可有舌前2/3味觉障碍,听觉过敏或听觉障碍。

由于该病的病因病理尚未完全阐明,西医目前主要采用药物和手术治疗。因为缺乏足够强的Ⅰ类研究,目前仍不能明确肯定药物(如类固醇激素和阿昔洛韦)对贝尔面瘫的疗效。对于手术治疗,目前普遍认为疗效尚难肯定,只宜在严重患者试用, ,偏倚的危险度较高,因而不能支持循证结论。中医学认为贝尔面瘫不同时期的病理变化是不一样的,且针灸治疗该病的方法较多。本研究主要采用严格的临床随机对照试验观察不同时期采用不同方法治疗成都地区380例贝尔面瘫患者的临床疗效,现报告如下。

1 临床资料

1.1 一般资料

采用随机对照试验方法将成都地区380例贝尔面瘫患者随机分为A组65例、B组78例、C组75例、D 组71例和E组83例。5组性别、年龄、病程、分期、神经定位基线比较,差异均无统计学意义(P＞0.05),具有可比性。详见表1。

1.2 诊断标准

参照《临床疾病诊断依据治愈好转标准》[1]和周围性面神经麻痹的中西医结合评定及疗效标准(草案)[2],确立诊断标准。

作者简介:陈晓琴(1980 - ),女,主治医师

通信作者:李瑛(1964 - ),女,教授,E-mail:jialee@mail.sc.