中国针灸

目的：比较急性期和恢复期介入针灸对特发性面神经麻痹（IFP）的影响。方法：根据是否在急性期内接受针灸干预将198例IFP患者分为早期针灸组（118例）和非早期针灸组（80例），经倾向性评分匹配（PSM），最终早期针灸组与非早期针灸组各纳入70例。在西医常规治疗基础上，两组均接受针灸治疗，早期针灸组于急性期（病程≤7 d）介入针灸，非早期针灸组于恢复期（病程>7 d）介入针灸。急性期予温针灸治疗，穴取患侧翳风、下关、合谷、足三里；恢复期予电针治疗，穴取患侧攒竹、丝竹空、阳白等，予疏密波，频率2 Hz/100 Hz。均每次30 min，隔日1次，每周3次，共治疗4周。比较两组患者治疗前、治疗1周和治疗4周后House-Brackmann(H-B)面神经功能分级、Sunnybrook面神经功能评分和面部残疾指数（FDI）评分。并于治疗1、4周后评定两组临床疗效和安全性。结果：治疗1、4周后，两组患者H-B面神经功能分级均较治疗前改善（P<0.05）；治疗4周后，早期针灸组H-B面神经功能分级优于非早期针灸组（P<0.05）。治疗1、4周后，两组患者Sunnybrook面神经功能评分、躯体功能评定（FDIP）评分较治疗前升高（P<0.05）；治疗4周后，早期针灸组Sunnybrook面神经功能评分、FDIP评分升高幅度大于非早期针灸组（P<0.05）。治疗4周后，两组社会生活功能评定（FDIS）评分较治疗前降低（P<0.05）。治疗4周后，早期针灸组总有效率（97.1%,68/70）高于非早期针灸组（87.1%,61/70,P<0.05）。两组不良事件发生率比较差异无统计学意义（P>0.05）。结论：在急性期介入针灸较恢复期介入针灸更有利于IFP患者受损面神经功能康复。

Objective To compare the effect of acupuncture-moxibustion on idiopathic facial palsy(IFP) at acute phase and recovery phase. Methods According to whether received acupuncture-moxibustion at acute phase or not, 198 IFP patients were divided into an early-phase intervention group(118 cases) and a non-early-phase intervention group(80 cases).With the propensity score matching employed, 70 cases were included in each group. On the basis of the conventional treatment of western medicine, acupuncture-moxibustion was supplemented in the two groups. In the early-phase intervention group,acupuncture-moxibustion was delivered at the acute phase(duration of illness≤7 days); in the non-early-phase intervention group,acupuncture-moxibustion was operated at the recovery phase(duration of illness>7 days). At the acute phase, warm needling was performed at Yifeng(TE17), Xiaguan(ST7), Hegu(LI4) and Zusanli(ST36) on the affected side; and at the recovery phase, electroacupuncture was delivered at Cuanzhu(BL2), Sizhukong(TE23) and Yangbai(GB14), etc. on the affected side,with the disperse-dense wave and 2 Hz/100 Hz of frequency. The intervention was operated for 30 min each time, once every two days, three treatments weekly and for 4 weeks. Before treatment, 1 week and 4 weeks of treatment, the House-Brackmann(H-B) facial nerve function grade, the score of Sunnybrook facial nerve function, and the score of facial disability index(FDI)were compared between the two groups. The clinical effect in 1 and 4 weeks of treatment and safety were evaluated. Results In 1 and 4 weeks of treatment, the H-B grade was improved when compared with that before treatment in each group(P<0.05), and in 4 weeks of treatment, H-B grade in the early-phase intervention group was superior to that of the non-early-phase intervention group(P<0.05). In 1 and 4 weeks of treatment, Sunnybrook scores and the scores of physical function of FDI were elevated in comparison with those before treatment in the two groups(P<0.05); and in 4 weeks of treatment, the elevation of these two indexes in the early-phase intervention group was greater than that of the non-early-phase intervention group(P<0.05). In 4 weeks of treatment, the scores of social function in FDI were reduced when compared with those before treatment in the two groups(P<0.05). In 4 weeks of treatment, the total effective rate(97.1%, 68/70) in the early-phase intervention group was higher than that(87.1%, 61/70) of the non-early-phase intervention group(P<0.05). There was no significant difference in the incidence of adverse events between the two groups(P>0.05).Conclusion Acupuncture-moxibustion therapy starting at the acute phase is more beneficial to the functional recovery of the impaired facial nerve than at the recovery phase in the IFP patients.