中国针灸

目的:探讨针灸治疗周围性面瘫(贝尔面瘫)的最佳介入时机和针灸择期治疗本病的临床优势方案。方法:采用多中心大样本随机对照试验方法,将900例贝尔面瘫患者随机分为分期针刺、分期针刺加灸、分期针刺加电针、分期针刺加经筋排刺以及不分期针刺5个治疗组,分别接受4个疗程的治疗,并在入组、治疗4个疗程后以及治疗后1月、3月随访中分别采用House-Brack-mann分级量表、面部残疾指数量表、面神经麻痹程度分级评分表等进行疗效评价;分别从患者治疗的介入时机和疾病的神经定位进行疗效综合分析。结果:急性期、静止期介入治疗的痊愈率分别为50.1%(223/445)、52.1%(162/311),均优于恢复期的25.9%(35/135)(均P<0.001)。5种治疗方案各期疗效比较差异均没有统计学意义(均P>0.05)。分期针刺、不分期针刺在急性期介入均优于恢复期介入(均P<0.01)。分期针刺加经筋排刺对鼓索以上和鼓索以下神经定位的疗效比较差异有统计学意义(P<0.01),鼓索以下疗效优于鼓索以上。结论:针灸治疗贝尔面瘫的最佳介入时机为急性期和静止期,即发病后的1³周;5种治疗方案均为贝尔面瘫的优势治疗方案。在医疗资源有限的情况下,急性期治疗推荐使用单纯毫针刺;对鼓索以上患者不推荐使用经筋排刺疗法。

Objective To explore the best intervention time of acupuncture and moxibustion for peripheral facial palsy(Bell's palsy) and the clinical advantage program of selective treatment with acupuncture and moxibustion.Methods Multi-central large-sample randomized controlled trial was carried out.Nine hundreds cases of Bell's palsy were randomized into 5 treatment groups,named selective filiform needle group(group A),selective acupuncture + moxibustion group(group B),selective acupuncture + electroacupuncture(group C),selective acupuncture + line-up needling on muscle region of meridian group(group D) and non-selective filiform needle group(group E).Four sessions of treatment were required in each group.Separately,during the enrollment,after 4 sessions of treatment,in 1 month and 3 months of follow-up after treatment,House-Brackmann Scale,Facial Disability Index Scale and Degree of Facial Nerve Paralysis(NFNP) were adopted for efficacy assessment.And the efficacy systematic analysis was provided in view of the intervention time and nerve localization of disease separately.Results The curative rates of intervention in acute stage and resting stage were 50.1%(223/445) and 52.1%(162/311),which were superior to recovery stage(25.9%,35/135) separately.There were no statistical significant differences in efficacy in comparison among 5 treatment programs at the same stage(all P>0.05).The efficacy of intervention of group A and group E in acute stage was superior to that in recovery stage(both P<0.01).The difference was significant statistically between the efficacy on the localization above chorda tympani nerve and that on the localization below the nerve in group D(P<0.01).The efficacy on the localization below chorda tympani nerve was superior to the localization above the nerve.Conclusion The best intervention time for the treatment of Bell's palsy is in acute stage and resting stage,meaning 1 to 3 weeks after occurrence.All of the 5 treatmentprograms are advantageous to Bell's palsy.In the condition of the limited medical sources,the simple filiform needle therapy is recommended in acute stage.For the patients with the disorder above chorda tympani nerve,the line-up needling on muscle region of meridian is not recommended.