经筋刺法联合甲钴胺治疗周围性面瘫的疗效及对面部血流动力学的影响.docx

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1、经筋刺法联合甲钻胺治疗周围性面瘫的疗效及对面部血流动力学的影响田春妮I,李春玲I,张翊一21铜川矿务局中心医院针灸推拿科 陕西铜川7270002西安市第五医院针灸康复科陕西西安710082【通讯作者】张翊一，【基金项目】2021年西安市卫生健康委员会科研项目(2021yb37)【摘要】目的：探讨经筋刺法联合甲钻胺治疗周围性面瘫的疗效及对面部血流动力学的影 响。方法：纳入2020年3月至2021年3月本院收治的周围性面瘫患者，采用随机数字表法 分为观察组(49例)及对照组(48例)，对照组进行甲钻胺穴位注射治疗，观察组在对照 组基础上使用经筋刺法治疗。于治疗前后测定面动脉收缩期峰值流速(Vs)、

2、舒张末期流 速(Vd)、阻力指数(Rl)及面部生物电信号，进行House-Brackman (H-B)面神经功能 分级评分、面瘫Portmann评分、面部残障指数(FDD评价。结果：两组患者治疗后Vs、 Vd 升高，Rl 降低(P0.05),治疗后观察组 Vs (65.2510.22) Cm/s、Vd (12.853.12) cm/s 高于对照组的 VS (52.129.63) cm/s、Vd (8.594.12) cm/s, RI (0.770.12)低于对照组的 RI (0.850.17) (P0.05)；治疗后两组生物电信号差显著降低(P0.05),观察组低于 对照组(尸0.05)：治疗

3、后两组患者H-B评分、社会功能(FDIS)评分显著降低，Portmann 评分、躯体功能(FDIP)评分显著升高(P0.05),观察组H-B评分(1.970.50)分、FDIS 评分(15.272.41)分显著低于对照组的H-B评分(2.660.70)分及FDIS评分(12.221.65) 分，POrtmalm评分(8.11 2.65)分、FDlP评分(20.123.26)分明显高于对照组的POrtmann 评分(12.17+3.22)分、FDIP评分(16.273.25)分(PVo.05)。结论：经筋刺法联合甲钻 胺穴位注射治疗周围性面瘫有较好的效果，可减少患者生物电信号差距，加快面部血流动

4、力 学，改善患者面部神经功能及残障指数，有较高的临床应用价值。【关键词】周围性面瘫；经筋刺法；甲钻胺；穴位注射；神经功能恢复；面部血流动力学Efficacy Of meridian acupuncture combined with mecobalamin in the treatmentof peripheral facial paralysis and the influence on facial hemodynamics andnerve function recoveryTian Chun-nil,Li Chun-Iing15Zhang Yi-yi21 Acupuncture and

5、 Massage Department5Tongchuan Mining Bureau CentralHospital,Tongchuan,Shaanxi,727000,China2 Acupuncture and Rehabilitation Department,Xian Fifth Hospital,Xian,Shaanxi,710082,China Corresponding author: Zhang Yiyi, Abstract Objective To investigate the efficacy of meridian acupuncture combined with m

6、ecobalamin in the treatment of peripheral facial paralysis, and the influence on facial hemodynamics and nerve function recovery. Methods Patients with peripheral facial paralysis admitted to the hospital from March 2020 to March 2021 were selected, and divided into observation group (49 cases) and

7、control group (48 cases) by random number table method. Patients in the control group were treated with acupoint injection of mecobalamin, and those in the observation group were treated with meridian acupuncture on this basis. The peak systolic velocity (Vs) of facial artery, end diastolic velocity

8、 (Vd), resistance index (RI) and facial bioelectric signals were measured before and after treatment. The House-Brackman (HB) facial grading system, facial paralysis Portmann score amd facial disability Index (FDI) were used for evaluation. Results After treatment, Vs and Vd were increased, while RI

9、 was decreased in the two groups (P0.05). After treatment, Vs and Vd in the observation group (65.2510.22) cm/s and (12.853.12) cm/s were higher than those in the control group (52.129.63) cm/s and (8.594.12) cm/s, while RI (0.770.12) was lower than that in the control group (0.850.(Pv0.05). After t

10、reatment, bioelectric signals in the two groups were significantly decreased (P0,05), which were lower in tthe observation group than in the control group (P0.05). After treatment, the HB score and social function (FDIS) score were significantly decreased, while Portmann score and physical function

11、(FDIP) score were significantly increased in the two groups (P0,05). The H-B score and FDIS score of the observation group (1.970.50) and (15.272.41) were significantly lower than those of the control group (2.660.70) and (12.221.65). Portmann score and FDIP score (8.112.65) and (20.123.26) were sig

12、nificantly higher than those of the control group (12.173.22) and (16.273.25) (P0.05). Conclusion Meridian acupuncture combined with acupoint injection of mecobalamin is effective in the treatment of peripheral facial paralysis, which can reduce the differences in bioelectric signals, accelerate fac

13、ial hemodynamics, improve facial nerve function and disability index.Key words Peripheral facial paralysis; Meridian acupuncture; Mecobalamin; Acupoint injection; Nerve function recovery; Facial hemodynamics周围性面瘫是一种常见的神经障碍性疾病，主要表现为口眼歪斜，部分可存在舌前味觉 减退或听觉过敏等表现，影响患者身心健康及生活质量。目前西医治疗主要以控制水肿、 抗病毒、神经营养等方式为主，

14、但部分患者效果不甚理想。在中医学上，周围性面瘫发生 主要原因为面部气血痹阻、经脉失养而导致筋肉不收，继而出现口眼歪斜症状，经筋刺法是 石学敏院士在中医“经筋理论”基础上总结而来的针刺疗法，可起到促进局部血液循环，改善 面部神经的功能口川。目前已有部分研究探讨了经筋刺法对周围性面瘫的疗效ML但较少有 研究对其作用机制进行研究及探讨。本研究分析经筋刺法联合甲钻胺对患者进行治疗并探讨 其作用机理，为临床资料提供数据支持及理论依据。1资料与方法1.1 一般资料纳入2020年3月至2021年3月本院收治的102例周围性面瘫患者，随机分为观察组及 对照组，两组分别有2、3例患者中途失访退出研究，最终观察组

15、及对照组分别有49、48 例患者纳入研究。观察组男性28例，女性21例，年龄(39567.41)岁：病程(4.171.22) d,左侧发病20例，右侧29例；对照组男性30例，女性18例，年龄(40.257.85)岁；病 程(4.221.30) d；左侧发病18例，右侧30例。两组患者一般资料无统计学差异(Px).05)。诊断标准：参考周围性面瘫相关标准，骤然起病，既往多有病毒感染史或受凉追 风史，表现为口眼歪斜、眼睑闭合不全、流泪，口角歪向健侧，鼻唇沟变浅：面部肌肉瘫痪、 呆滞、麻木：耳后疼痛，无法鼓腮、皱眉：舌前味觉减退。纳入标准：符合诊断标准；首次、 单侧发病；年龄18-70岁。排除标准

16、：存在器质性病变者；其他原因包括肿瘤、腮腺炎等引 起的面瘫；合并精神系统疾病者；存在甲钻胺过敏史者；依从性差，未能完成治疗及调查者。 1.2方法两组患者均给予抗病毒治疗、改善循环、营养神经等治疗，对照组进行甲钻胺(天津金 耀药业有限公司，H, 1ml： 0.5mg)穴位注射治疗，穴位：阳白、地仓平刺，颊车、翳风直 刺，深度O.3O.5寸，推入0.25ml甲钻胺注射液，按压止血，每周一、三、五各治疗一次， 其余日休息，2周为一疗程，连续治疗2疗程。观察组每周一、三、五行甲钻胺穴位注射，联合使用经筋刺法治疗，周二、四、六行经 筋刺法，周日休息一天，2周为1疗程，连续治疗2个疗程。经筋刺法选穴及治法：阳白四 透以阳白为中心向头维、上星、丝竹空、攒竹四穴透刺，深度0.57寸；地仓、颊车间经筋 排刺，每隔0.5寸按照阳明经循行路线进行直刺，深度O.3O5寸；四白两透以四