毫火针为主治疗周围性面瘫时机选择—黄石玺教授的经验总结

发布时间：2018-05-26 20:26

本文选题：面瘫 + 针灸　；参考：《中国中医科学院》2017年硕士论文

【摘要】：背景周围性面瘫是神经系统疾病中的一种常见病、多发病,常常急性起病,数小时或者1～3日内症状达到本病的高峰。临床上以突然一侧面部表情肌瘫痪,病侧额纹消失或变浅,眼裂增大,鼻唇沟平坦,口角下垂歪向健侧为特征。面瘫是“面子上的工程”,虽然不致命,治疗不及时或不得当则易“毁容”,影响患者的生活、工作及心理状态,降低患者的生活质量,增加抑郁风险。面瘫的发病率为26～34/10万,患病率为258/10万,且青壮年居多。多数患此病的患者未经治疗亦能完全恢复,但仍有20%～30%的病人面神经功能不能完全恢复而遗留后遗症。面神经炎如恢复不完全时,常可产生瘫痪肌的挛缩、面肌痉挛或联带运动,也就是面神经麻痹的后遗症。随着人们生活工作压力的增大,生活节奏的增加,运动减少,以车代步的生活方式,致使年轻群体体质逐渐下降,面瘫的发生仍在继续增加,这将对患者本人及其家庭、社会带来极大的影响,造成巨大的损失。一直以来面瘫的分期及时间制定上存在多种说法,就目前的文献分析,急性期多在1～7天,各位医家都比较认同,但静止期、恢复期、后遗症期就各不相同,没有统一的标准,多数为医家个人经验。黄石玺教授认为面瘫的分期更多的是为了指导治疗或判断预后情况,每位患者的致病因素不同,体质不同及病情轻重的差异,在临床工作中观察到,除了急性期可以确定为1周左右,其恢复期与后遗症期要根据患者具体的病情而定,不可绝对化确定,更不能一概而论。目前有关针灸介入时机存在很大争议,医学界尚无确切公认的说法,主要集中在急性期是否应该进行针刺治疗。目前两种观点:现在医学多认为疾病早期,面神经受压肿胀,此时针刺刺激会导致组织渗透增加,组织液增多,水肿加重,故不建议早期针灸介入;而传统医学多认为应本着“既病防变”的原则,早期介入针灸,保护正气,控制传变,使疾病在早期阶段即被治愈。因此关于面瘫针灸介入时机,特别是面瘫早期是否可以针灸及介入针灸治疗后是否具有临床价值问题需要进一步探讨研究,提高对周围性面瘫的认识,探索其治疗时机及经济有效的治疗方案具有重要的现实意义。目的观察毫火针为主配合体针和温针灸一体的疗法治疗发病7天内和发病8～30天周围性面瘫患者的临床疗效,探讨周围性面瘫毫火针为主介入的最佳时机。方法根据病程将符合纳入标准的60例患者分为A组和B组,各30例患者。发病7天内为A组,发病8～30天为B组,两组均采用毫火针为主配合体针和温针灸一体的疗法。取穴:选用患侧太阳、丝竹空、阳白、四白、颧毼、迎香、下关、承浆、地仓透颊车、翳风;远端取穴:双侧合谷。毫针刺上述穴位,毫火针点刺翳风、风池、牵正、阳白、迎香、地仓,在太阳、下关、翳风、颧毼穴的针柄上放置点燃的2cm长的艾柱。每次留针20min。毫火针治疗前3次每天1次,之后隔天1次,体针每天治疗1次,10次为一个疗程,一个疗程后间隔2天。观察6个疗程,分别于第2、4、6疗程后统计治疗效果,并于末次治疗30天后随访评价远期疗效,采用House-Brackman(H-B)面神经功能分级及中医症状体征量化积分进行评价。结果(1)疗程结束统计疗效,毫火针为主配合体针和温针灸一体的疗法治疗发病7天内和发病8～30天的周围性面瘫患者,面神经功能及中医症状体征均有改善,说明毫火针为主配合体针和温针灸一体的疗法对于30天内的周围性面瘫的恢复有促进作用,且发病7天内介入者疗效及中医症状体征改善均要优于发病8～30天介入者。(2)周围性面瘫发病7天内介入毫火针为主配合体针和温针灸一体的疗法者,从第2疗程后与治疗前比较差异就有统计学意义,而发病8～30天介入治疗者第2疗程后组内比较不具备统计学意义,第4、6疗程后差异有统计学意义,表明发病7天内和发病8～30天介入毫火针为主配合体针和温针灸一体的疗法比较,发病7天内介入毫火针为主的治疗者面神经恢复较快。(3)末次治疗30天随访统计可以看出,A、B两组的痊愈率及总有效率均有提高,且A组痊愈率及总有效率明显高于B组,说明毫火针为主的治疗不仅可以加速神经恢复,对于远期疗效也有较好的效果。(4)第6疗程后,分析8例无效患者发现,治疗前他们的面神经分级均在Ⅴ级和Ⅵ级,即重瘫和全瘫,说明患者面神经分级越高,炎症对神经损伤越重者,神经恢复就越艰难。对病人末次治疗30天随访也发现,面神经分级在Ⅲ级及以下者,往往在30天内能恢复到Ⅰ级。(5)统计第6疗程后60例周围性面瘫患者面神经分级与痊愈率的关系可以看出,两者呈负相关,即发病时面神经分级越高,痊愈率越低,也说明发病时患者面神经分级越高,面神经恢复越慢。结论通过对周围性面瘫文献的研究,在查阅和分析其他医家研究成果和临床观察的基础上,结合黄石玺教授对周围性面瘫治疗的独特见解,我们认为在周围性面瘫发病7天内即可介入针灸治疗,不仅不会加重临床症状,还会提高临床疗效,提高治愈率,缩短病程。
[Abstract]:The peripheral facial paralysis is a common disease of the nervous system disease, which is frequently occurring and often acute. The symptoms can reach the peak of the disease within a few hours or 1~3 days. The clinical symptoms are paralysis of facial expression muscle, the diseased side of the frontal striae disappear or shallower, the eye fissure increases, the nose lip is flat, the angle of the mouth is slanted to the healthy side. Facial paralysis is the "face" Although the project on the son is not fatal, the treatment is not timely or not easy to be disfigured, it can affect the life, work and state of the patient, reduce the quality of life and increase the risk of depression. The incidence of facial paralysis is 26 to 34/10 million, the prevalence rate is 258/10 million, and the majority of the years are strong. Again, but still 20% to 30% of the patient's facial nerve function can not be completely recovered and left sequelae. When facial neuritis is incomplete, it often produces the contracture of the paralytic muscle, the spasm of the facial muscle or the associated movement, that is the sequelae of the facial nerve paralysis. The way of life gradually reduces the physique of the young group, and the occurrence of facial paralysis continues to increase. This will bring great influence on the patient and his family and society, causing huge loss. There are many kinds of statements on the stages and time of facial paralysis. In the present literature analysis, the acute period is more than 1~7 days. They all agree, but the period of rest, the recovery period, the sequelae are different, there is no uniform standard, and most of them are the personal experience of the doctors. The staging of the facial paralysis is more for the purpose of guiding the treatment or judging the prognosis. The pathogeny factors of each patient are different, the differences of physique and the severity of the condition are different in Huangshi. In addition to the acute period can be determined for about 1 weeks, the recovery period and the sequelae should be determined according to the patient's specific condition. It can not be determined absolutely, but it can not be generalized. There is a lot of controversy on the timing of acupuncture and moxibustion, and there is no definite recognition in the medical field. It is mainly focused on whether acupuncture should be carried out in the acute period. At present two points of view: medical treatment is now considered early disease, facial nerve compression swelling, at this time acupuncture stimulation will lead to increased tissue infiltration, increased tissue fluid and edema, so it is not recommended for early acupuncture intervention; but traditional medicine should be based on the principle of "disease prevention and change", early intervention acupuncture, protection of positive gas, control transmission, disease in The early stage is cured. Therefore, it is important to study the timing of acupuncture and moxibustion for facial paralysis, especially whether the clinical value of acupuncture and interventional acupuncture treatment in the early stage of facial paralysis needs further study. It is of great practical significance to improve the understanding of the peripheral facial paralysis and to explore the time of treatment and the economic and effective treatment plan. To observe the clinical efficacy of the milli needle combined acupuncture and warm acupuncture in the treatment of patients with peripheral facial paralysis within 7 days and 8~30 days of onset of peripheral facial paralysis. The best time for the intervention of peripheral facial paralysis was discussed. Methods according to the course of disease, 60 patients were divided into group A and group B, each of 30 patients. The incidence of the disease was A within 7 days. Group, 8~30 days of disease was group B, the two groups were treated with the main combination needle and warm acupuncture. In the sun, the Xiaguan, Yifeng, the needle handle of the zygomatic point on the needle of 2cm long, 1 times a day 3 times a day before treatment, 1 times a day, 1 times a day for the body acupuncture, 10 times a course of treatment and 2 days after a course of treatment. Observe the effect of 6 courses after the 2,4,6 course, and 3 after the last treatment. After 0 days follow-up, the long-term curative effect was evaluated, and the House-Brackman (H-B) facial nerve function classification and TCM symptom and physical signs were evaluated. Results (1) the curative effect of the end of the course of treatment, the milli needle and the warm acupuncture and moxibustion in the treatment of peripheral facial paralysis patients within 7 days and 8~30 days of disease, facial nerve function and traditional Chinese Medicine The symptoms and signs were improved, indicating that the treatment of the milli needle and the combination of warm acupuncture and moxibustion has a promoting effect on the recovery of peripheral facial paralysis within 30 days, and the effect of the intervention in 7 days and the improvement of the symptoms and signs of traditional Chinese medicine are better than those of the 8~30 days of intervention. (2) the intervention of the milli needles in the peripheral facial paralysis for 7 days The treatment of acupuncture and warm acupuncture was statistically significant after the second course of treatment and before the treatment, while the 8~30 days after the second course of intervention was not statistically significant. The difference was statistically significant after the 4,6 course of treatment, indicating that there were 7 days and 8~30 days after the onset of the disease. Compared with the therapy of moxibustion, the facial nerve was recovered quickly in the 7 days after the onset of the treatment. (3) the follow-up statistics of the last 30 days of treatment showed that the recovery rate and total effective rate of group A, B two were improved, and the recovery rate and total effective rate of group A were significantly higher than that in group B. (4) after the sixth course of treatment, 8 cases of ineffective patients were found to be graded in grade V and VI before treatment, that is, paraplegia and total paralysis. It shows that the higher the level of facial nerve, the more serious the nerve injury is, the more difficult the nerve recovery is. For the last 30 days of treatment, the facial nerve is also found, and the facial nerve is found, and the facial nerve also found the facial nerve after the last 30 days follow-up. The grade I and below can be recovered to grade I in 30 days. (5) the relationship between the facial nerve classification and the recovery rate in 60 cases of peripheral facial paralysis after sixth courses of treatment shows that the higher the level of facial nerve and the lower the recovery rate, the higher the facial nerve classification and the slower the facial nerve recovery. Conclusion through the study of the literature on the peripheral facial paralysis, on the basis of consulting and analyzing the research results and clinical observation of other doctors, and combining the unique views of the Huangshi seal on the treatment of peripheral facial paralysis, we think that the intervention of acupuncture and moxibustion can not aggravate the clinical symptoms and improve the clinical treatment in the 7 days of the peripheral facial paralysis. Effect, improve the cure rate, shorten the course of disease.
【学位授予单位】：中国中医科学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R246.6

【参考文献】