神经肌肉电针法治疗面神经炎的临床研究

发布时间：2018-01-11 01:27

本文关键词：神经肌肉电针法治疗面神经炎的临床研究　出处：《中国人民解放军医学院》2016年硕士论文　论文类型：学位论文

【摘要】：目的：按照301医院针灸科多年治疗面神经炎的经验,通过对160例面神经炎患者进行神经肌肉电针法与传统治疗方法对照研究,并对电针刺激评价面神经炎的信度和效度进行研究,为面神经炎患者临床选取更直接、更有效、更经济的评价和治疗方案提供依据。方法：1.针灸治疗：160例面神经炎患者采用SPSS统计软件进行完全随机分组法编号,患者按就诊顺序对应编号分成神经肌肉电针组(A组)和传统方案治疗组(B组),每组患者各80人.A组就诊第1周采用耳尖穴、完骨穴、内耳区交替放血疗法；第2-4周采用沿神经肌肉走行,即按患侧枕额肌、眼轮匝肌、提上唇肌、颧肌、口轮匝肌、下唇方肌分布取穴方法取5组穴位进行治疗。穴位主要为患侧阳白穴、阳白旁穴；瞳子移穴、承泣穴；颧移穴、地仓穴；迎香穴、上迎香穴；夹承浆穴、承浆旁穴。B组：第1周,予口服激素、神经营养药物及改善循环药物进行治疗；第2-4周采用第九版《针灸治疗学》面神经炎治疗方案进行取穴治疗。主要穴位有患侧阳白穴、攒竹穴、四白穴、颧毼穴、地仓穴、颊车穴、翳风穴、牵正穴,太阳穴、合谷穴.两组患者电针均给予疏密波,2～100Hz交替进行刺激。每日1次,留针30min,5天为一疗程,休息2天,继续下一疗程,连续治疗4疗程后观察临床效果。2.电针刺激法评价面神经炎的信度和效度：采用电针刺激表情肌时的反应,即电针刺激患侧面部,根据表情肌反应程度判断面神经受损情况(轻度、中度、重度),并以判断预后(好、一般、差)；同时采用肌电图评估法,根据观察肌电图提示面神经损伤程度即完全损伤、不完全损伤、无损伤,以判断预后；根据两种检测结果的差异性来检验电针刺激法评价面神经炎的信度和效度。结果：1.针灸治疗结果显示：神经肌肉电针法组患者面瘫症状恢复快且完全,治愈率明显优于传统方案组(P0.01)；有效率也优于传统方案组(P0.01)。2.面瘫评价结果显示：两种方法评介面瘫损伤程度无明显差异(P0.05),对于预后的判断是一致性(P0.05)。结论：1.放血疗法合神经肌肉电针法治疗面神经炎能够明显缩短面神经炎患者的病程,且恢复的更完全,比传统方案治疗面神经炎更好,临床上治疗面神经炎可参照此方案进行。2.电针刺激法与肌电图评估法在评价面神经损伤方面一致,具有良好的信度和效度.因为电针刺激法简便、有效、低廉,值得临床推广应用。
[Abstract]:Objective: according to the experience of treating facial neuritis in Department of Acupuncture and moxibustion of 301 Hospital, 160 cases of facial neuritis were treated with neuromuscular electroacupuncture and traditional treatment. The reliability and validity of electroacupuncture stimulation in evaluating facial neuritis were studied, which was more direct and effective for the patients with facial neuritis. Methods 1. Acupuncture and moxibustion was used to treat 160 patients with facial neuritis by SPSS software. The patients were divided into neuromuscular electroacupuncture group (group A) and traditional treatment group (group B) according to the corresponding numbering according to the order of consultation. 80 patients in each group were treated with Auricular acupoint and end bone point in the first week. Internal ear area alternate bloodletting therapy; In the 2-4 weeks, the nerve muscle was used, that is, the occipital frontalis muscle, orbicularis oculi muscle, levator lip muscle, zygomaticus muscle, orbicularis oris muscle. Treatment of 5 groups of acupoints by the distribution of the lower lip muscles. The acupoints are mainly Yangbai points and Yangbai points in the affected side. The pupil moves the acupoint, the Cheng sobs the acupoint; Zygomatic-shifting acupoint, Ducang acupoint; Yingxiang point, up Yingxiang point; Group B was treated with oral hormones, neurotrophic drugs and circulatory improvement drugs in the first week. In the 2-4 weeks, we used 9th version of "Acupuncture and moxibustion Therapeutics" to treat facial neuritis. The main acupoints were Yangbai point, Zanzhu point, Sibai point, zygomaticus point, Decang point, buccal che point and Yifeng point. The patients in the two groups were stimulated by electroacupuncture at 2100Hz. Once a day, the needle was kept for 5 days as a course of treatment, and the rest was 2 days. The clinical effect was observed after 4 consecutive courses of treatment. 2. The reliability and validity of electroacupuncture in evaluating facial neuritis: the reaction of electroacupuncture on facial expression muscle, that is, electroacupuncture to stimulate the affected side. Facial nerve injury (mild, moderate, severe) was judged according to the degree of expression muscle reaction, and the prognosis was evaluated (good, average, poor). At the same time, the method of electromyography was used to evaluate the degree of facial nerve injury, that is, complete injury, incomplete injury and no injury, according to the observation of EMG, in order to judge the prognosis. According to the difference of the two test results to test the reliability and validity of electroacupuncture stimulation in evaluating facial neuritis. Results 1. The results of acupuncture and moxibustion showed that the symptoms of facial paralysis in neuromuscular electroacupuncture group recovered quickly and completely. The cure rate was significantly better than that of the traditional regimen group (P 0.01). The effective rate was also better than that of the traditional regimen group (P 0.01). The evaluation results of facial paralysis showed that there was no significant difference between the two methods in evaluating the injury degree of facial paralysis (P0.05). Conclusion: 1. Bloodletting therapy combined with neuromuscular electroacupuncture for facial neuritis can significantly shorten the course of facial neuritis and recover more completely. Compared with the traditional treatment of facial neuritis, clinical treatment of facial neuritis can refer to this program .2.Electroacupuncture stimulation method and electromyography evaluation method in the evaluation of facial nerve injury is consistent. It has good reliability and validity, because electroacupuncture stimulation is simple, effective and cheap, so it is worth popularizing in clinic.
【学位授予单位】：中国人民解放军医学院
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R246.6

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