耳背静脉放血配合针刺治疗风热型特发性面神经麻痹的临床疗效观察

发布时间：2018-08-24 16:50

【摘要】：目的：本研究通过对耳背静脉放血结合针刺治疗风热型特发性面神经麻痹的临床疗效观察,客观评价其疗效,为耳背静脉放血疗法治疗风热型特发性面神经麻痹的临床应用及推广提供依据。方法：纳入研究的患者为2015年4月至2016年1月就诊于广州中医药大学第一附属医院针灸科门诊,符合本次纳入标准,并且自愿参加本研究,共60例。研究方案为在药物治疗的基础上,按照1：1的比例,将60例患者随机分配至治疗组(即耳背静脉放血加针刺组)和对照组(即单纯针刺组),每组各30例。对照组采取常规针刺,主穴：阳白透鱼腰、太阳、攒竹、牵正、迎香、颧毼、地仓透颊车、夹承浆、人中、中渚(均为患侧)、合谷(对侧),配穴：风热证加曲池。面瘫初起时采用轻手法浅刺,只留针不加电,病程超过一周可加用电针,用连续疏波,每次20-30分钟,隔日一次,周一、周三、周五治疗,1周3次为1疗程,总共治疗四个疗程。治疗组在对照组的基础上,在病程两周内施加耳背静脉放血治疗,双侧交替进行放血。分别于首次就诊治疗前,病程两周后,治疗结束后对患者进行评估。采用House-Brackmann面神经功能评价分级系统(以下简称H-B评级)、周围性面神经炎治疗成绩评分表(以下简称Portmann评分表)、面部残疾指数(FDI)作为联系评价指标,分别对两组的疗效进行评估。完成数据采集整理工作后,使用SPSS20.0软件进行统计学分析。结果：本研究分别于首次就诊治疗前、病程两周后、治疗结束后进行三次数据采集(分别标记为T1、T2、T3数据),以P0.05为差异具有统计学意义的标准进行评价；1、通过对两组患者一般资料(性别、年龄、病程、H-B治疗前分级,Portmann治疗前评分,FDIP、FDIS治疗前评分)的比较,经统计学分析,差异均无统计学意义,P0.05,表明两组组间具有可比性。2、临床疗效：治疗组和对照组总有效率分别为90%、80%,经秩和检验,差异无统计学意义,P0.05,表明治疗组和对照组治疗均有效,但不能认为治疗组总有效率优于对照组。3、在H-B评级中,两组之间T2、T3差异无统计学意义,P＞0.05；组内T2、T3经统计学分析,差异具有统计学意义,P0.05。表明两组治疗均有疗效,但尚不能说明治疗组优于对照组。4、Portmann评分中,组内T2、T3时间结点分析差异有统计学意义,P0.05；治疗组与对照组之间无统计学差异,P0.05；在T2时间结点,治疗组和对照组两组间有显著的统计学差异,P0.05；在T3时间结点,治疗组和对照组两组间无显著的统计学差异,P0.05；也就是说,治疗组和对照组在不同时间结点上均有疗效,治疗组在T2结点的疗效优于对照组,但两组的总疗效无明显差异。5、FDI评分中,包括FDIP和FDIS评分,组内时间结点T2、T3的差异有统计学意义,P0.05;治疗组与对照组之间有统计学差异,P0.05；对于两个分组之间时间结点的比较,在T2、 T3时间结点,治疗组和对照组两组间无显著的统计学差异,P＞0.05也就是说,治疗组和对照组在不同时间结点上均有疗效,但不能说明治疗组优于对照组。结论：1.耳背静脉放血配合针刺及常规针刺治疗风热型特发性面神经麻痹均有效。2.两组在治疗特发性面神经麻痹的总体疗效效果相当,但治疗组在提升急性期-静止期过渡期的Portmann评分上优于对照组。
[Abstract]:Objective: To observe the clinical efficacy of auricular dorsal vein bleeding combined with acupuncture in the treatment of wind-heat idiopathic facial paralysis, and objectively evaluate its efficacy, so as to provide basis for clinical application and popularization of auricular dorsal vein bleeding therapy in the treatment of wind-heat idiopathic facial paralysis. Sixty patients were randomly assigned to the treatment group (i.e. ear vein bleeding plus acupuncture group) and the control group (i.e. simple acupuncture group) on the basis of drug treatment and in accordance with the ratio of 1:1. 30 cases in each group. The control group was treated with routine acupuncture, the main points: Yang Bai Diaoyu waist, sun, bamboo, pulling, Yingxiang, zygomatic shuttles, barn through the cheek car, clip slurry, in person, Zhongzhu (both sides), Hegu (opposite side), with acupoints: wind-heat syndrome plus curved batteries. Shubo, 20-30 minutes each time, once every other day, Monday, Wednesday, Friday treatment, three times a week for a course of treatment, a total of four courses of treatment. The treatment group on the basis of the control group, in the course of two weeks to apply auricular vein bleeding treatment, bilateral alternate bleeding. Assessment. House-Brackmann Facial Nerve Function Assessment Grading System (hereinafter referred to as H-B rating), Peripheral Facial Neuritis Treatment Score Scale (hereinafter referred to as Portmann rating table), Facial Disability Index (FDI) as a linked evaluation index, the efficacy of the two groups were assessed. After data collection and collation, the use of SPSS20.0 software. Results: Data were collected three times (marked as T1, T2, T3 data) before the first treatment and two weeks after the course of the disease, respectively, and the difference was evaluated statistically by P 0.05. 1. The general data (gender, age, course of disease, H-B pre-treatment grade, Portma) of the two groups were analyzed. The comparison of NN score before treatment, FDIP score before treatment, FDIS score before treatment showed no statistical significance, P 0.05, indicating that the two groups have comparability.2, clinical efficacy: the total effective rate of the treatment group and the control group were 90%, 80%, respectively, by rank sum test, there was no significant difference, P 0.05, indicating that the treatment group and the control group were effective. But can not think that the total effective rate of the treatment group is better than the control group.3, in the H-B rating, there is no significant difference between the two groups T2, T3, P > 0.05; T2, T3 within the group by statistical analysis, the difference is statistically significant, P 0.05. It shows that the two groups have curative effect, but still can not show that the treatment group is better than the control group.4, Portmann score, the group T2, T3 time. Node analysis was statistically significant, P 0.05; There was no statistical difference between the treatment group and the control group, P 0.05; At T2 time node, there was significant statistical difference between the treatment group and the control group, P 0.05; At T3 time node, there was no significant statistical difference between the treatment group and the control group, P 0.05; That is to say, there was no significant statistical difference between the treatment group and the control group, P 0.05; The curative effect of the treatment group was better than that of the control group at T2 node, but the total curative effect of the two groups had no significant difference. There was no significant difference between the treatment group and the control group at T2 and T3 time points, P > 0.05 means that both the treatment group and the control group have curative effect at different time points, but it can not show that the treatment group is superior to the control group. Facial paralysis is effective. 2. The two groups in the treatment of idiopathic facial paralysis of the overall effect is similar, but the treatment group in the promotion of acute-static transition Portmann score is better than the control group.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R246.6

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