【摘要】：目的：本研究通過(guò)對(duì)耳背靜脈放血結(jié)合針刺治療風(fēng)熱型特發(fā)性面神經(jīng)麻痹的臨床療效觀察,客觀評(píng)價(jià)其療效,為耳背靜脈放血療法治療風(fēng)熱型特發(fā)性面神經(jīng)麻痹的臨床應(yīng)用及推廣提供依據(jù)。方法：納入研究的患者為2015年4月至2016年1月就診于廣州中醫(yī)藥大學(xué)第一附屬醫(yī)院針灸科門診,符合本次納入標(biāo)準(zhǔn),并且自愿參加本研究,共60例。研究方案為在藥物治療的基礎(chǔ)上,按照1：1的比例,將60例患者隨機(jī)分配至治療組(即耳背靜脈放血加針刺組)和對(duì)照組(即單純針刺組),每組各30例。對(duì)照組采取常規(guī)針刺,主穴：陽(yáng)白透魚腰、太陽(yáng)、攢竹、牽正、迎香、顴毼、地倉(cāng)透頰車、夾承漿、人中、中渚(均為患側(cè))、合谷(對(duì)側(cè)),配穴：風(fēng)熱證加曲池。面癱初起時(shí)采用輕手法淺刺,只留針不加電,病程超過(guò)一周可加用電針,用連續(xù)疏波,每次20-30分鐘,隔日一次,周一、周三、周五治療,1周3次為1療程,總共治療四個(gè)療程。治療組在對(duì)照組的基礎(chǔ)上,在病程兩周內(nèi)施加耳背靜脈放血治療,雙側(cè)交替進(jìn)行放血。分別于首次就診治療前,病程兩周后,治療結(jié)束后對(duì)患者進(jìn)行評(píng)估。采用House-Brackmann面神經(jīng)功能評(píng)價(jià)分級(jí)系統(tǒng)(以下簡(jiǎn)稱H-B評(píng)級(jí))、周圍性面神經(jīng)炎治療成績(jī)?cè)u(píng)分表(以下簡(jiǎn)稱Portmann評(píng)分表)、面部殘疾指數(shù)(FDI)作為聯(lián)系評(píng)價(jià)指標(biāo),分別對(duì)兩組的療效進(jìn)行評(píng)估。完成數(shù)據(jù)采集整理工作后,使用SPSS20.0軟件進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果：本研究分別于首次就診治療前、病程兩周后、治療結(jié)束后進(jìn)行三次數(shù)據(jù)采集(分別標(biāo)記為T1、T2、T3數(shù)據(jù)),以P0.05為差異具有統(tǒng)計(jì)學(xué)意義的標(biāo)準(zhǔn)進(jìn)行評(píng)價(jià)；1、通過(guò)對(duì)兩組患者一般資料(性別、年齡、病程、H-B治療前分級(jí),Portmann治療前評(píng)分,FDIP、FDIS治療前評(píng)分)的比較,經(jīng)統(tǒng)計(jì)學(xué)分析,差異均無(wú)統(tǒng)計(jì)學(xué)意義,P0.05,表明兩組組間具有可比性。2、臨床療效：治療組和對(duì)照組總有效率分別為90%、80%,經(jīng)秩和檢驗(yàn),差異無(wú)統(tǒng)計(jì)學(xué)意義,P0.05,表明治療組和對(duì)照組治療均有效,但不能認(rèn)為治療組總有效率優(yōu)于對(duì)照組。3、在H-B評(píng)級(jí)中,兩組之間T2、T3差異無(wú)統(tǒng)計(jì)學(xué)意義,P＞0.05；組內(nèi)T2、T3經(jīng)統(tǒng)計(jì)學(xué)分析,差異具有統(tǒng)計(jì)學(xué)意義,P0.05。表明兩組治療均有療效,但尚不能說(shuō)明治療組優(yōu)于對(duì)照組。4、Portmann評(píng)分中,組內(nèi)T2、T3時(shí)間結(jié)點(diǎn)分析差異有統(tǒng)計(jì)學(xué)意義,P0.05；治療組與對(duì)照組之間無(wú)統(tǒng)計(jì)學(xué)差異,P0.05；在T2時(shí)間結(jié)點(diǎn),治療組和對(duì)照組兩組間有顯著的統(tǒng)計(jì)學(xué)差異,P0.05；在T3時(shí)間結(jié)點(diǎn),治療組和對(duì)照組兩組間無(wú)顯著的統(tǒng)計(jì)學(xué)差異,P0.05；也就是說(shuō),治療組和對(duì)照組在不同時(shí)間結(jié)點(diǎn)上均有療效,治療組在T2結(jié)點(diǎn)的療效優(yōu)于對(duì)照組,但兩組的總療效無(wú)明顯差異。5、FDI評(píng)分中,包括FDIP和FDIS評(píng)分,組內(nèi)時(shí)間結(jié)點(diǎn)T2、T3的差異有統(tǒng)計(jì)學(xué)意義,P0.05;治療組與對(duì)照組之間有統(tǒng)計(jì)學(xué)差異,P0.05；對(duì)于兩個(gè)分組之間時(shí)間結(jié)點(diǎn)的比較,在T2、 T3時(shí)間結(jié)點(diǎn),治療組和對(duì)照組兩組間無(wú)顯著的統(tǒng)計(jì)學(xué)差異,P＞0.05也就是說(shuō),治療組和對(duì)照組在不同時(shí)間結(jié)點(diǎn)上均有療效,但不能說(shuō)明治療組優(yōu)于對(duì)照組。結(jié)論：1.耳背靜脈放血配合針刺及常規(guī)針刺治療風(fēng)熱型特發(fā)性面神經(jīng)麻痹均有效。2.兩組在治療特發(fā)性面神經(jīng)麻痹的總體療效效果相當(dāng),但治療組在提升急性期-靜止期過(guò)渡期的Portmann評(píng)分上優(yōu)于對(duì)照組。
[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.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R246.6

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本文編號(hào)：2201427