【作者】 陆昱成；

【导师】 陈兴华；

【作者基本信息】 广州中医药大学 ， 针灸推拿学， 2011， 硕士

【摘要】 目的周围型面神经麻痹又称为面瘫,中医学称为“面痉”、“口歪”、“口僻”“口喎”、“口眼歪斜”等不同的病名。周围型面神经麻痹是以局部营养神经血管因受风寒而发生痉挛,引致该神经组织缺血、水肿；或因炎症,使面神经产生肿胀、受压,神经功能发生障碍,因而出现面肌瘫痪。周围性面瘫是临床多发病、常见病,针灸作为临床治疗周围性面瘫的最常用方法之一,其疗效已得到广泛认可。但在与药物联合应用的研究方面,各医家看法不一,临床结论也不尽相同,因此本研究采用量化、随机对照的方法,观察针刺结合牵正散治疗周围性面瘫的临床疗效。方法本研究将62例周围性面瘫患者按首次来诊的先后顺序,用随机数字表法将所观察的病例随机分为两组,针药组31例,针刺组31例。针药组选取太阳、阳白、地仓透颊车、翳风、合谷(健侧)。人中沟歪斜配水沟,体弱者配足三里。同时服用牵正散(为白附子、僵蚕、全蝎,药物采用台湾庄松荣药厂生产的科学中药),每次服用1g,每天3次,温开水送下。针刺组选穴同针药组。两组疗程相同,即：隔日1次,3次为1个疗程,共4个疗程,疗程间休息2天。经治疗后观察House-Brachmann面神经功能分级标准、抑郁自评量表(SDS)及临床疗效。结果通过House-Brachmann面神经功能分级标准、抑郁自评量表(SDS)进行评价,结果显示,针刺结合牵正散治疗周围性面瘫可明显提高HB分级,改善临床症状,缓解精神抑郁状况,提高临床疗效。1.治疗前两组患者各个级别的病例数差异无统计学意义(P>0.05)；治疗后针药组与针刺组在Ⅰ级的差别具有统计学意义(P<0.05),而其他组别差异则均无统计学意义。2.治疗前组间比较P=0.856,提示组间具有可比性；针刺组前后比较P=0.190,提示治疗前后评分差异无显著性意义；针药组前后比较P=0.014,提示评分下降有统计学意义。说明针药组可有效的降低患者SDS自评分。3.两组总有效率、显效率、无效率的差异无统计学意义,提示两组在此方面效果相当；痊愈率方面,针药组优于针刺组(P<0.05),而在有效率方面,针刺组优于针药组(P<0.05)。结论针刺结合牵正散治疗周围性面瘫可明显提高HB分级,改善临床症状,相比较普通针刺组差异具有统计学意义,提示针刺结合牵正散疗效更为显著。临床疗效方面,针药组的痊愈率高于针刺组,与HB分级结果相一致。抑郁自评量表(SDS)测评表明,部分面瘫患者存在精神抑郁情况,平均评分则处于抑郁症诊断标准的临界,表明患者在面瘫后的心理压力巨大,尤其是年轻的患者,担心治疗、后遗症等问题。通过针药结合迅速缓解临床症状后各种担忧均得到缓解,与SDS评分一致。结果表明：针刺结合牵正散治疗周围性面神经麻痹疗效明显优于对照组。更多还原

【Abstract】 ObjectivePeripheral facial palsy also called facial paralysis, in TCM called "Mianjing", "Kouwai" and "Koupi", "Kouguo", "Kouyanwaixie", etc. The local nutrition vessels and nerves suffer wind-chill then causes neural tissue ischemia and edema, or inflammation that cause the facial nerve swelling and under pressuring, neural function obstacles, thus lead to facial paralysis. Peripheral facial paralysis is a common clinical frequently-occurring disease, acupuncture is one of the most commonly used methods in treating facial nerves palsies, its curative effect has been widely recognized. However, when in combination with drugs, different doctors show different opinions, clinical conclusions are different, too. Therefore, this study used quantifiable, randomized method to observ the clinical curative effect of acupuncture treatment combined with Qianzhengsan in treating facial nerves palsiesMethodsWith the random number table,62 cases of facial nerves palsies patients according to the order that first diagnosed were randomly divided into the acupuncture with medicine group (31 cases) and acupuncture group(31 cases) acupuncture with medicine group selected Taiyang, Yangbai, Dicang towards Jiache, Yifeng, Hegu (healthy side). People with nasolabial sulcus skewed added Shui Gou, the infirm with Zusanli. Took Qianzhengsan (including Baifuzi, JiangCan, Quanxie)at the same time, 1g at a time, three times a day, with warm water. Acupuncture group Chose pionts same as acupuncture with medicine group. The treatment course (every other day,3 times a day as a course,4 course)were the same, too. After therapy, observed House-Brachmann classification standard of facial nerve function, depression self-rating scale (SDS) and clinical curative effect.ResultsThe House-Brachmann classification standard of facial nerve function and depression self rating scale (SDS) showed that acupuncture combined with Qianzhengsan in treating facial nerves palsies could evidently improve HB classification, improve the clinical symptoms and alleviate depression, improve the clinical effect.1.Before the treatment, there were no statistic difference for cases between the two groups in every scale (P>0.05); after the treatment, there was statistic difference in I scale (P<0.05) and no statistic difference in the scales between the two groups.2. Before the treatment, compared within the two groups, P=0.856, suggest the two groups are comparable;test group compared before treatment and after treatment P=0.190, suggest that there was no great difference before and after treatment; control group compared before treatment and after treatment P=0.014, suggest that there was great difference before and after treatment;and we get the conlusion that test group can reduce patients’SDS score effectively.3.There were no great statistic difference between the two groups in total effective rate, effective rate, ineffeciency, suggest that the effect equals between the two groups;test group is better than control group in cure rate (P<0.05), control group is better than test group in effective rate (P <0.05)ConclusionAcupuncture combined with Qianzhengsan in treating facial nerves palsies could obviously improve HB classification, improve the clinical symptoms, compared with ordinary acupuncture group, there was a statistically significant difference, which mean that the treatment group had a more remarkable curative effect. In the clinical curative effect, the cure rate of treatment group was higher than acupuncture group, which was corresponding to HB classification result.The depression self rating scale (SDS) assessment showed that some patients with mental depression, their average ratings were reaching the depression diagnosis standard, it showed that they had psychological pressure for facial palsies, especially those young patients who worried treatment and sequela, etc. After treatment by acupuncture with Chinese medicine, worry reduced followed by the rapid improvement of clinical symptoms, this was consistent with SDS scoreResultsThe efficacy of acupuncture combined with Qianzhengsan in treating facial nerves palsies is obvious better than control group.更多还原