电针结合面肌功能训练在单纯性面瘫康复中的疗效
摘要：目的:本研究通过随机的三组对照试验，将电针、面肌功能训练、电针加
面肌功能训练三种不同方法对单纯性面瘫面神经功能的康复治疗的影响进行研究,借助表面肌电检测分析仪检测患者面部患健两侧的均方根（RMS）的平均值比值，来观察和比较电针组、面肌功能训练组、电针+面肌功能训练联合疗法对面瘫反复的临床疗效，并对患者面部患健两侧的均方根（RMS）的平均值比值的比较进行疗效的评价和分析。
方法:本研究采用随机对照法进行临床观察,将符合纳入标准的单纯性面瘫患者120例,采用随机数表法随机分为电针+面肌功能训练组、面肌功能训练组、电针组各40例，每组患者之间经过统计后，在性别、年龄、发病情况、面瘫侧、病程等比较，差异无统计学意义(P＞0.05)。参照表面肌电图的在急性发展期间、在稳定期间、在恢复期间不同的波形的走势和形态对电针治疗组、功能训练治疗组、电针+面肌功能训练组的检测结果进行评价，对治疗前后康复效果进行对比。治疗组采用电针+面肌功能训练联合方法进行康复治疗,对照组采用电针、面肌功能训练治疗。全部患者都要进行肌电图的检测，分别在发病5天内、15天内、35天后做肌电图检测，并利用肌电图的肌电信号进行评价，运用表面肌电检测分析仪检测患者面部患健两侧的均方根（RMS）的平均值比值，来比较三组治疗前后的临床疗效。
结果:运用辅助表面肌电检测分析仪对患者的面部患健两侧的均方根（RMS）的平均值比值进行分析后，来比较三组治疗前后的临床效果，其中电针组痊愈16例，显效16例，好转7例，无效1例，治愈率为80%。面肌功能训练组痊愈18例，显效14例，好转6例，无效2例，治愈率为80%。电针+面肌功能训练组痊愈23例，显效11例，好转6例，无效0例，治愈率为85%。从不同病程时的患侧与健侧RMS平均值比值来看，对于每种不同的肌群，在对40例患者的比值中，第15天的数据高于第5天，第35天的RMS的值高于第15天。比较电针组、面肌功能训练组、电针+面肌功能训练组的不同治疗病程时间，组间的P＜0.05，差异显著。患侧与健侧RMS平均值比值，发现颊肌群、口轮匝肌群、额肌群、鼻肌群在不同的病程患者中，RMS平均值的比值都有上升，其中，电针+面肌功能训练的疗效等表面肌电图各项指标高于其他组，组间的P＜0.05，具有统计学意义，差异显著。 结论：电针组和面肌功能训练组具有一定的疗效，两组治疗方法都具有较好的疗效。电针加面肌功能训练对恢复期单纯性面瘫的疗效明显优于电针组的治疗方法，也优于面肌功能训练组的治疗方法。表面肌电图辅助电针+面肌功能训练联合疗法对面瘫反复的临床疗效显著，值得临床推广。
关键词：表面肌电图；电针；面肌功能训练；单纯性面瘫
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Electric acupuncture combined with facial features in the curative effect of idiopathic facial paralysis rehabilitation
training
Abstract: Objective: three groups were randomized controlled trials in this study, electric acupuncture, facial features, electric acupuncture plus facial function training in three different methods for idiopathic facial paralysis of facial nerve function to study the influence of rehabilitation therapy, by using methods of electrical detection analyzer with facial health on both sides of the average ratio of root mean square (RMS), to observe and compare the curative group, the facial features including training group, plus facial function training the clinical curative effect of combination therapy for facial paralysis repeatedly, and for the patient on either side of the face of the healthy root mean square (RMS) the comparison of the average ratio of curative effect evaluation and analysis.
Methods: this research adopts randomized controlled method to conduct clinical observation, 120 cases of patients with idiopathic facial paralysis,, will be consistent with the inclusion criteria using the stochastic indicator method were randomly divided into electric acupuncture plus facial features, facial function training exercise group, electric acupuncture group ,there are 40 cases patients in each group, after statistics the sex, age, incidence, side of facial paralysis and course of the disease, there was no statistically significant difference (P > 0.05). Reference methods of electric figure during the acute development, during the period of stability, in the shape of the recovery during different waveforms and form groups of cupping therapy, functional training, electric acupuncture plus facial function training group to evaluate test results. The rehabilitation effect is compared before and after the treatment. Treatment group with electric acupuncture plus facial features combined training method for rehabilitation treatment, control group treated with electric acupuncture, facial function training. All patients to test the electromyography, respectively in the 5 days, 15 days, after 35 days do emg test, and evaluate the use of electromyography emg, using the methods of electrical detection analyzer with facial health on both sides of the average ratio of root mean square (RMS), to compare the clinical efficacy of three groups before and after treatment.
Results: Analysisthe the results using auxiliary methods of electrical detection analyzer on either side of the face of health and the patients with the average ratio of root mean square (RMS) , comparing the clinical effect of three groups before and after treatment, curative group ,there are 16 cases cured, 16 cases had marked effect, improvement in 7 cases, 1 had no effect, the cure rate was 80%. in the facial features training group, there are 18 cases cured, 14 cases were markedly effective, 6 cases improved, 2 cases failed, the cure rate was 80%. Electric acupuncture plus facial function recovery exercise group has 23 cases, among them 11 cases were markedly
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effective, 6 cases improved, 0 no effect, the cure rate was 85%. Different from the course of the disease in one side and healthy side, RMS average ratio for each of the different muscle groups, in the ratio of 40 cases of patients, 15 days of data is higher than 5 days, 35 days of the RMS value is higher than 15 days. Comparing the curative group, the facial features including training group, plus facial features of different treatment course of exercise group and the contralateral side RMS average ratio, found the cheek muscles, orbicularisoris muscles, frontal muscle group, nasal muscle in patients with different course, the ratio of the RMS average has increased, among them, the curative effect of electric acupuncture plus facial function training methods, such as electric chart each index is higher than other groups.
Conclusion: the curative group and the facial features training group has certain curative effect, two groups of treatment have good curative effect. Electric acupuncture plus facial function training on recovery of idiopathic facial paralysis group is obviously better than the effect of electric acupuncture treatment, also is better than that of the treatment of facial function training group. Methods of electric chart aided cupping plus facial function training combined therapy for facial paralysis repeated clinical curative effect is distinct, worth clinical promotion.
Key words: methods of electric diagram; Electric acupuncture; Facial features of training; Idiopathic facial paralysis
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目录
摘要 ................................................................................................................................................... I
1.1研究背景 ............................................................................................................................ 1 1.2研究现状 ............................................................................................................................ 2 2临床资料........................................................................................................................................ 4
2.1 一般资料 ........................................................................................................................... 4 2.2 中医与西医诊断标准 ....................................................................................................... 4 2.3 纳入与排除标准 ............................................................................................................... 5 2.4 分组方法 ........................................................................................................................... 5 2.5 剔除以及脱落的标准 ....................................................................................................... 5 3研究方法........................................................................................................................................ 6
3.1 仪器 ................................................................................................................................... 6 3.2治疗原则 ............................................................................................................................ 6 3.3 电针治疗方法 ................................................................................................................... 6 3.4面肌功能训练康复方法 .................................................................................................... 7 3.5 表面肌电图评价单纯性面瘫的方法 ............................................................................... 7 3.6 不良事件的处理方法 ....................................................................................................... 8 3.7 统计方法 ........................................................................................................................... 8 3.8疗效观察及疗效标准 ........................................................................................................ 9 4 研究结果....................................................................................................................................... 9
4.1电针组康复结果 .............................................................................................................. 10 4.2面肌功能训练组结果 ...................................................................................................... 10 4.3电针结合功能训练组结果 .............................................................................................. 11 4.4三组结果的对比与分析 .................................................................................................. 12 5讨论 ............................................................................................................................................. 13
5.1面神经的分段、三级分支与表情肌的关系 .................................................................. 13 5.2面瘫的发病机理及分析 .................................................................................................. 15 5.3影响治疗单纯性面瘫的因素 .......................................................................................... 16 5.4电针的治病原理及分析 .................................................................................................. 17 5.5面肌功能训练的治疗原理及分析 .................................................................................. 17 5.6电针结合面肌功能训练对单纯性面瘫康复的作用 ...................................................... 18 5.7 表面肌电图检测的优点 ................................................................................................. 18 6结论 ............................................................................................................................................. 19 7存在的不足与展望 ...................................................................................................................... 21 8结 语............................................................................................................................................ 21 参考文献......................................................................................................................................... 23 综述 ................................................................................................................................................ 25 参考文献......................................................................................................................................... 28 附 录 .............................................................................................................................................. 29 附表 ................................................................................................................................................ 31 致 谢 .............................................................................................................................................. 32
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