【作者】 何姗諲；

【导师】 张宏；

【作者基本信息】 广州中医药大学 ， 针灸推拿学， 2010， 硕士

【摘要】 1研究目的周围性面瘫是常见病、多发病,由于患病后影响外观形象,给患者身心造成很大痛苦,直接影响患者日常生活活动。因此,选择采用疗效好的治疗手段,是研究的热点。针灸治疗面瘫历史悠久,效果肯定,本研究拟采用随机对照的方法,观察电针结合艾灸治疗风寒阻络型周围性面瘫的临床疗效,力求为临床治疗周围性面瘫提供有意义的研究成果,为推广针灸治疗周围性面瘫提供可靠的临床依据。2研究方法以单纯电针治疗为对照,以1993年中国协和医科大学出版社出版的《临床常见疾病诊疗标准》制定疗效评定标准进行评价和分析,以此来评价电针结合艾灸治疗风寒阻络型周围性面瘫的临床疗效。治疗方法：①电针取穴：采用主穴,循经取穴及随症配穴。主穴取太阳、阳白、地仓、颊车、合谷。随症则人中沟歪斜配地仓透水沟与承浆；目闭合不全者加攒竹、四白；素体赢弱者配足三里、曲池。电针方法：选用30×25mm毫针,刺入深度为10～20mm进针后调整至病人出现酸,麻,胀得气后,用快速捻转补泻法留针,接上(上海华谊牌G6805-1A)低频电子脉冲治疗仪,取疏密波,频率在14～20次／分,调节电流输出至“0”位。接通电源,调节输出电流由小渐大,以病人舒适耐受为度,以面部肌肉出现节律性轻微收缩宜。每次治疗30min。②艾灸取穴：地仓、颊车穴、风池、阳白穴,若有耳后压痛同时取翳风。艾灸方法：针刺同时进行艾灸(温和灸),点燃艾条,固定在距穴位2～3cm处进行温和灸,以局部温暖舒适为宜,至皮肤潮红为度。每个穴位治疗时间约3～5min。③疗程：每次治疗30min,每日1次,每5日为一疗程,疗程间休息2日,共计4个疗程。3研究结果①周围性面瘫的五个主要临床特征为：面部表情不自然、眼裂闭合不全、鼻唇沟变浅、口角歪斜、额纹消失。我们观察了两种治疗方案对上述五种主要临床症状的影响,发现在单纯电针治疗及电针结合艾灸治疗均可显著改善患者的五个主要症状(面部表情不自然、眼裂闭合不全、鼻唇沟变浅、口角歪斜、额纹消失),降低积分；两组比较发现,电针结合艾灸要好于单纯电针治疗,且在面部表情不自然、眼裂闭合不全程度、口角歪斜程度3方面,经统计学比较,有显著性差异,p<0.05。②无论是单纯电针治疗还是电针结合艾灸治疗风寒阻络型周围性面瘫,均有较好的临床疗效,对照组(单纯电针治疗组)的痊愈率33.33%,显效率36.67%,有效16.67%,无效13.33%,总有效率为86.67%；治疗组(电针结合艾灸)痊愈率46.67%,显效率30.00%,有效20.00%,无效3.33%,总有效率为96.67%,经统计学比较,电针结合艾灸疗效要好于单纯电针治疗。4研究结论①电针结合艾灸治疗风寒阻络型周围性面瘫具有良好的临床疗效,治愈率及总有效率均高于与单纯电针治疗。②文献研究表明现阶段关于针灸治疗周围性面瘫的基础研究相当薄弱,其具体的作用机理仍不十分清楚,因此,应加强基础研究的投入。③另一方面疗效判定缺乏客观的统一标准。因此,对这些问题深入研究,将有利于我们探讨药物及治疗方法对周围性面瘫的疗效,从而开发更新治疗手段。④文献研究表明,采用多种治疗方式,即综合疗法对于提高周围性面瘫的治愈率有积极的意义。更多还原

【Abstract】 1 The objects of the researchFacial paralysis is a common disease, affecting the appearance due to illness after the image of great physical and mental suffering to patients, directly affecting patient activities of daily living. So, choose good treatment effect, is a research focus. Acupuncture treatment of facial paralysis has a long history and effective, this study was a randomized control method to observe electro-acupuncture combined with moxibustion cold obstruction syndrome of peripheral facial paralysis in the clinical efficacy, and strive for the clinical treatment of peripheral facial paralysis meaningful research results, to promote acupuncture treatment of peripheral facial paralysis according to a reliable clinical.2 The method of the researchTo pure electric acupuncture as the control and evaluation system to HB 1993, Peking Union Medical College Press the "standard of clinical diagnosis and treatment of common diseases," to develop standards to evaluate the efficacy of assessment and analysis, in order to evaluate the electro-acupuncture combined with moxibustion treatment of cold obstruction syndrome of peripheral facial paralysis of clinical efficacy.Treatment:①Acupuncture acupoints:The main point, along with the disease by selecting points and acupoints. The main point to take the sun, sun white, to warehouses, cheek cars, gu. Communication with the disease are among the skewed distribution to warehouse flooded ditch and the Order of pulp; projects were added Cuanzhu dysraphism,4 white; ferrite weak that those with less than three, the song pool. EA Methods:30×25mm needle, pierce a depth of 10 ~ 20mm needle adjusted to the patient occurred after the acid, hemp, distended gas, with a quick stay of Acupuncture needles, connected to the low frequency electronic pulse therapeutic apparatus, get density, the frequency at 20Hz or more, adjust current output to "0" bit. Switch on the power to regulate the output current by a small mounting, the patient tolerance for the degree of comfort to the facial muscles appear slightly rhythmic contraction of facial heat is appropriate. Each treatment 30min.②moxibustion acupoints:in warehouses, trucks cheek point, the wind pool, sun white point, if the ear tenderness while taking Yifeng. Moxibustion methods: Acupuncture at the same time moxibustion (mild moxibustion), ignited moxa, a fixed point 2 ~ 3cm away from the office for mild moxibustion to suitable local warm and comfortable to the skin for the degree of flushing. Treatment time per point is about 3~5min.③Treatment:Each treatment 30min, day 1, every 5 days a course of treatment breaks 2, a total of 4 courses.3 The results of the research①Peripheral facial paralysis of the five main clinical characteristics: facial expressions are not natural, eye crack closure was incomplete, shallow nasolabial fold, mouth oblique, the amount of lines disappear. We observed two kinds of treatment programs on the impact of five major clinical symptoms found in the simple acupuncture treatment and acupuncture combined with moxibustion therapy could significantly improve the patient’s five major symptoms (facial expressions are not natural, eye-splitting dysraphism, nasolabial fold shallow, mouth askew, the amount of grain disappeared), lower integration; the two groups found that acupuncture combined with moxibustion acupuncture treatment is better than simple, and not in the natural facial expression, eye level split dysraphism, mouth askew Level 3, the by statistical comparison, there was significant difference, p<0.05.②Acupuncture alone or acupuncture combined with moxibustion treatment of cold obstruction syndrome of peripheral facial paralysis had good clinical efficacy. Among them, the control group (EA group) the cure rate was 33.33%, effective rate is 36.67%, effective rate of 16.67%,13.33% invalid rate, the total effective rate was 86.67%; treatment group (electro-acupuncture combined with Ai Moxibustion) cure rate was 46.67%, effective rate is 30.00%, 20.00% effective, ineffective to 3.33%, total effective rate was 96.67%. The statistical comparison, electro-acupuncture combined with moxibustion treatment to be better than EA.4 The conclusion of this research①Electro-acupuncture combined with moxibustion treatment of cold obstruction syndrome of peripheral facial paralysis with good clinical efficacy, the cure rate and total effective rate was higher than with pure electric acupuncture.②Acupuncture treatment in early stage no significant adverse events, and can effectively improve the cure rate and total effective, acupuncture should be promoted early intervention.③Literature shows that at this stage on the acupuncture treatment of peripheral facial paralysis weak basic research, the specific mechanism is still not very clear, therefore, should strengthen investment in basic research.④The other hand, determine the effect of lack of objective criteria. Therefore, in-depth study of these issues will help us to explore drugs and treatments on the efficacy of peripheral facial paralysis to develop newer treatment.⑤Literature shows that, using a variety of treatments, that combination therapy for improving the cure rate of peripheral facial paralysis has a positive meaning.更多还原