本文選題：面癱 + 針灸�。� 參考：《中國中醫(yī)科學(xué)院》2017年碩士論文

【摘要】：背景周圍性面癱是神經(jīng)系統(tǒng)疾病中的一種常見病、多發(fā)病,常常急性起病,數(shù)小時或者1～3日內(nèi)癥狀達到本病的高峰。臨床上以突然一側(cè)面部表情肌癱瘓,病側(cè)額紋消失或變淺,眼裂增大,鼻唇溝平坦,口角下垂歪向健側(cè)為特征。面癱是“面子上的工程”,雖然不致命,治療不及時或不得當則易“毀容”,影響患者的生活、工作及心理狀態(tài),降低患者的生活質(zhì)量,增加抑郁風(fēng)險。面癱的發(fā)病率為26～34/10萬,患病率為258/10萬,且青壯年居多。多數(shù)患此病的患者未經(jīng)治療亦能完全恢復(fù),但仍有20%～30%的病人面神經(jīng)功能不能完全恢復(fù)而遺留后遺癥。面神經(jīng)炎如恢復(fù)不完全時,�？僧a(chǎn)生癱瘓肌的攣縮、面肌痙攣或聯(lián)帶運動,也就是面神經(jīng)麻痹的后遺癥。隨著人們生活工作壓力的增大,生活節(jié)奏的增加,運動減少,以車代步的生活方式,致使年輕群體體質(zhì)逐漸下降,面癱的發(fā)生仍在繼續(xù)增加,這將對患者本人及其家庭、社會帶來極大的影響,造成巨大的損失。一直以來面癱的分期及時間制定上存在多種說法,就目前的文獻分析,急性期多在1～7天,各位醫(yī)家都比較認同,但靜止期、恢復(fù)期、后遺癥期就各不相同,沒有統(tǒng)一的標準,多數(shù)為醫(yī)家個人經(jīng)驗。黃石璽教授認為面癱的分期更多的是為了指導(dǎo)治療或判斷預(yù)后情況,每位患者的致病因素不同,體質(zhì)不同及病情輕重的差異,在臨床工作中觀察到,除了急性期可以確定為1周左右,其恢復(fù)期與后遺癥期要根據(jù)患者具體的病情而定,不可絕對化確定,更不能一概而論。目前有關(guān)針灸介入時機存在很大爭議,醫(yī)學(xué)界尚無確切公認的說法,主要集中在急性期是否應(yīng)該進行針刺治療。目前兩種觀點:現(xiàn)在醫(yī)學(xué)多認為疾病早期,面神經(jīng)受壓腫脹,此時針刺刺激會導(dǎo)致組織滲透增加,組織液增多,水腫加重,故不建議早期針灸介入;而傳統(tǒng)醫(yī)學(xué)多認為應(yīng)本著“既病防變”的原則,早期介入針灸,保護正氣,控制傳變,使疾病在早期階段即被治愈。因此關(guān)于面癱針灸介入時機,特別是面癱早期是否可以針灸及介入針灸治療后是否具有臨床價值問題需要進一步探討研究,提高對周圍性面癱的認識,探索其治療時機及經(jīng)濟有效的治療方案具有重要的現(xiàn)實意義。目的觀察毫火針為主配合體針和溫針灸一體的療法治療發(fā)病7天內(nèi)和發(fā)病8～30天周圍性面癱患者的臨床療效,探討周圍性面癱毫火針為主介入的最佳時機。方法根據(jù)病程將符合納入標準的60例患者分為A組和B組,各30例患者。發(fā)病7天內(nèi)為A組,發(fā)病8～30天為B組,兩組均采用毫火針為主配合體針和溫針灸一體的療法。取穴:選用患側(cè)太陽、絲竹空、陽白、四白、顴毼、迎香、下關(guān)、承漿、地倉透頰車、翳風(fēng);遠端取穴:雙側(cè)合谷。毫針刺上述穴位,毫火針點刺翳風(fēng)、風(fēng)池、牽正、陽白、迎香、地倉,在太陽、下關(guān)、翳風(fēng)、顴毼穴的針柄上放置點燃的2cm長的艾柱。每次留針20min。毫火針治療前3次每天1次,之后隔天1次,體針每天治療1次,10次為一個療程,一個療程后間隔2天。觀察6個療程,分別于第2、4、6療程后統(tǒng)計治療效果,并于末次治療30天后隨訪評價遠期療效,采用House-Brackman(H-B)面神經(jīng)功能分級及中醫(yī)癥狀體征量化積分進行評價。結(jié)果(1)療程結(jié)束統(tǒng)計療效,毫火針為主配合體針和溫針灸一體的療法治療發(fā)病7天內(nèi)和發(fā)病8～30天的周圍性面癱患者,面神經(jīng)功能及中醫(yī)癥狀體征均有改善,說明毫火針為主配合體針和溫針灸一體的療法對于30天內(nèi)的周圍性面癱的恢復(fù)有促進作用,且發(fā)病7天內(nèi)介入者療效及中醫(yī)癥狀體征改善均要優(yōu)于發(fā)病8～30天介入者。(2)周圍性面癱發(fā)病7天內(nèi)介入毫火針為主配合體針和溫針灸一體的療法者,從第2療程后與治療前比較差異就有統(tǒng)計學(xué)意義,而發(fā)病8～30天介入治療者第2療程后組內(nèi)比較不具備統(tǒng)計學(xué)意義,第4、6療程后差異有統(tǒng)計學(xué)意義,表明發(fā)病7天內(nèi)和發(fā)病8～30天介入毫火針為主配合體針和溫針灸一體的療法比較,發(fā)病7天內(nèi)介入毫火針為主的治療者面神經(jīng)恢復(fù)較快。(3)末次治療30天隨訪統(tǒng)計可以看出,A、B兩組的痊愈率及總有效率均有提高,且A組痊愈率及總有效率明顯高于B組,說明毫火針為主的治療不僅可以加速神經(jīng)恢復(fù),對于遠期療效也有較好的效果。(4)第6療程后,分析8例無效患者發(fā)現(xiàn),治療前他們的面神經(jīng)分級均在Ⅴ級和Ⅵ級,即重癱和全癱,說明患者面神經(jīng)分級越高,炎癥對神經(jīng)損傷越重者,神經(jīng)恢復(fù)就越艱難。對病人末次治療30天隨訪也發(fā)現(xiàn),面神經(jīng)分級在Ⅲ級及以下者,往往在30天內(nèi)能恢復(fù)到Ⅰ級。(5)統(tǒng)計第6療程后60例周圍性面癱患者面神經(jīng)分級與痊愈率的關(guān)系可以看出,兩者呈負相關(guān),即發(fā)病時面神經(jīng)分級越高,痊愈率越低,也說明發(fā)病時患者面神經(jīng)分級越高,面神經(jīng)恢復(fù)越慢。結(jié)論通過對周圍性面癱文獻的研究,在查閱和分析其他醫(yī)家研究成果和臨床觀察的基礎(chǔ)上,結(jié)合黃石璽教授對周圍性面癱治療的獨特見解,我們認為在周圍性面癱發(fā)病7天內(nèi)即可介入針灸治療,不僅不會加重臨床癥狀,還會提高臨床療效,提高治愈率,縮短病程。
[Abstract]:The peripheral facial paralysis is a common disease of the nervous system disease, which is frequently occurring and often acute. The symptoms can reach the peak of the disease within a few hours or 1~3 days. The clinical symptoms are paralysis of facial expression muscle, the diseased side of the frontal striae disappear or shallower, the eye fissure increases, the nose lip is flat, the angle of the mouth is slanted to the healthy side. Facial paralysis is the "face" Although the project on the son is not fatal, the treatment is not timely or not easy to be disfigured, it can affect the life, work and state of the patient, reduce the quality of life and increase the risk of depression. The incidence of facial paralysis is 26 to 34/10 million, the prevalence rate is 258/10 million, and the majority of the years are strong. Again, but still 20% to 30% of the patient's facial nerve function can not be completely recovered and left sequelae. When facial neuritis is incomplete, it often produces the contracture of the paralytic muscle, the spasm of the facial muscle or the associated movement, that is the sequelae of the facial nerve paralysis. The way of life gradually reduces the physique of the young group, and the occurrence of facial paralysis continues to increase. This will bring great influence on the patient and his family and society, causing huge loss. There are many kinds of statements on the stages and time of facial paralysis. In the present literature analysis, the acute period is more than 1~7 days. They all agree, but the period of rest, the recovery period, the sequelae are different, there is no uniform standard, and most of them are the personal experience of the doctors. The staging of the facial paralysis is more for the purpose of guiding the treatment or judging the prognosis. The pathogeny factors of each patient are different, the differences of physique and the severity of the condition are different in Huangshi. In addition to the acute period can be determined for about 1 weeks, the recovery period and the sequelae should be determined according to the patient's specific condition. It can not be determined absolutely, but it can not be generalized. There is a lot of controversy on the timing of acupuncture and moxibustion, and there is no definite recognition in the medical field. It is mainly focused on whether acupuncture should be carried out in the acute period. At present two points of view: medical treatment is now considered early disease, facial nerve compression swelling, at this time acupuncture stimulation will lead to increased tissue infiltration, increased tissue fluid and edema, so it is not recommended for early acupuncture intervention; but traditional medicine should be based on the principle of "disease prevention and change", early intervention acupuncture, protection of positive gas, control transmission, disease in The early stage is cured. Therefore, it is important to study the timing of acupuncture and moxibustion for facial paralysis, especially whether the clinical value of acupuncture and interventional acupuncture treatment in the early stage of facial paralysis needs further study. It is of great practical significance to improve the understanding of the peripheral facial paralysis and to explore the time of treatment and the economic and effective treatment plan. To observe the clinical efficacy of the milli needle combined acupuncture and warm acupuncture in the treatment of patients with peripheral facial paralysis within 7 days and 8~30 days of onset of peripheral facial paralysis. The best time for the intervention of peripheral facial paralysis was discussed. Methods according to the course of disease, 60 patients were divided into group A and group B, each of 30 patients. The incidence of the disease was A within 7 days. Group, 8~30 days of disease was group B, the two groups were treated with the main combination needle and warm acupuncture. In the sun, the Xiaguan, Yifeng, the needle handle of the zygomatic point on the needle of 2cm long, 1 times a day 3 times a day before treatment, 1 times a day, 1 times a day for the body acupuncture, 10 times a course of treatment and 2 days after a course of treatment. Observe the effect of 6 courses after the 2,4,6 course, and 3 after the last treatment. After 0 days follow-up, the long-term curative effect was evaluated, and the House-Brackman (H-B) facial nerve function classification and TCM symptom and physical signs were evaluated. Results (1) the curative effect of the end of the course of treatment, the milli needle and the warm acupuncture and moxibustion in the treatment of peripheral facial paralysis patients within 7 days and 8~30 days of disease, facial nerve function and traditional Chinese Medicine The symptoms and signs were improved, indicating that the treatment of the milli needle and the combination of warm acupuncture and moxibustion has a promoting effect on the recovery of peripheral facial paralysis within 30 days, and the effect of the intervention in 7 days and the improvement of the symptoms and signs of traditional Chinese medicine are better than those of the 8~30 days of intervention. (2) the intervention of the milli needles in the peripheral facial paralysis for 7 days The treatment of acupuncture and warm acupuncture was statistically significant after the second course of treatment and before the treatment, while the 8~30 days after the second course of intervention was not statistically significant. The difference was statistically significant after the 4,6 course of treatment, indicating that there were 7 days and 8~30 days after the onset of the disease. Compared with the therapy of moxibustion, the facial nerve was recovered quickly in the 7 days after the onset of the treatment. (3) the follow-up statistics of the last 30 days of treatment showed that the recovery rate and total effective rate of group A, B two were improved, and the recovery rate and total effective rate of group A were significantly higher than that in group B. (4) after the sixth course of treatment, 8 cases of ineffective patients were found to be graded in grade V and VI before treatment, that is, paraplegia and total paralysis. It shows that the higher the level of facial nerve, the more serious the nerve injury is, the more difficult the nerve recovery is. For the last 30 days of treatment, the facial nerve is also found, and the facial nerve is found, and the facial nerve also found the facial nerve after the last 30 days follow-up. The grade I and below can be recovered to grade I in 30 days. (5) the relationship between the facial nerve classification and the recovery rate in 60 cases of peripheral facial paralysis after sixth courses of treatment shows that the higher the level of facial nerve and the lower the recovery rate, the higher the facial nerve classification and the slower the facial nerve recovery. Conclusion through the study of the literature on the peripheral facial paralysis, on the basis of consulting and analyzing the research results and clinical observation of other doctors, and combining the unique views of the Huangshi seal on the treatment of peripheral facial paralysis, we think that the intervention of acupuncture and moxibustion can not aggravate the clinical symptoms and improve the clinical treatment in the 7 days of the peripheral facial paralysis. Effect, improve the cure rate, shorten the course of disease.
【學(xué)位授予單位】：中國中醫(yī)科學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R246.6

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