| 摘要: |
| 目的：基于面动脉彩超观察刺络放血疗法对中重度贝尔麻痹患者面肌运动功能的改善情况和临床疗效。方法：将72例中重度贝尔麻痹患者随机分为治疗组与对照组，每组各36例。在急性期，治疗组和对照组均予普通针刺+常规西药治疗；在亚急性期和恢复期，治疗组采用普通针刺+常规西药治疗+刺络放血疗法治疗，对照组采用普通针刺+西药常规治疗；2组均治疗5个疗程。比较2组治疗前后面动脉下颌段及鼻翼段的收缩期峰值血流速度（peak systolic velocity，PSV）、舒张末期血流速度（end diastolic velocity，EDV）和阻力指数（resistance index，RI），以及House-Brackmann面神经功能分级量表（House-Brackmann Grading System，HBGS）、Sunnybrook面神经评定系统（Sunnybrook Facial Grading System，SFGS）评分，并评价临床疗效。结果：2组均脱落2例，最终治疗组、对照组均为34例。总有效率、愈显率治疗组分别为91.18%（31/34）和70.59%（24/34），对照组为85.29%（29/34）和58.83%（20/34），2组比较，差异均有统计学意义（P＜0.05）。2组患侧面动脉下颌段及鼻翼段PSV、EDV、RI水平，HBGS分级和SFGS各项目评分治疗前后组内比较及治疗后组间比较，差异均有统计学意义（P＜0.01或P＜0.05）；2组SFGS静态项评分中颊、总分，和随意运动项目、联动项目评分中微笑、耸鼻、吸吮、总分治疗前后组内比较及治疗后组间比较，差异均有统计学意义（P＜0.05或P＜0.01）。结论：面动脉彩超能从PSV、EDV、RI体现贝尔麻痹患者治疗前后的变化，刺络放血疗法较普通针刺更能升高中重度贝尔麻痹患者PSV、EDV，降低RI，可更有效地改善中重度贝尔麻痹患者的面肌运动功能，尤其对微笑、耸鼻、吸吮动作的改善更为显著。 |
| 关键词: 贝尔麻痹 中重度 刺络放血 针刺疗法 临床研究 |
| DOI： |
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| Clinical effect of blood-letting puncture in treatment of moderate-to-severe Bell’s palsy：A study based on color Doppler ultrasound of the facial artery |
| CHEN Jiaming,WU Weikun,ZHUANG Chuijia |
| (Quanzhou Orthopedic-Traumatological Hospital，Quanzhou 362000，Fujian，China;Quanzhou Hospital of Traditional Chinese Medicine，Quanzhou 362000，Fujian，China) |
| Abstract: |
| Objective：To investigate the clinical effect of blood-letting puncture in the treatment of patients with moderate-to-severe Bell’s palsy based on color Doppler ultrasound of the facial artery，as well as its effect in improving the motor function of facial muscles.Methods：A total of 72 patients with moderate-to-severe Bell’s palsy were randomly divided into treatment group and control group，with 36 patients in each group.In the acute stage，the patients in both groups were given conventional acupuncture combined with conventional Western medicine treatment；in the subacute stage and the convalescence stage，the patients in the treatment group were given conventional acupuncture，conventional Western medicine treatment，and blood-letting puncture，while those in the control group were given conventional acupuncture and conventional Western medicine treatment.Both groups were treated for 5 courses.The two groups were compared in terms of the peak systolic velocity (PSV)，end diastolic velocity (EDV)，and resistance index (RI) of the mandibular and lateral nasal branches of the facial artery，as well as House-Brackmann Grading System (HBGS) score and Sunnybrook Facial Grading System (SFGS) score.Results：Two patients were lost to follow-up in each group，resulting in 34 patients in each group.There were significant differences between the treatment group and the control group in overall response rate ［91.18% (31/34) vs 85.29% (29/34)，P < 0.05］ and marked effective/cure rate ［70.59% (24/34) vs 58.83% (20/34)，P < 0.05］.After treatment，both groups had significant changes in the PSV，EDV，and RI of the mandibular and lateral nasal branches of the facial artery and the scores of each item of HBGS and SFGS，and there were significant differences in these indicators between the two groups after treatment (P < 0.01 or P < 0.05).And both groups had significant changes in the cheek and total score of static items in SFGS,as well as smiling, nose wrinkling，and sucking movements score of voluntary movement items in SFGS and synkinesis items in SFGS.And there were significant differences in these indicators between the two groups after treatment (P＜0.01 or P＜0.05）.Conclusion：Color Doppler ultrasound of the facial artery can reflect the changes in patients with Bell’s palsy through PSV，EDV，and RI.Compared with conventional acupuncture，blood-letting puncture can increase PSV and EDV，reduce RI，and effectively improve the motor function of facial muscles in patients with moderate-to-severe Bell’s palsy，with particularly greater improvements in smiling，nose wrinkling，and sucking movements. |
| Key words: Bell’s palsy moderate-to-severe blood-letting puncture acupuncture therapy clinical research |
