Clinical Research On Effect Of Opposing Needling Method On Peripheral Motor Nerve Injury Of Facial Paralysis In Acute Stage

[Objective] Study of observing the therapeutic effects of opposing needling method on treatment of facial paralysis in acute stage, and explore the best intervention period in the treatment of facial paralysis.[Methods] 108 cases of peripheral facial paralysis patients were randomly divided into three groups:an acute stage group with opposing needling method, an acute stage group with needling on the affected side, a resting stage group with needling on the affected side.3 groups were made of basic treatment, based on the use of acupuncture methods with the same prescription.Research design and treatment plan:the basic treatment was with medication of prednisone, vitamin B1and B12. Vitamin B1and B12 was prescription for 20days, everyday 3times and every time 10mg, while prednisone start-high. In the first 3 days, patient should take 30mg/day; in the next three days, this dosages was reduced to 20mg; in the 7th-9th day, the dosages was 10mg/day; and in the last 3 days it was 5mg/day. Three groups were treated with their own relevant method. Acute stage group with opposing needling method:acupuncture treatment begun in acute stage. Chosen the points of ST2, ST4, ST6, ST7, GB14, EX-HN2and EX-HN11 in the healthy side, combined with GB20 and LI4 on both side. Perpendicular insertion of needle on ST2, ST6, ST7, EX-HN2and EX-HN110.5cun, LI4 and GB200.5-0.8cun; oblique insertion from ST4 to ST6, from GB14 to EX-HN50.5cun. The even manipulation was adopted in this group which should be slightly twisting without lifting and thrusting. Acute stage group with needling on the affected side: acupuncture treatment begun in acute stage. Chosen the points of ST2, ST4, ST6, ST7, GB14, EX-HN2and EX-HN11 in the affected side, combined with GB20 and LI4 on both side. Shallow insertion of needle on ST2, ST4, ST6, ST7, GB20, EX-HN2and EX-HN11 0.3-0.5cun, without lifting and thrusting and twisting was used in this group. The even manipulation was adopted in LI4 and GB20 which inserted perpendicularly 0.5-0.8cun depth. Resting stage group with needling on the affected side:in acute stage, patients in this group begun basic therapy only, while acupuncture treatment begun in resting stage (8days after being attack). Chosen the points of ST2, ST4, ST6, ST7, GB14, EX-HN2and EX-HN11 in the affected side as the main points, combined with GB20 and LI4 on both side. Oblique insertion from ST4 to ST6, from GB14 to EX-HN50.8cun, the other points inserted 0.5-0.8cun with even method. Course of treatment:all the 3 groups acupuncture 1 times a day (extended back over the weekend 2 days),10 times for a course.2 courses is a whole treatment.Therapeutic evaluation:The curative effect were evaluated with House-Brackmann (H-B) six-point subjective grading scale which was adopted by the American Academy of Otolaryngology-Head and Neck Surgery on the recommendation of the Facial Nerve Disorders Committee, and the facial nerve function evaluation scale adopted by Japan facial nerve institute.Data process and statistical analysis:Epidata3.1 was used to establish database, and CHISS software was used to analyze the results.[Results]1. Comparison of the curative effect with each evaluation method among different groups in different times before and after treatment.To compare the score and grade of the facial nerve function, H-B scales of before and after treatment,1 month,3 month follow-up, p<0.01, statistically significant differences. Acupuncture treatment is effective for peripheral facial paralysis of acute and resting stage.2. Comparison of effects between groups of different periods(1) After treatment:to compare the improvement of the score and grade of the facial nerve function. H-B scales of before and after treatment between every two groups, p>0.05, statistically no significant differences.(2) After 1 month follow-up:to compare the improvement of the score of facial nerve function, H-B scales, there has no statistically differences between acute stage group with opposing needling method and acute stage group with needling on the affected side (P>0.05), while the 2group in acute stage has significant statistically difference with the group in resting stage.To compare the improvement of the grade of facial nerve function, there has no statistically differences between acute stage group with opposing needling method and acute stage group with needling on the affected side, and the 2 groups of puncture on the affected side in both acute and resting stage (P>0.05). The therapeutic effect of acute stage group with opposing needling method is superior to resting stage group with needling on the affected side (p<0.01).(3) After 3 month follow-up:To compare the improvement of score and grade of the facial nerve function, H-B scales, the therapeutic effect of acute stage group with opposing needling method is the best (p<0.01), acute stage group with needling on the affected side is superior to resting stage group with needling on the affected side (p<0.01).3. Comparison of the therapeutic effect with each evaluation method among different groups in different times before and after treatment.There has no statistically differences between acute stage group with opposing needling method and acute stage group with needling on the affected side (P>0.05), while the 2group in acute stage has significant statistically difference with the group in resting stage (p<0.01).[Conclusions]1. The therapeutic effect is most obvious with intervention of treatment in the acute stage. 2. To compare with the group of acute stage needling on the affected side, acupuncture on the healthy side has the same total effective rate. Besides, the latter has high cure rate, relatively short course, and less sequela.