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背景:贝尔麻痹原因不明,且由于不同的病因和病程可导致病情轻重不同的结果,目前临床上对面肌功能测定和预后还没有取得一致的意见。目的:探讨贝尔麻痹的定位诊断、瞬目反射(Blinkreflex,BR)和神经电图(electroneurography,ENoG)测试结果与预后的关系,并进一步探讨治疗时机的选择。设计:前后对照研究。单位:广西壮族自治区北海市人民医院耳鼻咽喉科。对象:1989-01/1999-12北海市人民医院耳鼻咽喉科住院符合诊断标准的贝尔麻痹患者42例,其中把资料完整的36例进行统计分析。方法:对36例贝尔麻痹患者均进行定位诊断、BR和ENoG测试,并对面肌功能进行评分。结果:对定位诊断其病变在D段、面肌功能评分在11分以下者,BR和ENoG测试显示面肌功能差的患者,保守治疗效果亦差,而行面神经减压术后可望提高疗效,发病1个月内检查结果与预后一致(P>0.05)。在发病后40d手术的2例,均能完全恢复;2个月行2例,1例完全恢复,1例部分恢复;3个月与4个月分别各行1例,都能部分恢复。结论:对临床上定位诊断病变在D段以下,面肌功能评分在11分以上,发病后1个月内BR测试R1波存在,ENoG测试面肌纤维损失<90%的患者,保守治疗可完全恢复。反之,效果就差,对保守治疗无效者,必须行面神经减压术。
Background: The cause of Bell’s paralysis is unknown, and due to different etiology and course of disease, different severity of illness can result. Currently no consistent opinion on the measurement and prognosis of facial muscle function has been obtained. Objective: To explore the relationship between the diagnosis of Bell’s palsy, Blinkreflex (BR) and electroneurography (ENoG) test results and prognosis, and to explore the choice of treatment opportunity. Design: A contextual control study. Unit: Beihai People’s Hospital of Guangxi Zhuang Autonomous Region Otolaryngology. PARTICIPANTS: Forty-two patients with Bell’s palsy admitted to Department of Otorhinolaryngology, Beihai People’s Hospital from January 1989 to December 1999 were analyzed retrospectively. Among them, 36 cases with complete data were analyzed statistically. Methods: All 36 patients with Bell’s palsy were diagnosed by location, BR and ENoG test, and facial muscle function was evaluated. Results: The diagnosis of lesions in the D segment, facial muscle function score of 11 points or less, BR and ENoG test showed poor facial muscle function in patients with conservative treatment is poor, and facial nerve decompression is expected to improve the efficacy , Within 1 month of onset of the test results consistent with the prognosis (P> 0.05). After the onset of 40d operation in 2 cases, can be completely restored; 2 months line 2 cases, 1 case of complete recovery, 1 case of partial recovery; 3 months and 4 months, respectively, one in each line, can partially recover. CONCLUSION: Conservative treatment can be restored completely in patients with clinical diagnosis of pathological lesions below the D segment, facial muscle function score above 11 points, BR wave R1 within 1 month after onset, and <90% loss of ENF on the testicular myofibers . Conversely, the effect is poor, ineffective conservative treatment, facial nerve decompression surgery must be performed.