| ObjectiveFacial paralysis is one of the most common complications after acoustic neuroma surgery.This study summarized and analyzed the symptoms,signs and syndrome distribution of patients with facial paralysis after acoustic neuroma operation,so as to preliminarily explore the syndrome characteristics and pathogenesis of the disease;A randomized controlled normative study was used to explore the clinical efficacy of "Tongdu Huayu acupuncture formula" in the treatment of facial paralysis after acoustic neuroma,so as to provide new ideas and optimal treatment strategies for acupuncture and moxibustion in the treatment of this disease.MethodsPart Ⅰ:Analysis of TCM syndrome characteristics of patients with facial paralysis after acoustic neuroma operation:All cases come from patients with facial paralysis after acoustic neuroma surgery treated in the outpatient department of acupuncture and moxibustion of the First Affiliated Hospital of Guangzhou University of traditional Chinese medicine or the Department of acupuncture and neurosurgery of the First Affiliated Hospital of Sun Yat sen University from January 2016 to June 2021.It is planned to collect 96 cases.After being included in the study,all patients first collected the information of four diagnosis of traditional Chinese medicine,including the main symptoms of facial paralysis and concurrent symptoms such as spirit,cold and heat,sweating,defecation,taste,diet,sleep,face color,tongue and pulse.The database of TCM four diagnosis information items was established in Excel.After importing the collected results into Spss 25.0 software,the Wald method and square Euclidean distance method were used for cluster analysis.According to the distribution of syndrome items,a TCM expert group composed of three chief physicians discussed the initial model of cluster analysis,combined with TCM professional knowledge and clinical practice,and finally determined the TCM syndrome name and classification standard of facial paralysis after acoustic neuroma surgery.According to this standard,the TCM syndrome type of each patient is determined by analyzing the clinical symptoms and tongue and pulse manifestations of each patient.Then,by summarizing the distribution of symptoms,signs and syndrome types of the included patients,we can preliminarily explore the syndrome characteristics and pathogenesis characteristics of the disease.Part Ⅱ:Clinical observation of Tongdu Huayu acupuncture formula in the treatment of facial paralysis after acoustic neuroma operation:after completing the collection of four diagnostic information,the patients with facial paralysis after acoustic neuroma surgery who meet the above requirements will be randomly assigned to Tongdu Huayu acupuncture formula combined with basic treatment group(treatment group A),conventional acupuncture formula combined with basic treatment group(treatment group B)and basic treatment group(control group)according to the random number table method.Subsequently,the patients in group A were treated with Tongdu Huayu acupuncture formula,that is,the Shenting,Baihui,Qianding,Houding,Fengfu,Dazhui of Du vessel and Sihua points on the bladder meridian were selected,together with Cuanzhu,Yangbai,Taiyang,Quanliao,Dicang,Jiache and Yingxiang points on the affected side.Group B was treated with the conventional acupoint selection scheme for the current clinical treatment of peripheral facial paralysis,that is,Cuanzhu,Yangbai,Taiyang,Quanliao,Di Cang,Jiache,Yingxiang on the affected side and bilateral Hegu acupoints were selected for treatment.Acupuncture and moxibustion treatment of the above two groups of patients are combined with syndrome differentiation,with Zusanli for Qi deficiency,Sanyinjiao for blood deficiency,Taixi for yin deficiency,Guanyuan for Yang deficiency,Fenglong and Quchi for phlegm heat,Fenglong and Yinlingquan for phlegm dampness,Qimen for qi stagnation,and Xuehai for blood stasis.Within 2 weeks after operation,the acupuncture was performed with the method of flat tonic and flat diarrhea after the injection.After the local needle sensation was generated,the needle was kept for 30 minutes,and the needle was performed every 10 minutes during the period.Two weeks after operation,combined with electroacupuncture,select density wave with frequency of about 2/100 Hz for 30 minutes.Once every other day,3 times a week,10 times as a course of treatment.After each course of treatment,rest for 1 week,and then carry out the next course of treatment.A total of 5 courses of treatment,50 times in all.Control group was not treated with acupuncture.The three groups of patients were treated with neurotrophic drugs and facial muscle function training,that is,the oral neurotrophic drugs were vitamin B1(10mg,tid),vitamin B6(10mg,tid)and Mecobalamin tablets(500 μ g.tid).Facial muscle function exercise:before exercise,the patient first applies a hot towel to the face for 5 min to improve blood circulation,and then takes the initiative to carry out facial muscle exercises such as raising forehead lines,frowning,closing eyes,shrugging nose,showing teeth,bulging cheeks,etc.each action is trained 20 times,and facial muscle function exercise was carried out 3 times a day.Before and after treatment,the patients in the three groups used the quantitative score of facial symptoms and signs to evaluate the improvement of symptoms and signs of facial paralysis;House Barkmann classification(H-B classification)and Sunnybrook Facial Nerve rating scale were used to evaluate facial nerve function.Through the facial disability index(FDI)questionnaire,self rating Anxiety Scale(SAS),self rating Depression Scale(SDS)and self rating Sleep Scale(SRSS),the degree of disability of facial muscle dysfunction and its impact on social activities,psychology and sleep state were evaluated,and then the clinical efficacy was evaluated.All data were entered in Excel and analyzed by SPSS 25.0 software.The measurement data conforming to the normal distribution is represented by(x±s)and analyzed by one-way ANOVA.If it does not conform to the normal distribution,it is expressed by quartile M(P25,P75),and the rank sum test in nonparametric analysis is used.The count data is expressed as a percentage(%),using y2 test,with P<0.05,the difference was statistically significant.ResultsThe first part is the analysis results of TCM syndrome characteristics:82 patients with facial paralysis after acoustic neuroma operation who meet the inclusion criteria were finally collected in this study.After four diagnosis information collection,the results showed that the frequency of mouth and eye deviation,rice remains in the affected side of the mouth when eating and unable to bulge cheeks in the main symptoms of facial paralysis was 100%,and the frequency of wide eye fissure was 76.8%.Among other comorbidities,the top 10 were tinnitus or deafness(91.46%),head tingling(76.83%),insomnia(65.85%),dreaminess(62.20%),pulse sinking(58.54%),Nightmare(56.10%),pulse astringency(54.88%),light and dark tongue(53.65%),fear of cold and like warm(51.22%),and ecchymosis on the tongue(47.56%).It can be seen that most patients with acoustic neuroma have blood stasis after operation,and the symptoms of brain uneasiness such as insomnia,dreaminess and nightmares are common complications after acoustic neuroma operation.Through the classification and analysis of systematic clustering method,the disease can be preliminarily divided into four main TCM syndrome types,namely 10 cases of yin deficiency and blood stasis syndrome(12.19%),18 cases of phlegm heat internal disturbance syndrome(21.95%),8 cases of Qi and blood deficiency syndrome(9.76%),and 46 cases of Yang deficiency and blood stasis syndrome(56.10%).There was significant difference in the distribution frequency of each syndrome type(P<0.05),that is,Yang deficiency and blood stasis syndrome was the most,followed by phlegm heat internal disturbance syndrome and yin deficiency and blood stasis syndrome,and Qi and blood deficiency syndrome was the least.Among the four syndrome types,Yang deficiency and blood stasis syndrome and yin deficiency and blood stasis syndrome were accompanied by blood stasis syndrome,a total of 56 cases,accounting for 68.29%.There were 26 cases of non blood stasis syndrome(including Qi and blood deficiency syndrome and phlegm heat disturbance syndrome),accounting for 31.71%.There was significant difference in the frequency distribution between them(P<0.05).It can be seen that most patients with facial paralysis after acoustic neuroma operation are mixed with syndrome of blood stasis,which reflects the pathogenesis characteristics of "blood stasis internal resistance".The second part is the clinical observation results of Tongdu Huayu acupuncture formula:According to the random number table method,the above 82 patients with facial paralysis after acoustic neuroma operation were randomly assigned.Results there were 30 patients in treatment group A,26 patients in treatment group B and 26 patients in control group.There was no significant difference in gender,age,course of disease and maximum diameter of tumor among the three groups(P>0.05).1.In terms of symptoms and signs of facial paralysis:after treatment,the quantitative scores of symptoms and signs of the three groups were statistically different from those before treatment(P<0.05),indicating that the facial symptoms and signs of each group were improved compared with those before treatment.There was significant difference among the three groups(P<0.05),and the score of treatment group A was significantly lower than that of treatment group B and control group,and that of treatment group B was significantly lower than that of control group.There was significant difference between the two groups(P<0.05),which showed that the improvement of facial symptoms and signs in treatment group A was better than that in treatment group B,and that in treatment group B was better than that in control group.2.In terms of facial nerve function:after treatment,the H-B classification and Sunnybrook Facial Nerve rating scale scores of treatment group A and treatment group B were significantly improved compared with those before treatment(P<0.05),and there was no significant difference in control group compared with those before treatment(P>0.05),which shows that the intervention of acupuncture and moxibustion can significantly improve the facial nerve function of patients with acoustic neuroma after operation.There was significant difference among the three groups(P<0.05),and the improvement effect of facial nerve function in treatment group A was significantly better than that in treatment group B and control group,and treatment group B was better than that in control group(P<0.05).This shows that acupuncture intervention can effectively promote the recovery of facial nerve function in patients with facial paralysis after acoustic neuroma surgery,and the treatment scheme of group A has a better effect on promoting the recovery of facial nerve function.3.In terms of physical disability,social,mental state and sleep:the FDI scale in the facial disability index(FDI)questionnaire reflects the degree of disability of facial neuromuscular dysfunction.The higher the score,the lower the degree of disability.After treatment,there was significant difference in the FDIP scale among the three groups(P<0.05).The FDIP score of treatment group A was significantly higher than that of treatment group B and control group(P<0.05).There was no significant difference between treatment group B and control group(P>0.05).The FDIS scale in the FDI questionnaire can reflect the impact of facial paralysis on patients’ social activities and psychology.The higher the score,the greater the impact.After treatment,the FDIS score of treatment group A was significantly lower than that of treatment group B and control group(P<0.05).The score of treatment group B was also significantly lower than that of control group(P<0.05),which suggested that the effect of treatment group A in improving the physical disability and psychosocial state related to postoperative facial paralysis was significantly better than that of treatment group B and control group,and the effect of treatment group B in improving psychosocial state was better than that of control group.4.In terms of anxiety and depression assessment,SAS and SDS can reflect the psychological states of patients with postoperative facial paralysis,such as anxiety and depression.After treatment,the SAS and SDS scores of the three groups were significantly different from those before treatment(P<0.05).There was significant difference in SAS and SDS scores among the three groups after treatment(P<0.05),and the SAS and SDS scores of treatment group A were significantly lower than those of treatment group B and control group,and treatment group B was also significantly lower than that of control group(P<0.05),indicating that treatment group A had the most significant effect in improving postoperative anxiety and depression,which was better than treatment group B and control group.Treatment group B was better than control group.5.In terms of sleep status comparison:after treatment,the SRSS score of the three groups decreased compared with that before treatment(P<0.05).There was significant difference in SRSS scale among the three groups after treatment(P<0.05).The SRSS scale of treatment group A was significantly lower than that of treatment group B and control group,and that of treatment group B was significantly lower than that of control group(P<0.05).The results showed that the effect of treatment group A on improving the postoperative sleep state of acoustic neuroma was better than that of treatment group B and control group,and treatment group B was better than that of control group.6.In terms of clinical efficacy evaluation:after treatment,in group A,5 cases were cured,8 cases were markedly effective,10 cases were improved and 7 cases were ineffective.The total effective rate was 76.7%and the cure and markedly effective rate was 43.3%.In group B,1 case was cured,3 cases were markedly effective,11 cases were improved and 11 cases were ineffective.The total effective rate was 57.7%and the cure and markedly effective rate was 15.4%.In control group,1 case was cured,1 case was markedly effective,5 cases were improved and 19 cases were ineffective.The total effective rate was 26.9%and the cure and markedly effective rate was 7.7%.There was significant difference in clinical efficacy among the three groups(P<0.05).There was no significant difference in the total effective rate between group A and group B(P>0.05),but there was significant difference in the cure and markedly effective rate(P<0.05).There were significant differences in the total effective rate and the cure and markedly effective rate between treatment group A and control group(P<0.05).There was significant difference in the total effective rate between treatment group B and control group(P<0.05),and there was no significant difference in the cure and markedly effective rate(P>0.05).The above results show that acupuncture intervention can effectively promote the recovery of patients with facial paralysis after acoustic neuroma surgery,and has a good clinical effect on the disease,while the cure and markedly effective rate of group A was more significant.Conclusion1.Paralysis after acoustic neuroma surgery can be preliminarily divided into four TCM syndrome types:Yang deficiency and blood stasis,phlegm heat internal disturbance,Yin deficiency and blood stasis,deficiency of Qi and blood."Blood stasis internal resistance and brain meridian obstruction" is the main pathogenesis characteristics,And this disease is accompanied by the symptoms of uneasiness of the brain.2.Compared with the conventional acupuncture formula for facial paralysis,the treatment scheme based on Tongdu Huayu acupuncture formula can significantly improve the symptoms and signs of patients with facial paralysis after acoustic neuroma operation,promote the recovery of facial nerve function,and the cure and markedly effective rate was more significant;It can better alleviate patients’ bad emotions such as anxiety and depression,improve sleep status and improve quality of life.It is the preferred scheme of acupuncture and moxibustion in the treatment of this disease. |
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