（专题讨论）谈谈面神经**治疗

8****r

讨论重点，对于面神经**治疗
1. 如果是Bell氏麻痹，您主张使用激素(prednisolone)？使用剂量与天数，如何逐步减量？
2. 如果是Bell氏麻痹，您主张使用抗病毒药物？使用何种抗病毒药？使用剂量与天数？
3. 如果是Ramsay-Hunt综合征，您主张使用激素(prednisolone)？使用剂量与天数，如何逐步减量？
4. 如果是Ramsay-Hunt综合征，您主张使用抗病毒药物？使用何种抗病毒药？使用剂量与天数？
5. 您会使用其他辅助药物或其他治疗(中西医甚或是手术)？使用时机？

以上讨论，希望能以文献探讨为主，个人临床经验为辅。

先分享一篇Lancet Neurology的研究
Prednisolone and valaciclovir in Bell’s palsy: a randomised, double-blind, placebo-controlled, multicentre trial


Prednisolone and valaciclovir in Bell's palsy: a randomised, double-blind, placebo-controlled, multicentre trial.
强的松和伐昔洛韦在bell's麻痹中的应用：随机，双盲，空白对照，多中心试验

BACKGROUND: Previous trials of corticosteroid or antiviral treatments for Bell's palsy have been underpowered or have had insufficient follow-up. The aim of this study was to compare the short-term and long-term effects of prednisolone and valaciclovir in the recovery of the affected facial nerve in a large number of patients.
背景：以前对皮质类固醇或者抗病毒治疗Bell's**研究力度不够，缺少足够的随访。我们这个研究的目的是通过大量的患者比较强的松和伐昔洛韦对面神经受损短期及长期的效果。

METHODS: In this randomised, double-blind, placebo-controlled, multicentre trial, patients aged 18 to 75 years who sought care directly or were referred from emergency departments or general practitioners within 72 h of onset of acute, unilateral, pe**heral facial palsy, between May, 2001, and September, 2006, were assessed. Patients were randomly assigned in permuted blocks of eight to receive placebo plus placebo; 60 mg prednisolone per day for 5 days then reduced by 10 mg per day (for a total treatment time of 10 days) plus placebo; 1000 mg valaciclovir three times per day for 7 days plus placebo; or prednisolone (10 days) plus valaciclovir (7 days). Follow-up was for 12 months. The primary outcome event was time to complete recovery of facial function, as assessed with a regional Sunnybrook scale score of 100 points. Analysis was by modified intention to treat. This study is registered with ClinicalTrials.gov, number NCT00510263.
方法：在这个随机，双盲，空白对照的多中心临床试验收集了2001年5月到2006年9月间的发病72h内的单侧周围性面瘫，要求患者的年龄18-75岁。一组为安慰剂对照+安慰剂对照，一组为60mg强的松/d×5天然后每日减少10mg（共10天）+安慰剂对照，一组为1000mg伐昔洛韦每日3次共7天+安慰剂对照，一组为强的松共10天+伐昔洛韦共7天。随访12个月。主要结局事件为面神经功能完全恢复，评价方法为Sunnybrook 100分量表。采用ITT的统计方法。这个研究在ClinicalTrials.gov注册，注册号为NCT00510263。

FINDINGS: Of 839 patients who were randomly assigned, 829 were included in the modified intention-to-treat **ysis: 206 received placebo plus placebo, 210 prednisolone plus placebo, 207 valaciclovir plus placebo, and 206 prednisolone plus valaciclovir. Time to recovery was significantly shorter in the 416 patients who received prednisolone compared with the 413 patients who did not (hazard ratio 1.40, 95% CI 1.18 to 1.64; p<0.0001). There was no difference in time to recovery between the 413 patients treated with valaciclovir and the 416 patients who did not receive valaciclovir (1.01, 0.85 to 1.19; p=0.90). The number of patients with adverse events was similar in all treatment arms.
发现：共839例随机分组，最后有829例进行了改良ITT分析。206例接受安慰剂对照+安慰剂对照，210例接受强的松+安慰剂对照，207例接受伐昔洛韦+安慰剂对照，206例接受强的松+伐昔洛韦。接受强的松的416例患者面神经恢复的时间明显少于413例没有强的松治疗的患者(hazard ratio 1.40, 95% CI 1.18 to 1.64; p<0.0001)。接受伐昔洛韦的413例患者与没有使用伐昔洛韦的患者比较面神经恢复的时间没有显著性差异(1.01, 0.85 to 1.19; p=0.90)。所有治疗组不良事件没有差异。

INTERPRETATION: Prednisolone shortened the time to complete recovery in patients with Bell's palsy, whereas valaciclovir did not affect facial recovery.
结论：强的松可以显著缩短Bell's麻痹患者面神经恢复的时间，伐昔洛韦并不能影响面神经的恢复。

李*

非常感谢楼主分享！正需要，呵呵

8****r

回复 2# 李丹


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