Furukawa Takatoshi, Abe Yasuhiro, Ito Tsukasa, Kubota Toshinori, Kakehata Seiji
Department of Otolaryngology, Head and Neck Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan.
Otol Neurotol. 2017 Feb;38(2):272-277. doi: 10.1097/MAO.0000000000001307.
Large-scale investigations have not been recently conducted on the efficacy of high-dose steroid administration of prednisolone (PSL) for Bell's palsy. We compared treatment results between normal-dose steroid (PSL 60 mg/d) and high-dose steroid (PSL 200 mg/d) + Hespander + Mannitol administration. We also investigated the recovery rate for antiviral agents.
Retrospective case review.
Tertiary referral center.
A total of 675 patients with Bell's palsy who had grade V and grade VI on the House-Brackmann (HB) scale were treated in our department between 1995 and 2014. These patients could be divided into a normal-dose group and high-dose group.
We separately assessed treatment outcomes for HB grade V patients and HB grade VI patients. Logistic regression analysis was also performed to investigate factors that can impact treatment outcomes, i.e., sex, age, days to start of treatment, PSL dosage, and antiviral drug administration.
Recovery rates were significantly better in the high-dose steroid + Hespander + Mannitol group in comparison with the normal-dose steroid group for HB grade V (100% versus 77.7%) and HB grade VI (92.5% versus 68.2%). Additional effects of antiviral agents were only shown in the normal-dose group. Significant factors for treatment outcomes were PSL 200 mg/d administration and early initiation of treatment. Insignificant factors were sex, age, and the antiviral agent.
We showed the high-dose steroid + Hespander + Mannitol administration produced significantly better outcomes than normal-dose steroid administration in the treatment of patients with Bell's palsy.
近期尚未针对大剂量泼尼松龙（PSL）治疗贝尔面瘫的疗效开展大规模调查。我们比较了常规剂量类固醇（PSL 60 mg/d）与大剂量类固醇（PSL 200 mg/d）联合己酮可可碱+甘露醇给药的治疗效果。我们还研究了抗病毒药物的恢复率。
回顾性病例分析。
三级转诊中心。
1995年至2014年间，我科共治疗了675例House-Brackmann（HB）分级为V级和VI级的贝尔面瘫患者。这些患者可分为常规剂量组和大剂量组。
我们分别评估了HB V级患者和HB VI级患者的治疗结果。还进行了逻辑回归分析，以研究可能影响治疗结果的因素，即性别、年龄、开始治疗的天数、PSL剂量和抗病毒药物的使用。
对于HB V级（100%对77.7%）和HB VI级（92.5%对68.2%）患者，大剂量类固醇+己酮可可碱+甘露醇组的恢复率显著优于常规剂量类固醇组。抗病毒药物的额外效果仅在常规剂量组中显示。治疗结果的显著因素是给予PSL 200 mg/d和早期开始治疗。不显著的因素是性别、年龄和抗病毒药物。
我们发现，在治疗贝尔面瘫患者时，大剂量类固醇+己酮可可碱+甘露醇给药的效果明显优于常规剂量类固醇给药。
