A型肉毒毒素注射联合改良强制性运动疗法与联合高强度传统康复治疗对脑卒中后上肢运动功能的疗效对比

发布时间：2018-06-03 07:21

本文选题：康复 + 肉毒毒素　；参考：《吉林大学》2017年硕士论文

【摘要】：研究背景:脑卒中是世界范围内第2大致死原因,也是成人残疾的主要原因之一,显著降低了此类人群的生活质量。为了寻找改善其生活质量的康复治疗方法,多种多样的研究得以开展。已有研究证实结合技术较单一康复治疗技术显示更好的康复效果。A型肉毒毒素注射认为是控制脑卒中后痉挛的有效方法,进而促进肢体运动功能的恢复。一些研究者认为肉毒毒素注射技术联合改良强制性运动疗法或高强度的传统康复疗法对脑卒中后运动功能恢复是较具前景的有效治疗方式。但是,目前尚未有文献报道肉毒毒素注射技术联合改良强制性运动疗法与联合高强度的传统康复疗法的临床康复疗效对比。目的:对比肉毒毒素注射技术联合改良强制性运动疗法与联合高强度的传统康复疗法对脑卒中后上肢运动功能的康复疗效,以探讨促进运动功能恢复的最佳康复疗法。方法:选择2014年2月-2016年11月于吉林大学第一医院康复中心住院脑卒中患者58例,年龄10-70周岁,发病时间2周-12个月。其中共32例患者符合入组标准,给予患侧上肢行A型肉毒毒素注射治疗。后应用随机数字表法分为肉毒毒素注射技术联合改良强制性运动疗法组和联合高强度的传统康复疗法组,各16例。2组患者上肢治疗时间均为1小时/天,5天/周,共4周。治疗前及治疗4周后采用改良Ashworth分级量表,Fugl-Meyer评估量表的上肢功能评估部分及Barthel指数进行疗效评估。结果:治疗4周后2组患者的改良Ashworth分级量表、Fugl-Meyer评估量表及Barthel指数评估结果较治疗前均明显提高,差异具有统计学意义(p0.05)。肉毒毒素注射技术联合改良强制性运动疗法组与联合高强度的传统康复疗法组治疗后疗效对比,改良强制性运动疗法组的Fugl-Meyer评估量表及Barthel指数平均得分均高于联合高强度的传统康复疗法组,差异具有统计学意义(p0.05);而改良Ashworth分级量表评估结果组间差异无统计学意义。结论:肉毒毒素注射技术联合改良强制性运动疗法与联合高强度的传统康复疗法均科促进脑卒中后上肢运动功能的康复。其中,肉毒毒素注射技术联合改良强制性运动疗法在运动功能的恢复及日常生活能力的改善疗效较为显著。
[Abstract]:Background: stroke is the second leading cause of death in the world and one of the major causes of adult disability. In order to find rehabilitation methods to improve their quality of life, a variety of studies have been carried out. It has been proved that combined therapy is more effective than single rehabilitation therapy. Botulinum toxin injection is considered to be an effective method to control spasm after stroke and promote the recovery of limb motor function. Some researchers believe that botulinum toxin injection combined with improved compulsory exercise therapy or high-intensity traditional rehabilitation therapy is a promising and effective treatment for the recovery of motor function after stroke. However, there is no literature about the clinical rehabilitation effects of botulinum toxin injection combined with modified compulsory exercise therapy and high intensity traditional rehabilitation therapy. Objective: to compare the effects of botulinum toxin injection combined with modified compulsory exercise therapy and high intensity traditional rehabilitation therapy on motor function of upper limb after stroke, and to explore the best rehabilitation therapy to promote the recovery of motor function. Methods: from February 2014 to November 2016, 58 stroke patients, aged 10-70 years, were selected from the rehabilitation center of the first Hospital of Jilin University. The onset time was 2 weeks to 12 months. A total of 32 patients were treated with botulinum toxin type A (Botulinum toxin A) injection. Then the patients were randomly divided into Botox injection technique combined with modified compulsory exercise therapy group and high intensity traditional rehabilitation therapy group. The upper limb treatment time of each group was 1 hour / day and 5 days / week for 4 weeks. The curative effect was evaluated with the modified Ashworth rating scale Fugl-Meyer evaluation scale and Barthel index before treatment and 4 weeks after treatment. Results: the results of Fugl-Meyer scale and Barthel index were significantly higher in the two groups after 4 weeks of treatment than before treatment, and the difference was statistically significant (P 0.05). The therapeutic effects of botulinum toxin injection combined with modified compulsory exercise therapy group and high intensity traditional rehabilitation therapy group were compared. The average scores of Fugl-Meyer evaluation scale and Barthel index in the modified compulsory exercise therapy group were higher than those in the traditional rehabilitation therapy group with high intensity, and the difference was statistically significant (p 0.05), but there was no significant difference between the two groups in the evaluation results of the modified Ashworth rating scale. Conclusion: botulinum toxin injection combined with modified compulsory exercise therapy and high intensity traditional rehabilitation therapy can promote the recovery of upper limb motor function after stroke. Among them, Botulinum toxin injection combined with improved compulsory exercise therapy has a significant effect on the recovery of motor function and the improvement of daily living ability.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3

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