苯海索联合物理治疗对脑瘫患儿肌张力障碍治疗效果的临床研究

发布时间：2018-07-05 05:24

本文选题：脑性瘫痪 + 肌张力障碍　；参考：《南昌大学》2017年硕士论文

【摘要】：目的:从结构与功能、活动与参与两个维度探讨苯海索联合物理治疗对脑性瘫痪儿童肌张力障碍的临床治疗效果,分析该治疗方法的影响因素,并记录该治疗方法的安全性及药物耐受情况,为脑瘫患儿肌张力障碍找到新的治疗方法。方法:将满足入组条件的研究对象依据机数字分组表随机分为3组:(1)苯海索联合物理治疗治疗组(A组,22例),接受苯海索及物理治疗;(2)物理治疗组(B组,22例),接受物理治疗,口服安慰剂对照;(3)苯海索治疗组(C组,11例),接受苯海索口服治疗。三组患儿在以上治疗基础上接受常规作业疗法、言语训练、矫形器及辅助器具、家庭护理。最终进入数据分析的有51例患儿(男性41例,女性10例)。患儿入组年龄范围为18个月至72个月(32个月±9)。三组患儿于分别于入组时、治疗中期(8周)及治疗末期(16周)进行以下项目评定:BarryAlbright肌张力障碍量表(Barry-Albright Dystonia scale,BADs)、88项脑瘫儿童粗大运动功能评估量表(Gross Motor Function Measuer-88,GMFM-88)、脑瘫儿童粗大运动功能分级系统(Gross Motor Function Classification System,GMFCS)、脑瘫儿童精细运动功能测试量表(Fine Motor Function Measure,FMFM)。同时监测实验对象的流涎好转情况、苯海索使用剂量及耐受情况。实验数据采用SPSS19.0统计软件包进行统计学分析,比较每组患儿治疗前后组内以及组间数据差异(协变量为基线数据),同时对BADs得分改善幅度的影响因素进行多元线性回归分析。设定P0.05为差异有统计学意义。结果:1、三组患儿基线数据对比均无统计学差异(P0.05)。2、A组患儿治疗末期(16周)BADs得分降低幅度平均值为3.76±2.914;B组患儿为0.71±3.288;C组患儿为3.22±2.863。经重复度量方差分析,差异有统计学意义(F=6.570,P0.01)。在治疗后各时间点BADs得分变化率(记录时间点得分-入组时间点得分)组间对比,经协方差分析差异有统计学意义(治疗8周F=4.258,P0.05;治疗16周F=5.289,P0.01)。A、C组患儿的BADs得分改善幅度优于B组患儿(P0.05)。3、治疗末期(16周)A组患儿GMFM-88总目标得分提高幅度平均值为8.01±5.760;B组患儿为3.88±3.309;C组患儿为3.88±3.799。治疗末期(16周)A组患儿FMFM能力分改善幅度平均值为8.45±6.083;B组为4.63±3.922;C组为4.22±2.746。经重复度量方差分析差异有统计学意义(FMFM能力分方差分析P0.05,其余两项观测指标P0.01)。治疗16周GMFM-88总目标分得分的提高幅度组间比较,经协方差分析有统计学差异(F=4.493,P0.05),A组GMFM-88总目标分得分提高幅度优于B、C组(p0.05)。治疗后各时间点三组患儿组间粗大运动功能分级(GMFCS)对比无统计学差异(P0.05)。治疗16周FMFM目标分提高幅度组间对比,经协方差分析有统计学差异(F=4.117,P0.05)。A组FMFM能力分提高幅度优于B、C组(P0.05)。4、A组患儿流涎改善率为87.5%;B组为4.7%;C组为83.3%。三组患儿流涎好转率组间对比有统计学差异(P0.05)。A、C组流涎好转率优于B组(P0.05)。5、研究对象最终药物剂量平均值为2.8±0.368mg/d,单位体重最终药物剂量平均值为0.25±0.012mg/kg/d。患儿对药物耐受良好,未发生严重不良反应事件。6、A组患儿BADs得分提高幅度与入组月龄无相关性(调整后R~2=0.135,β=0.067,P=0.362),与过度运动症状存在正相关性(β=0.464,p=0.017)。存在过度运动症状的患儿BADs改善幅度低于无过度运动的患儿(F值=5.271,P0.05)。结论:1.苯海索联合物理治疗可以早期有效改善脑瘫儿童肌张力障碍的严重程度,相对于常规物理治疗及苯海索治疗能更好提高患儿的粗大运动功能、精细运能力。2.苯海索联合物理治疗相对于常规物理治疗及苯海索治疗不能进一步提高肌张力障碍脑瘫患儿的粗大运动功能分级。3.苯海索联合物理治疗相对苯海索治疗不能更好的改善肌张力障碍脑瘫患儿流涎症状。4.过度运动症状可能是影响苯海索治疗脑瘫儿童肌张力障碍疗效的不利因素。
[Abstract]:Objective : To study the effect of combined physical therapy of benzene and sea cable on the muscular tension disorder of children with cerebral palsy from two dimensions : structure and function , activity and participation . The age ranged from 18 months to 72 months ( 32 months 卤 9 ) . Among the three groups , the following items were evaluated at medium - term ( 8 - week ) and end - of - treatment ( 16 weeks ) : Barrymore Dystonia scale ( BCE ) , 88 patients with cerebral palsy ( Gross Motor Function Classification System , GMFM - 88 ) , Gross Motor Function Classification System ( GMFCS ) , Fine Motor Function Measure ( FMFM ) . Results : 1 . There was no statistical difference in baseline data between group A and group B ( P 0.05 ) . Results : 1 . There was no statistical difference in baseline data between group A and group B ( P 0.05 ) . Results : 1 . There was no significant difference in baseline data between group A and group B ( P 0.05 ) . Results : 1 . There was no significant difference in baseline data between group A and group B ( P < 0.05 ) . Results : 1 . There was significant difference in baseline data between group A and group B ( 3.22 卤 2.863 ) . There was a significant difference in the rate of change of the score ( score - entry time point score ) between the points of time after treatment ( the score of recording time point score - entry time point ) . The difference of covariance analysis was significant ( 8 weeks F = 4.258 , P 0.05 ; treatment 16 weeks F = 5.289 , P0.01 ) . Compared with group B ( P0.05 ) , the average score of GMFM - 88 was 8.01 卤 5.760 in group A and 3.88 卤 3.799 in group B , 3.88 卤 3.922 in group B , 4.63 卤 3.922 in group B , 4.22 卤 2.746 in group B , 4.63 卤 3.922 in group B , 4.22 卤 2.746 in group B and 4.22 卤 2.746 in group B . There was significant difference between the two groups ( F = 4.493 , P < 0.05 ) , and the total score of GMFM - 88 in group A was better than that of group B and C ( P < 0.05 ) . There was no statistical difference between group A GMFM - 88 ( P0.05 ) . In group A , the rate of improvement of FMFM was better than that of group B and C ( P0.05 ) . The rate of improvement of salivary mucosaltation in group A was 87.5 % ; group B was 4.7 % ; group C was 83.3 % ; the mean drug dose of group A was 2.8 卤 0.36mg / d , and the mean value of final drug was 0 . 25 卤 0 . 012mg / kg / day . In children with excessive exercise symptoms , the improvement was lower than that in children without excessive exercise ( F = 5.271 , P0.05 ) . Conclusion : 1 . The combined physical therapy of benzene and sea cable can effectively improve the severity of dystonia in children with cerebral palsy .
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R742.3

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