A型肉毒毒素治疗脑卒中后上肢痉挛疗效的系统评价
本文关键词: A型肉毒毒素 脑卒中 痉挛 疗效 系统评价 出处:《新疆医科大学》2014年硕士论文 论文类型:学位论文
【摘要】:目的:评价A型肉毒毒素(Botulinum Toxin Type A)对脑卒中后上肢痉挛的治疗效果。证实使用治疗A型肉毒毒素与脑卒中后痉挛上肢的活动能力及性能的恢复相关。方法:计算机检索2004年~2013年1月期间的PubMed、中国学术期刊网全文数据库(CNKr)、中国万方医学网文献数据库、Cochrane、Ovid电子图书馆临床对照试验资料库。检索语种不限。纳入比较单纯康复治疗与康复治疗结合肉毒毒素两种方案治疗脑卒中后上肢痉挛疗效的随机对照试验,并观察经两种方式治疗后的脑卒中患者的Ashworth分级(Modified Ashworthscale, MAS)、 Fugl-Meyer上肢运动评测(Fugl-Meyer assessment scale, FMA)、功能独立性评(Functional Independence Measure, FIM)、 Barthel指数(Barthel Index)o由2名评价员独立评价并核对研究质量。采用RevMan5.2版软件进行统计分析。结果:共7个随机对照试验317例患者被纳入该项研究。Meta分析结果显示:单纯康复治疗组与康复治疗结合A型肉毒毒素治疗组的治疗效果相比较,二者在Fugl-Meyer上肢运动评测[MD=-9.13,95%CI(-12.59,-5.67), P0.00001]. Ashworth分级[MD=0.66,95%CI(038,0.94), P0.00001]、Barthel指数[OR=-15.01,95%CI(-23.84,-6.17),P0.0009]、功能独立性评钡[MD=-2.53,95%CI(-4.77,0.08), P=0.06]方面的差异具有统计学意义。结论:康复治疗结合A型肉毒毒素治疗较单纯康复治疗在经治疗12周后Ashworth分级、Fugl-Meyer上肢运动评测、功能独立性评测、Barthel指数方面体现出更好的治疗效果,该项结果证实了使用A型肉毒毒素与脑卒中后上肢的活动能力及性能的恢复相关,康复治疗联合A型肉毒毒素治疗是一种更为合理的康复治疗方式。
[Abstract]:Objective: to evaluate the therapeutic effect of Botulinum Toxin Type A (Botulinum Toxin Type A) on upper limb spasm after stroke. A computer-based search of PubMede from 2004 to January 2013, CNKran, CNKran, and CochraneOvid Electronic Library Clinical controlled trial Database of China Wanfang Medical Network. The search languages are not limited. A randomized controlled trial of therapeutic and rehabilitative therapy combined with botulinum toxin in the treatment of upper limb spasm after stroke. The Ashworth grade modified Ashworth scale, MASA, Fugl-Meyer upper limb motor evaluation, Fugl-Meyer assessment scale, FMAA, functional Independence measure, Barthel index Barthel Index)o were independently evaluated by two evaluators and the quality of the study was checked by two evaluators. Results: a total of 317 patients in 7 randomized controlled trials were included in the study. Meta-analysis showed that the therapeutic effects of rehabilitation alone group and rehabilitation combined with botulinum toxin A group were compared. The two were evaluated by Fugl-Meyer upper limb motion [MD-9.13C95 CI-12.59 CI-5.67, P0.00001] .The difference of Ashworth grading [MD-0.6695 CI: 0380.94m, P0.00001] Barthel index [OR-15.01C95 CI-23.84-6.170.0009], functional independence barium [MD-2.5395CI-4.7CI-4.7C- 0.080.080.06] conclusion: rehabilitation therapy combined with rehabilitation therapy is more effective than rehabilitation therapy alone in the treatment of Botulinum toxin A (Botulinum toxin A). Conclusion: rehabilitation therapy combined with botulinum toxin A therapy is more effective than rehabilitation therapy alone in the treatment of botulinum toxin A. After 12 weeks, Ashworth grading and Fugl-Meyer upper limb motion assessment were performed. The evaluation of functional independence showed a better therapeutic effect in terms of Barthel index, which confirmed that the use of botulinum toxin A was associated with recovery of upper limb activity and performance after stroke. Rehabilitation therapy combined with botulinum toxin A therapy is a more reasonable rehabilitation therapy.
【学位授予单位】:新疆医科大学
【学位级别】:硕士
【学位授予年份】:2014
【分类号】:R743.32
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