A型肉毒毒素注射对脑卒中上肢屈肌痉挛的影响

发布时间：2018-11-17 09:06

【摘要】：目的：观察A型肉毒毒素注射对脑卒中患者上肢痉挛状态的影响，探讨肌张力的改变与上肢运功功能及日常生活活动能力的关系。方法：选取脑卒中患者40例，随机分为治疗组和对照组，治疗组患者给予A型肉毒毒素注射后进行常规康复治疗，对照组患者仅进行常规康复治疗。在治疗前和治疗2周后、6周后、12周后进行评价，采用改良Barthel指数(Modified Barthel index，MBI)中与上肢运动有关的项目(包括进食、修饰、沐浴、穿衣和如厕)以评定患者日常生活活动(Activities of daily living， ADL)能力；采用简易Fugl-Meyer量表（Fugl-Meyer assessment scale，FMA)中上肢部分评定患者上肢运动功能；采用改良Ashworth量表(Modified Ashworth scale，MAS)评定患者肌痉挛程度。结果：治疗组患者治疗2周后MAS评分与治疗前相比，差异有统计学意义，与对照组比较，差异显著，具有统计学意义，FMA与MBI评分较治疗前有提高，但与对照组比较无统计学意义。治疗6周后及12周后，治疗组MAS评分、MBI、FMA评分较治疗前差异均有统计学意义，与对照组比较，差异具有统计学意义，提示治疗组日常生活活动能力及肢体运功功能提高更为明显。对照组MAS评分、MBI、FMA评分在治疗后2周后与治疗前比较差异无统计学意义，治疗后6周后及12周后提高显著，差异均有统计学意义，说明常规治疗可以改善痉挛状态，提高上肢运功功能及提高日常生活活动能力，但显效较为缓慢，需要6周以上康复治疗，运动功能和日常生活活动能力才有提高。结论: 肉毒毒素注射可以快速有效并持续的降低肌张力，改善痉挛状态，结合康复治疗，可明显提高日常生活活动能力及肢体运功功能。在时效方面，痉挛减轻在注射后第2周即显效，第6周时趋于稳定，药效可持续至治疗12周后。
[Abstract]:Objective: to observe the effect of botulinum toxin A injection on the spasticity of upper extremities in stroke patients and to explore the relationship between muscle tension and the function of upper limb motility and activities of daily living. Methods: forty patients with stroke were randomly divided into two groups: the treatment group and the control group. The patients in the treatment group were given routine rehabilitation therapy after botulinum toxin A injection, while the patients in the control group were treated with conventional rehabilitation therapy only. Items related to upper limb movement (including eating, grooming, bathing) in the modified Barthel index (Modified Barthel index,MBI) were evaluated before and after treatment for 2 weeks, 6 weeks, 12 weeks later. Clothing and toilet) to assess the (Activities of daily living, ADL) ability of patients with daily life activities; The motor function of upper extremity was assessed by the simple Fugl-Meyer scale (Fugl-Meyer assessment scale,FMA) and the degree of muscle spasm was evaluated by modified Ashworth scale (Modified Ashworth scale,MAS). Results: after 2 weeks of treatment, the MAS scores of the patients in the treatment group were significantly different from those before treatment, and the scores of FMA and MBI were significantly higher than those of the control group. But there was no statistical significance compared with the control group. After 6 weeks and 12 weeks of treatment, the scores of MAS and MBI,FMA in the treatment group were significantly different from those before treatment, and the differences were statistically significant compared with those in the control group. It suggested that the activity of daily life and the function of limb movement in the treatment group were improved more obviously. In the control group, there was no significant difference in MAS score and MBI,FMA score between 2 weeks after treatment and before treatment. The difference was significant after 6 weeks and 12 weeks after treatment, indicating that routine treatment could improve the spasm state. The function of upper limb movement was improved and the ability of daily life was improved, but the remarkable effect was slow. It needed more than 6 weeks rehabilitation treatment to improve the motor function and daily living ability. Conclusion: Botulinum toxin injection can reduce muscle tension and improve spasticity. Combined with rehabilitation therapy, Botulinum toxin injection can obviously improve the ability of daily living and the function of limb movement. In the aspect of aging, the effect of spasmodic relief was obvious at the second week after injection, and stabilized at the sixth week, and the drug effect lasted until 12 weeks after treatment.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.3

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