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注射用A 型肉毒毒素改善亚急性期和恢复期脑卒中患者肌肉痉挛和活动功能效果的比较
引用本文:贾存玮,谢峥,赵波.注射用A 型肉毒毒素改善亚急性期和恢复期脑卒中患者肌肉痉挛和活动功能效果的比较[J].神经疾病与精神卫生,2017,17(3):187-190.
作者姓名:贾存玮  谢峥  赵波
作者单位:1. 730070,中国人民解放军兰州总医院安宁分院神经内科;2. 730070,中国人民解放军兰州总医院安宁分院皮肤科
摘    要:目的 评价注射用A型肉毒毒素改善脑卒中亚急性期和恢复期肌肉痉挛和活动功能的效果比较.方法 选择2013年6月~2016年1月在我院就诊的脑卒中患者86例,根据病史长短分为亚急性期组(<1个月)37例和恢复期组(≥1个月)49例,均接受肉毒毒素200 U肌肉注射,疗程4周,评价治疗后改良Ashworth量表(MAS)、改良Tardieu量表(MTS)、徒手肌力检查法(MMT)、被动关节活动度(PROM)、Barthel指数和Fugl-Meyer量表.结果 所有患者均顺利接受治疗,两组随访时间分别为26(22~30)d和29(24~31)d,组间比较差异无统计学意义(Z=1.332,P=0.307);亚急性期组治疗后肘部、腕部MAS评分较疗前改善(P<0.05),而恢复期组MAS无明显差异(P>0.05),亚急性期组均优于恢复期组(P<0.05);亚急性期组治疗后肘部R1、D和腕部R1、R2均有改善(P<0.05),恢复期组治疗后MTS中肘部R1、D和腕部R1较治疗前改善(P<0.05),亚急性期组腕部R1、R2优于恢复期组(P<0.05);亚急性期组治疗后MMT肘部外展较治疗前改善(P<0.05),其他指标无改善;亚急性期组PROM腕部外展、腕部活动度较治疗前改善(P<0.05),恢复期组各指标治疗后无明显改善(P>0.05),亚急性组腕部外展优于恢复期组(P<0.05);亚急性期组Barthel指数、Fugl-Meyer和恢复期Fugl-Meyer较治疗前升高(P<0.05),但组间比较差异均无统计学意义(P>0.05).结论 肉毒毒素能改善脑卒中亚急性期和恢复期肌肉痉挛和功能,但亚急性期治疗效果更明显.

关 键 词:卒中  A型肉毒毒素  恢复期  亚急性期  肌肉痉挛

Comparison of injectable botulinum toxin type A on muscle spasm and motor function in patients with subacute and convalescent stroke
JIA Cun-wei,XIE Zheng,ZHAO Bo.Comparison of injectable botulinum toxin type A on muscle spasm and motor function in patients with subacute and convalescent stroke[J].Nervous Diseases and Mental Health,2017,17(3):187-190.
Authors:JIA Cun-wei  XIE Zheng  ZHAO Bo
Abstract:Objective To evaluate the efficacy of injectable botulinum toxin type A on muscle spasms and motor function in subacute and convalescent stroke patients.Methods From June 2013 to Jan-uary 2016, 86 stroke patients were included in this study. They were divided into subacute group (<1 month, n=37) and convalescent group (≥1 month,n=49) according to the length of disease history. Modified Ashworth Scale (MAS), Modified Tardieu Scale (MTS), Manual Muscle Test (MMT), Passive Range of Motion (PROM), Barthel index and Fugl-Meyer scale were evaluated after intramuscular injection of 200 U botulinum toxin for 4 weeks.Results All patients were successfully treated. The follow-up time was 26 d (22 ~ 30 d) and 29 d (24 ~ 31 d) separately, with no significant differences (Z=1.332,P=0.307). The MAS scores of subacute group in el-bow and wrist were improved after treatment (P<0.05), but there was no significant difference in convalescent group (P>0.05). Subacute group was significantly superior to convalescent group (P<0.05). The elbow R1, D and wrist R1 after treatment in subacute group were improved (P<0.05). Elbow R1, D and wrists R1 of MTS in convalescent group were improved after treatment (P<0.05). Wrist R1, R2 of subacute group were significantly superior to convalescent group (P<0.05). In the subacute group, the PROM abduction and activity of the wrist were improved (P<0.05). There was no significant improvement in convalescent group after treatment. The re-covery of the wrist in subacute group was better than that in convalescent group (P<0.05) . The Barthel index, Fugl-Meyer in subacute group and Fugl-Meyer of convalescent group were higher after treatment. But there was no significant difference between two groups (P>0.05).Conclusions Botulinum toxin can ameliorate the spas-ticity and function in patients with subacute and convalescent stage of stroke, but the effect for subacute stage is more obvious.
Keywords:Stroke  Botulinum toxin  type A  Convalescence  Subacute stage  Muscle spasm
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