A型肉毒毒素抑制大鼠胃平滑肌收缩的放射免疫测定

目的：在胃肌层注射A型肉毒毒素（botulinum toxin type,A,BTX-A)后，P物质（substance P,SP)是否参与BTX－A抑制胃平滑肌收缩调节，尤其是局部短期变化，并探讨BTX－A的作用与SP的关系，为临床疗效提供新思路。方法：健康雄性Wistar大鼠14只，随机分为BTX－A组及对照组，在胃体前壁与幽门部交界线中点平滑肌内注射BTX－A 5U（25U／ml)，或生理盐水0.2ml；注射3min后切取局部前壁组织行放射免疫测定。结果：胃前壁注射区局限性膨出，逐渐加剧；未见蠕动波／收缩波通过局部。从切取待测的胃前壁侧面观：厚度与周围比较无明显界限，但皱襞减少、变浅。BTX－A组SP平均含量较对照组低39％（P＜0．05）。结论：经腹腔在胃前壁注射BTX－A后，不但阻碍了局部粘膜下神经丛或肌间神经丛突触前膜乙酰胆碱释放，而且也抑制了SP，导致胃平滑肌收缩功能障碍。     

A型肉毒毒素对大鼠离体十二指肠平滑肌自发性收缩的影响

目的 观察A型肉毒毒素(botulinum toxin A,BTX-A)对离体十二指肠平滑肌的自发性收缩是否存在抑制作用,这种抑制作用的时效特点与胆碱能M受体抑制剂作用的异同,BTX-A是否可抑制外源性乙酰胆碱(acetylcholine,ACh)增强的十二指肠收缩,BTX-A预处理平滑肌后外原性ACh是否可增强十二指肠平滑肌的收缩.旨在为临床应用BTX-A治疗小肠收缩功能紊乱所致的疾病提供理论和实验依据.方法 选取Sprague-Dawley大鼠,实验时击头部致昏后,距幽门0.5 cm处取1.0～1.5 cm的肠管,置于37℃Krebs液的恒温平滑肌槽中,肌条的一端固定在肌槽底部的塑料弯钩上,另一端固定在张力传感器上.肌条在1 g的前负荷下孵育,随机分为BTX-A组(n=12),阿托品组(n=12),ACh+ BTX-A素组(n=12),ACh+阿托品组(n=12),BTX-A+ ACh组(n=12).在自发性收缩平稳20分钟后,根据研究方案,分别加入BTX-A( 10 U/ml)或阿托品(1μmol/L)、ACh(100 μmol/L).Biolap 420 E生物机能实验系统记录十二指肠纵形平滑肌条在不同给药条件下的收缩变化.结果 BTX-A抑制了十二指肠平滑肌自发性收缩的频率、张力及振幅(P＜0.01),这种抑制作用持续＞1小时.阿托品抑制了十二指肠平滑肌自发性收缩的频率、张力及振幅(P ＜0.01),但用药5分钟后,十二指肠平滑肌的收缩开始恢复,用药10分钟后,十二指肠平滑肌的收缩已基本恢复;十二指肠平滑肌自发性收缩的频率、张力及振幅与用药前比较,差异无统计学意义(P＞0.05).ACh增强了十二指肠平滑肌自发性收缩的频率、张力及振幅(P＜0.01),BTX-A抑制了ACh增强的十二指肠平滑肌收缩的频率、张力及振幅(P ＜0.01).ACh增强了十二指肠自发性收缩的频率、张力及振幅(P＜0.01),阿托品抑制了ACh增强十二指肠平滑肌收缩的频率、张力及振幅(P＜0.01).BTX-A抑制了十二指肠平滑肌自发性收缩的频率、张力(P＜0.01)及振幅(P ＜0.05),加入外源性ACh后不能增强十二指肠平滑肌收缩的频率、张力及振幅.结论 BTX-A抑制离体十二指肠平滑肌自发性收缩,BTX-A的抑制作用与阿托品不同,表现出不完全抑制十二指肠的收缩频率、张力和收缩幅度,这种作用为逐渐而持续性抑制.BTX-A抑制了外源性ACh增强的十二指肠平滑肌的收缩.BTX-A抑制了十二指肠平滑肌自发性收缩后,外源性ACh不能增强十二指肠平滑肌的收缩,提示BTX-A可作用于突触后膜M受体,从而抑制了ACh与M受体结合,具有类似“阿托品样效应”.     

局部注射A型肉毒毒素后远隔部位F波的改变

目的探讨局部注射A型肉毒毒素(BTX-A)后其远隔部位F波的改变及其可能机制。方法对19例偏侧面肌痉挛(HFS)患者、5例Meige综合征患者及2例痉挛性斜颈(TS)患者行BTX-A注射，并在注射前、注射后1周及注射后12～24周时分别检测其尺神经及胫神经F波的各项参数变化。结果①注射后1周，有3例患者共5条尺神经未引出肯定波形。②与注射前比较，尺、胫神经F波平均潜伏期以及尺神经F波时限在注射1周后显著延长，且这种改变与注射剂量无明显相关性；注射12～24周时，上述两参数与注射前比较，差异均无显著性意义。结论F波平均潜伏期和时限是评价BTX-A远隔效应的敏感指标；BTX-A的远隔效应似与检查部位和注射部位间的距离有关，而与注射剂量无明显相关性。     

A型肉毒毒素抑制大鼠离体食管下括约肌收缩的实验研究

目的:研究A型肉毒毒素(BTX-A)对大鼠食管下括约肌(LES)离体肌条自发性收缩的影响,并观察BTX-A对电场刺激(EFS)引发的肌条收缩是否存在抑制作用。方法:成年SD大鼠叩击头部致昏后取食管下括约肌制备肌条,随机分为对照(control)组、BTX-A组、EFS组、EFS+BTX-A组,采用Biolap420E生物机能实验系统记录下括约肌肌条收缩实验数据。结果:①BTX-A降低食管下括约肌肌条自发性收缩张力及振幅(P<0.05);②EFS增强食管下括约肌肌条张力及振幅(P<0.01);③BTX-A抑制EFS对食管下括约肌肌条张力增强效应(P<0.01)及振幅增大效应(P<0.01)。结论:①BTX-A可抑制食管下括约肌肌条自发性收缩;②EFS可增强食管下括约肌肌条收缩能力;③BTX-A可抑制EFS引发的食管下括约肌肌条收缩能力的增强。     

氟虫腈对小鼠离体胃平滑肌的作用及甲氧氯普胺对其的影响

目的:观察氟虫腈对小鼠离体胃平滑肌的作用及甲氧氯普胺对其的影响.方法:取小鼠离体胃平滑肌,将其置于50 mL恒温(37℃)灌流肌槽中,记录5个剂量组氟虫腈(1.020、1.275、1.594、1.992、2.490 g/L)作用下肌条的收缩活动;小鼠离体胃平滑肌经氟虫腈(1.594 g/L)预作用后3min加入5个剂量组甲氧氯普胺(0.02、0.04、0.08、0.14、0.24 g/L),观察其对胃肌条收缩活动的影响.结果:急性中毒小鼠胃平滑肌收缩活动与对照组相比肌张力及收缩幅度均下降(P＜0.05或P＜0.01),该作用经甲氧氯普胺干预后无明显变化(P＞0.05).结论:氟虫腈可抑制小鼠离体胃平滑肌收缩活动,急性中毒小鼠经甲氧氯普胺干预后胃平滑肌收缩活动未受影响.     

A型肉毒毒素注射治疗脑卒中后肌肉痉挛的护理

目的:探讨A型肉毒毒素(BTX-A)治疗脑卒中后肌肉痉挛的护理方法及效果。方法:对32例肢体痉挛患者应用BTX-A局部多点注射,注射前做好药物的储存,加强患者的心理护理,注射时无菌操作,准确配药,药物浓度在50 U/ml,注射后观察有无头晕、疼痛、呼吸困难等副作用,注射后3-5 d指导患者的康复训练。结果:本组32例患者经BTX-A注射治疗后均获得良好效果;出现晕针现象3例,无1例出现皮下血肿、感染。结论:正确、规范的护理能够提高BTX-A的注射疗效,减少并发症。     

中枢外源性P物质对大鼠胃电-机械活动的影响

目的大鼠侧脑室给药观察中枢外源性P物质(SP)对胃电-机械活动和体表胃电活动(EGG)的影响,应用SP受体拮抗剂和阿托品探究SP作用的受体机制;比较冷应激后胃对SP和SP受体拮抗剂的动力学反应性的变化。方法雄性Wistar大鼠44只,随机分为7组:正常对照,SP,SP受体拮抗剂,阿托品,冷应激对照,冷应激+SP,冷应激+SP拮抗剂。冷应激大鼠模型制备后,进行体内慢波、快波及胃窦环行肌运动、体表胃电记录。结果①侧脑室SP给药10μL(1×10-8mol/L),能引起胃窦运动明显增强(P<0.05)。②应激使胃运动幅度极显著升高、频率加快(P<0.01),应激后大鼠对侧脑室注入P物质的胃动力学反应性较前明显增强(P<0.05)。③在本实验中,未发现侧脑室注射SP受体拮抗剂(犤D-Pro2,D-Phe7,D-Trp9犦-SubstanceP)10μL(1×10-8mol/L),有阻断内源性SP引起胃窦收缩的作用。侧脑室注射M受体阻断剂阿托品10μL(1×10-7mol/L),不能阻断脑内P物质对胃的收缩效应。结论中枢注入的P物质可以作为促进胃电-机械活动的调节因子参与中枢增强胃肠的调控。     

A型肉毒毒素肌肉注射治疗脑血管病后肢体痉挛36例

目的:探讨A型肉毒毒素(BTX-A)肌肉注射治疗脑血管病后肢体痉挛的疗效。方法:对36脑血管病后肌痉挛患者用国产BTX-A注射,注射剂量、位点根据受累肌肉大小多少程序个体化用药,观察注射前后肌力肌张力变化分别以康复治疗。结果:治疗后随着注射部位肌肉痉挛程度降低,配合康复治疗对痉挛性肌张力增高患者较前明显改善。结论:BTX-A肌肉注射配合康复治疗对脑血管病后肌痉挛是有较好的治疗效果。     

胃镜下胃壁注射A型肉毒毒素治疗单纯性肥胖的临床研究

目的 研究胃镜下胃壁注射A型肉毒毒素(BTX-A)治疗单纯性肥胖的减重疗效和安全性.方法 19例单纯性肥胖患者随机分为试验组Ⅰ(BTX-A 200 U)和试验组Ⅱ(BTX-A 300 U),胃镜下将药物注射于胃壁肌层共20个点,治疗前和治疗后1周、4周、12周分别对进食量、体重、BMI、腰围、臀围、胃固体排空时间、胃电图等进行随访.结果 两组患者治疗后进食量较治疗前明显减少(P<0.05);体重、BMI、腰围、臀围均明显减少(P<0.05);胃固体半排空时间明显延长(P<0.05),胃延迟相时间延长,但无统计学差异;胃电图各指标治疗前后无明显变化.无明显不良反应发生.结论 胃镜下注射BTX-A能减慢胃排空、减少进食量,安全有效地减轻体重.     

外周神经电刺激引导下A型肉毒毒素注射在痉挛型脑性瘫痪中的应用

目的探讨在外周神经电刺激引导下A型肉毒毒素(BTX-A)局部注射治疗痉挛型脑瘫的疗效。方法共选取30例痉挛型脑瘫患儿,在外周神经电刺激引导下采用BTX-A局部多点注射,于治疗前、后采用改良Ashworth量表(MAS)和粗大运动功能评定量表(GMFM-88)进行评定。结果 BTX-A注射1周后,MAS评分显著降低,并维持至6个月时(P<0.001)。与治疗前相比,注射1周后,GMFM-88评分无显著性差异(P>0.05),3个月和6个月时显著增加(P<0.001)。结论外周神经电刺激引导下BTX-A局部多点注射治疗痉挛型脑瘫疗效显著。     

肉毒毒素结合肌力训练治疗痉挛型双瘫患儿39例疗效观察

目的:探讨A型肉毒毒素(BTX-A)注射结合肌力训练对痉挛型双瘫患儿粗大运动功能的影响。方法:将72例痉挛型双瘫患儿依据其意愿分为观察组39例和对照组33例,均进行综合康复训练,且观察组在此基础上加用BTX-A注射和肌力训练。治疗前和治疗3个月后分别采用改良Ashworth量表(MAS)和粗大运动功能测试量表(GMFM)中站立相(D)和走、跑、攀登相(E)二项进行疗效评估。结果:治疗前后两组MAS评分和GMFM中D项、E项评分比较差异均有统计学意义(P<0.01),且治疗后两组比较差异均有统计学意义(P<0.05)。结论:BTX-A注射结合肌力训练能快速有效地缓解痉挛型双瘫患儿下肢肌肉的痉挛,提高患儿粗大运动功能。     

参附注射液拮抗吸入麻醉药对气管平滑肌的痉挛作用

目的　研究参附注射液对吸入麻醉对引起气管平滑肌痉挛的影响作用。方法　选择 1 2 0例气管内全身麻醉的患者。随机分为治疗组 (n=60 )和对照组 (n=60 ) ,治疗组患者在麻醉诱导后 ,行气管插管 ,记录机控呼吸的气管压力值 ,再静脉滴注参附注射液 2 ml/kg。手术结束前再记录机控呼吸道压力值。结果　手术结束前两组间气道压力值有显著差异 ,P<0 .0 5。结论　参附注射液能明显缓解或者拮抗吸入麻醉药对气管平滑肌的痉挛     

肉毒毒素结合康复训练治疗痉挛型脑瘫

目的:观察局部肌肉注射A型肉毒毒素(BTX-A)治疗痉挛型脑瘫的疗效。方法:83例痉挛型脑瘫患儿分为观察组53例和对照组30例,均采用BTX-A局部肌肉注射和推拿治疗;观察组同时结合系统的康复训练等。治疗前后均以改良阿氏量表(MAS)评分肌张力,运动评价量表(PRS)评定运动功能。结果:治疗3个月后与治疗前比较2组MAS评分均明显下降,PRS评分明显升高(均P<0.05);与对照组比较观察组表现更明显(P<0.05)。结论:局部肌肉注射BTX-A结合系统康复训练能有效缓解痉挛型脑瘫患儿的肌张力,改善步态、提高行走能力。     

Effect of botulinum toxin on endplate noise in myofascial trigger spots of rabbit skeletal muscle

OBJECTIVE: To assess the effect of botulinum toxin type A (BTX-A) on the endplate noise prevalence in rabbit myofascial trigger spots to confirm the role of excessive acetylcholine release on the pathogenesis of myofascial trigger points and to develop an objective indicator of the effectiveness of BTX-A in the treatment of myofascial trigger points. DESIGN: Eighteen adult New Zealand rabbits were divided into three groups that received a single bolus of BTX-A over a myofascial trigger spot region on one side of the biceps femoris muscle. Another 10 rabbits received multiple-point injections in a myofascial trigger spot where endplate noises were found. A control study was performed on the other side of the biceps femoris muscle. The endplate noise prevalence in a myofascial trigger spot region was assessed. RESULTS: It was found that injection of BTX-A reduced the prevalence of endplate noise. No significant differences between a single bolus injection and multiple-point injections were noted, although there was some evidence that multiple-point injections might maintain the endplate noise decreasing effect much longer than a single injection. CONCLUSIONS: This study demonstrated the suppressive effect of BTX-A on endplate noise prevalence in a myofascial trigger spot region. The prevalence of endplate noise in the myofascial trigger point region may be a useful objective indicator for evaluating the therapeutic effectiveness of BTX-A injection to treat myofascial trigger points.     

A preliminary comparison of the efficacy and tolerability of botulinum toxin serotypes A and B in the treatment of myofascial pain syndrome: a retrospective, open-label chart review

BACKGROUND: Myofascial pain syndrome (MPS) is characterized by acute or chronic regional muscle pain associated with single or multiple trigger points within taut bands of muscle. Botulinum toxins have clinical utility when sustained focal muscle relaxation is required and may be a useful addition to the treatment armamentarium for MPS. OBJECTIVE: The purpose of the present article was to compare the efficacy and tolerability of botulinum toxin serotypes A and B (BTX-A and BTX-B) in the treatment of MPS. METHODS: This was a retrospective, open-label, single-center chart review. Charts of all patients who received either BTX-A or BTX-B for MPS between January and November 2001 were included in the review. Patients rated the intensity of their pain on a visual analog scale (VAS) from 0 = no pain to 10 = worst pain imaginable before and after receiving BTX-A or BTX-B. RESULTS: The charts of 91 patients (74.7% female, 25.3% male; mean [SD] age, 47 [10.2] years) who received BTX-A (n = 56; mean dose, 256.9 U; range, 100-600 U) or BTX-B (n = 35; mean dose, 9000 U; range, 2500-20,000 U) were included in this retrospective review. Patients who received BTX-A had significantly greater mean reductions in VAS pain scores compared with those who received BTX-B (mean reduction, 2.7 vs 1.8, respectively; P < 0.001). Patients who received BTX-A also reported significantly longer durations of pain relief compared with those who received BTX-B (4.5 vs 2.7) months; P < 0.001). Eight of 56 patients (14.3%) in the group that received BTX-A reported mild adverse events that included flulike symptoms, injection-site pain, and weakness of the neck muscles. Seven of 35 patients (20.0%) in the group that received BTX-B reported adverse events that included mild flulike symptoms, dry eyes, severe visual disturbances, and severe dry mouth. CONCLUSION: Patients with MPS who received BTX-A reported significantly greater reductions in pain for longer durations compared with those who received BTX-B. No patients who received BTX-A experienced severe systemic adverse events, compared with 4 patients who received BTX-B. The results of this comparison are consistent with the US Food and Drug Administration-approved labeling indicating that BTX-A is not interchangeable with any other botulinum toxin in terms of biological activity.     

Pooled analysis of the safety of botulinum toxin type A in the treatment of poststroke spasticity

OBJECTIVE: To examine the safety of botulinum toxin type A (BTX-A). DESIGN: Analysis of pooled data of 9 double-blind, placebo-controlled studies of patients with spasticity after stroke. SETTING: University hospitals and specialty rehabilitation centers in the United States. PARTICIPANTS: A total of 482 patients with upper-limb spasticity and 310 with lower-limb spasticity (overall mean age, 58y; 60% men). INTERVENTION: Treatment with BTX-A (n=534; 1-3 treatments; mean dose, 231U) or placebo (n=258). MAIN OUTCOME MEASURE: Adverse events. RESULTS: Most patients (69%) received only 1 treatment with BTX-A. Patients were followed for a mean of 17.8 weeks (range, 0.1-44.7wk) after each treatment. A total of 352 (65.9%) patients in the BTX-A group and 163 (63.2%) in the placebo group reported at least 1 adverse event (P=.475). The most frequent adverse events reported by patients (>5% but <10% in either group) were respiratory infection, seizures, incoordination, and injection site pain, none of which occurred at a significantly higher rate in the BTX-A group (all P>.05). The majority of adverse events were rated as mild or moderate in severity. Only nausea was reported at a significantly higher rate in the BTX-A group (12/534 [2.2%]) than the placebo group (0/258) (P=.011); in contrast, injection site pain, chest pain, and allergic reaction were reported significantly more frequently in the placebo group. CONCLUSIONS: BTX-A has an acceptable safety profile for treatment of patients with focal spasticity following stroke, a population in which adverse events and comorbidities are common.     

A型肉毒毒素治疗脑性瘫痪患儿上肢痉挛的疗效分析

目的分析A型肉毒毒素(BTX-A)阻滞术缓解脑瘫患儿上肢痉挛的疗效。方法将2004 年1 月~2011 年12 月本院收治47 例痉挛型偏瘫的脑瘫患儿分为对照组(n=25)和试验组(n=22)。对照组接受常规作业康复训练,试验组在此基础上接受上肢BTX-A 阻滞术治疗。根据试验组患儿体重和改良Ashworth 评分(MAS)来确定BTX-A 剂量,每次用量在30~110 IU 之间,平均(50.7±12.7) IU。结果治疗前,两组患儿MAS、简易上肢功能检查法评分均无显著性差异(P>0.05)。试验组治疗后MAS评分明显低于治疗前(P<0.01),且低于对照组(P<0.05)。两组患儿的上肢功能评分均有提高(P<0.05),试验组提高值明显高于对照组(P<0.01)。结论BTX-A可有效降低脑瘫儿童的上肢肌张力,有助于上肢运动功能的提高。     

生脉注射液抗急性百草枯中毒大鼠自由基损伤作用的实验研究

目的 探讨生脉注射液对急性百草枯中毒的治疗作用.方法 将50只SD大鼠随机分为5组(空白组、阴性对照组、阳性对照组、生脉低剂量组和生脉高剂量组),每组各10只.空白组大鼠腹腔注射生理盐水30 ml/kg,其他组复制成百草枯急性中毒模型.观察大体标本、组织病理以及生物学标志(肺湿重/干重比、肺泡灌洗液中性粒细胞比和蛋白含量).同时测定血清和肺泡灌洗液中丙二醛含量以及超氧化物歧化酶和谷胱甘肽过氧化物酶活力.结果 与阴性对照组相比,生脉低剂量组肺组织病理显示肺淤血、肺水肿明显减轻,而且血浆和肺泡灌洗液中丙二醛含量分别由(5.04±0.50)、(1.19±0.18)nmol/ml下降至(4.04±0.21)、(0.79±0.04)nmol/ml,超氧化物歧化酶活力由(123.30±20.39)、(26.43±2.22)U/ml升高至(277.09±11.66)、(37.10±2.49)U/ml,谷胱甘肽过氧化物酶活力由(1796.63±81.12)、(598.24±62.50)U/ml升高至(2151.54±148.32)、(1788.44±175.11)U/ml;2组比较差异均有统计学意义(P均<0.01).结论 生脉注射液可使急性百草枯中毒引起的脂质过氧化损伤得到改善,低剂量效果更佳.     

肉毒毒素注射结合功能训练对痉挛型脑瘫患儿站立与步行功能的影响

目的：观察A型肉毒毒素（BTX-A）注射结合功能训练对痉挛型脑瘫患儿站立与步行功能的影响。方法：100例痉挛型脑瘫患儿随机分为BTX-A组50例和对照组50例。BTX-A组采用BTX-A注射下肢痉挛肌群结合功能训练,对照组仅采用单纯的功能训练。患儿在治疗前和治疗后2周、3个月、6个月进行综合痉挛量表（CSS）评分及粗大运动功能量表（GMFM）中的D和E两项评分。结果：治疗后2周、3及6个月时,2组患儿CSS评分均较治疗前呈逐渐下降趋势（P〈0.05）,且在治疗后3及6个月时BTX-A组CSS评分更低于对照组（P〈0.05）;2组患儿GMFM（DE区）评分均较治疗前呈逐渐上升趋势（P〈0.05）,且在治疗后3及6个月时BTX-A组GMFM（DE区）评分更高于对照组（P〈0.05）。结论：肉毒毒素注射和单纯的功能训练均能缓解脑瘫患儿肢体痉挛,改善运动功能,但BTX-A注射结合功能训练能更有效缓解脑瘫患儿的肢体痉挛,提高其运动能力,能明显缩短治疗时间,改善患儿的步态,提高其站立与步行功能。