不同剂量A型肉毒毒素肌注对脑卒中后肌痉挛患者肌力和步行功能的影响

目的探讨不同剂量A型肉毒毒素肌注对脑卒中后肌痉挛患者肌力和步行功能的影响。方法前瞻性选取延安大学咸阳医院2015年8月至2017年8月收治的96例卒中后恢复期患者,按随机数表法分为大剂量组、中剂量组与小剂量组,各32例。三组均在常规康复训练基础上联合A型肉毒毒素肌注治疗其中大剂量组注射剂量400 U,中剂量组300 U/,小剂量组200 U,浓度均为50 U/ml。比较三组A型肉毒毒素起效时间与持续时间,治疗前与治疗后3个月的肌力恢复情况(采用改良A shworth分级评分评价)、步行功能(采用Holden步行功能评估)、10 m步行时间与日常生活能力(应用改良Barthel指数评估)、临床神经功能缺损程度(采用NDS评分)及不良反应总发生率。结果大剂量组起效时间明显较中剂量组与小剂量组更快,持续时间较中剂量组与小剂量组更长(P<0.05)。三组治疗前的Ashworth评分、Holden评分、10 m步行时间与BI指数的差异无统计学意义(P>0.05);治疗后3个月三组Ashworth评分与10 m步行时间均较治疗前显著减小、Holden评分与BI指数较治疗前显著增大(P<0.05)。大剂量组治疗后3个月的Ashworth评分与10 m步行时间显著低于中剂量组与小剂量组、Holden评分与BI指数显著高于中剂量组与小剂量组(P<0.05)。治疗后3个月三组NDS评分均较治疗前显著减小(P<0.05)。大剂量组治疗后3个月的NDS评分显著低于中剂量组与小剂量组(P<0.05)。大剂量组与中剂量组不良反应总发生率9.38%与3.13%,差异无统计学意义(P>0.05)。结论A型肉毒毒素可促进卒中后肌痉挛患者肌力与步行功能的恢复,提高日常生活能力,且大剂量组应用的起效时间最快、持续时间最长,效果最优,同时不良反应未见明显增加,为最佳应用剂量。

Effects of different doses of botulinum toxin A intramuscular injection on muscle strength and walking function in patients with pos-tstroke spasm

Objective To investigate the optimal dose of intramuscular injection of botulinum toxin type A for treatment of post-stroke tendon spasm.Methods A total of 96 patients undergoing recovery from stroke from August 2015 to August 2017 of our hospital were divided into high-dose group,middle-dose group and low-dose group according to the random number table method,with 32 cases in each group.All three groups were treated with intramuscular injection of botulinum toxin type A on the basis of routine rehabilitation training.The high-dose group was injected with 400 U,medium-dose group 300 U,and small-dose group 200 U with a concentration of 50 U/ml.The onset time and duration of botulinum toxin type A,the muscle recovery(assessed by the modified Ashworth scale),walking function(assessed by the Holden walking function),degree of clinical neurological impairment(NDS score),10 m walking time and daily living ability(assessed by the modified Barthel index) of before treatment and 3 months after treatment and the total incidence of adverse reactions were compared between three groups.Results The effective time of the high-dose group was significantly faster than that of the middle-dose group and the low-dose group,and the duration was longer than that of the medium-dose group and the low-dose group(P <0.05).There were no significant difference in Ashworth score,Holden score,10 m walking time and B1 index before treatment among the three groups(P> 0.05).The Ashworth score and 10 m walking time3 months after treatment of the three groups were significantly reduced compared to before treatment,while the Holden score and BI index were significantly increased(P <0.05).The Ashworth score and 10 m walking time in the high-dose group were significantly lower than those in the middle-dose group and the low-dose group at 3 months after treatment,and the Holdens score and B1 index were significantly higher than those in the middle-dose group and the low-dose group(P <0.05).The NDS scores of the three groups decreased significantly after 3 months of treatment(P <0.05).The NDS score of the high dose group was significantly lower than that of the medium dose group and the low dose group at 3 months after treatment(P <0.05).The overall incidence of adverse reactions in high-dose group and middle-dose group was 9.38% and3.13%,the difference was not statistically significant(P> 0.05).Conclusion Botulinum toxin type A can promote the recovery of muscle strength and walking function of patients with muscle spasm after stroke,improve daily life ability,and the high-dose group has the fastest onset time,the longest duration,the best effect,and the adverse reaction is not See a significant increase for the best applied dose.