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中国临床研究:2020,33(10):1377-1382
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A型肉毒毒素结合任务导向训练治疗脑卒中后上肢痉挛
(1.海南医学院第一附属医院康复医学科,海南海口570102;2.海南医学院第一附属医院神经内科,海南海口570102)
Botulinum toxin type A combined with task-oriented training in the treatment of upper limb spasticity after stroke
摘要
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投稿时间:2020-02-25   网络发布日期:2020-10-20
中文摘要: 目的 观察A型肉毒毒素(BoNT-A)结合任务导向性训练治疗脑卒中后早期痉挛上肢功能恢复的疗效。 方法 采用前瞻性研究方法,选取2017 年 1月至 2019年 10月神经内外科、康复科收治的首次脑卒中后上肢早期痉挛患者48例为研究对象,将患者分为三组:对照组(21例,采用常规的物理手法、物理疗法及针灸治疗)、观察组(16例,在对照组基础上结合以任务为导向的作业治疗)和治疗组(11例,在评估后进行超声引导下BoNT-A注射,注射前后进行与观察组相同的康复治疗),疗程均为8周。分别于治疗前和治疗后采用改良Ashworth分级(MAS)、上肢恢复级别评估、WOLF运动功能评价量表(WMFT)、改良Rankin量表、功能独立性评定量表(FIM)等评定上肢功能,以及采用改良Barthel指数(MBI)评估患者日常生活能力。 结果 治疗后,三组患者的屈肘肌群MAS、上肢恢复级别、WMFT、FIM、MBI评定与治疗前比较,差异均有统计学意义(P<0.05,P<0.01),其中屈肘肌群MAS、上肢恢复级别量表评定治疗组优于观察组与对照组,改良Rankin、MBI、FIM评定治疗组与观察组优于对照组,WMFT评定治疗组优于观察组,差异均有统计学意义(P<0.05,P<0.01)。 结论 BoNT-A结合任务导向性训练治疗脑卒中后早期痉挛可降低患者上肢肌张力,改善手功能,提高患者日常生活能力,减少后遗症的发生。
Abstract:Objective To observe the curative effect of botulinum toxin type A (BoNT-A) combined with task-oriented training on the recovery of upper limb function in patients with upper-limb spasticity(ULS) post-stroke. Methods A prospective study was conducted in 48 patients with early ULS post-stroke from January 2017 to October 2019.The patients were divided into control group (n=21,treated with conventional physical manipulation,physical therapy and acupuncture),observation group (n=16,treated with task-oriented occupational therapy based on the method in control group) and treatment group (n=11,treated with ultrasound-guided BoNT-A injection after evaluation on the basis of method in observation group before and after injection).The course of treatment was 8 weeks in three groups.Before and after treatment,modified Ashworth scale (MAS),assessment of upper limb motor recovery,WOLF motor function test (WMFT),modified Rankin scale,functional independence measure(FIM) were used to evaluate upper limb function,and modified Barthel index (MBI) was used to evaluate activities of daily living (ADL). Results There were statistical differences in MAS,assessment of upper limb motor recovery level,WMFT,FIM and MBI between pre-treatment and post-treatment in three groups (P<0.05,P<0.01).MAS of elbow flexor muscle groups and assessment of upper limb motor recovery level in treatment group were better than those in observation group and control group;modified Rankin scale,MBI and FIM in treatment group and observation group were better than those in control group;WMFT in treatment group was better than that in observation group (P<0.05,P<0.01). Conclusion In the treatment of ULS post-stroke,BoNT-A combined with task-oriented training can reduce upper limbs muscle tension,improve hand function and ADL of patients,and reduce the occurrence of sequelae.
文章编号:     中图分类号:    文献标志码:B
基金项目:海南省自然科学基金项目(817325);海南医学院青年培育基金项目(HY2016-19)
引用文本:
孙丽春,王亚苗,吴乾利,等.A型肉毒毒素结合任务导向训练治疗脑卒中后上肢痉挛[J].中国临床研究,2020,33(10):1377-1382.

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