影响巴氯芬缓解脑源性肌痉挛效果的原因分析

Cause analysis of weakening Baclofen effect in treating brain-derived muscular spasm

目的:分析影响巴氯芬缓解脑源性肌痉挛效果的原因,探讨巴氯芬应用中的注意事项。方法:选择2003-01/2004-07首都医科大学宣武医院收治的30例服用巴氯芬缓解脑源性肌痉挛效果不佳的病例进行分析,服药前后以改良Asworth评分测定肌张力,运用SPSS11.1统计软件进行处理,同时分析其可能原因。结果:治疗前评分(4.33±0.66)分,治疗后评分(4.23±0.77)分,差异无显著性意义,表明服药前后痉挛缓解不明显。分析其原因为:①重度中枢神经系统损伤。②挛缩。③骨折。④脑积水。⑤副反应过强。⑥异位骨化。⑦癫痫。⑧深静脉血栓。结论:巴氯芬对较重的痉挛效果不理想,而轻、中度痉挛效果较好,故痉挛治疗应综合进行,早期合理体位摆放,减少痉挛出现,预防挛缩,防止异位骨化,早筛查发现骨折,尤其对脑损伤患者应及时监测脑室压力变化。另外不要忘记治疗原发病,改善脑功能状态。

AIM:To analyze the cause of weakening Baclofen effect in treating brain derived muscular spasm and explore what we should pay attention to in the application of Baclofen. METHODS:Thirty patients who had no satisfied effect in the treatment of brain derived muscular spasm with Baclofen were selected from Xuanwu Hospital,Capital University of Medical Sciences between January 2003 and July 2004.Their muscle tones were estimated with modified Ashworth scale before and after oral Baclofen.The data were processed with SPSS 11.1,and then the possible factors were analyzed. RESULTS:The scores of modified Ashworth were(4.33±0.66) points and (4.23±0.77) points respectively before and after oral Bclofen,and there was no significant difference between the two groups.It suggested that muscular tones was not improved obviously,which resulted from①serious central nervous system injury;②contracture;③fracture;④hydrocephalus;⑤serious ill effect;⑥heterotopic ossification;⑦epilepsy,and;⑧deep venous thrombosis. CONCLUSION:Baclofen is effective in treating mild to moderate brain derived muscular spasm,but not severe spasm,so comprehensive measures should be taken to treat spasm.It is essential to keep a proper body position, prevent contracture and heterotopic ossification early and detect fracture, especially inspect ventricle pressure of patients with brain injury.Another important thing is to treat the primary diseases of patients and improve brain function.