多巴丝肼并甲钴胺联合针灸与功能训练对脑梗死后运动功能障碍的影响:随机、双盲对照实验

Effect of Levodopa and Benserazide Hydrochloride,mecobalamin in combination with acupuncture and functional training on motor dysfunction after acute cerebral i nfarction:a randomized,double-blind controlled study

目的:探讨脑梗死后运动功能障碍的有效治疗方法。方法:武汉大学医学院附属中山医院神经科2002-01/2004-05收治的急性期脑梗死偏瘫的208例患者,均为首次脑卒中,发病时间72h以内,Fugl-Meyer评分为0分,排除意识障碍及失语者。208例患者被随机分成治疗组(110例)及对照组(98例)。治疗组以多巴丝肼、甲钴胺、针灸及功能训练等进行序贯治疗,于疗程第16,31天以简式Fugl-Meyer运动功能评分法进行积分评定(FMA),并与常规治疗组进行双盲对照研究。结果:FMA<50分:第16天治疗组14例,对照组为16例;第31天治疗组13例,对照组为15例,两组差异无显著性意义(P>0.05);对于FMA>50分者,两组差异有显著性意义P<0.05),而且随着时间的(推移,差异越显著(P<0.01)。结论:多巴丝肼、甲钴胺、针灸及功能训练等综合序贯治疗能较好促进急性期脑梗死患者的运动功能恢复,推测其机制可能与激活神经细胞增殖,诱导其参与损伤修复有关。

AIM:To investigate the effective therapy for functional dysfunction after acut e cerebral infarction. METHODS:Totally 208 cases of acute cerebral infarction with hemiplegia were en rolled by the Department of Neurology of Zhongshan Hospital Affiliated to Medica l College of Wuhan University from January 2002 to May 2004.They were all primar y stroke patients within 72 hours of onset and scored zero on Fugl Meyer assess ment(FMA).Patients with disorder of consciousness and aphasia were excluded.All the subjects were assigned randomly to treatment group(110 cases) and control gr oup(98 cases).Treatment group was treated by Levodopa and Benserazide Hydrochlor ide,mecobalamin in combination with acupuncture and physiotheraphy,and control g roup was treated by routine medicine treatment.On days 13 and 31,the simplified FMA was adopted as criteria for assessment of the therapeutic effect and double blind controlled study was performed between the treatment and control groups. RESULTS:On day 16, FMA< 50 was found in 14 cases of treatment group,and in 16 of control group;on day 31,there were 13 and 15 in the two groups respectively,a nd there were no significant difference between the two groups(P >0.05).There we re significant differences between the two groups of cumulative score for FMA >5 0 points(P< 0.05),and the differences became more and more significant with time passed. CONCLUSION:The therapy of Levodopa and Benserazide Hydrochloride,mecobalamin i n combination with acupuncture and physiotheraphy is an effective method for mot or functional recovery of patients with acute cerebral infarction.The mechanism maybe relates to activating the proliferation of neurocytes and inducing neurocy tes to participate in injury repair.