A型肉毒毒素结合功能训练对脑卒中患者生存质量的影响

Effects of Botulinum toxin type A(BTX-A) injection and comprehensive anti-spasticity treatment on quality of life of stroke survivors

目的:通过对脑卒中患者进行A型肉毒毒素(BTX-A)结合综合功能训练前后多个时间点进行生存质量的评测及随访,探讨A型肉毒毒素与功能训练对脑卒中患者肌肉痉挛状态及生存质量等功能结局的影响。方法:选择32例伴有上肢痉挛的脑卒中患者,患侧上肢屈肌痉挛改良Ashworth评分2—3级。随机分为BTX-A治疗组及对照组。BTX-A治疗组患者选择肱二头肌、前臂屈肌群,使用国产A型肉毒毒素在肌腹进行分点注射。注射后进行训练。对照组不使用A型肉毒毒素,仅进行康复功能训练。治疗前、治疗后1周、治疗后2周、治疗后6周、治疗后12周分别检测1次。测量指标包括:改良Ashworth痉挛量表评分及卒中影响量表等。结果:治疗组治疗后4次评测与治疗前相比,肌张力、卒中影响量表评分与对照组比较差异均有显著性意义。治疗后4次评测数据两两之间相比,卒中影响量表得分在治疗后6周达高峰,治疗后12周时有所下降,与治疗前相比,差异均有显著性意义。结论:A型肉毒毒素结合综合康复治疗措施可降低脑卒中患者痉挛上肢的肌张力,增加痉挛上肢的功能性活动,改善脑卒中患者的生存质量。远期疗效较单纯功能训练好。

Objective： To investigate the effect of local injection of Botulinum toxin type A （BTX-A） and comprehensive anti-spasticity treatment on quality of life of stroke survivors. Method：Thirty-two stroke survivors were randomly divided into two groups：BTX-A group and control group. All patients had spasticity of upper limb of modified Ashworth scale（MAS） ranged 2-3 degree. 16 patients as BTX-A group whom received BTX-A injection in the biceps brachii muscles and flexor muscles of forearm on 10-15 points after dilution according to their conditions. All patients were treated with rehabilitation therapy and other anti-spasticity techniques. The degree of spasticity and quality of life were evaluated before injection and in the 1st, 2nd, 6th 12th weeks after injection by modified Ashworth scale and Stroke Impact Scale. Result：Biceps muscle tone and the scores of Stroke Impact Scale showed significantly different between BTX-A group and controlled group. Compared with preinjection, BTX- A group showed that muscle tone was significantly decreased and activity of daily living was improved. The effects lasted more than 12 weeks. Conclusion：Intramuscular multi point injection of BTX-A is useful in reducing muscle spasticity. It was also helpful for improving quality of life of stroke survivers.