A型肉毒毒素对意识障碍患者上肢严重肌痉挛的应用价值

Application of botulinum toxin A for the treatment of severe upper limb spasticity in patients with disorders of consciousness

目的:探讨A型肉毒毒素局部注射在治疗意识障碍患者上肢严重肌痉挛的应用价值。方法:18例意识障碍患者上肢严重肌痉挛,应用A型肉毒毒素局部注射痉挛肌肉,以改良Ashworth量表(MAS)比较上肢肌张力在治疗前和治疗后1周、4周、12周改善程度,同时以照料者主观评价三项护理任务(穿衣、清洁手掌及剪指甲)完成的难易程度来评定临床功能性目标改善程度。结果:注射A型肉毒毒素治疗后上肢肌痉挛程度明显减轻,屈肘肌MAS评分在治疗前与治疗后1周、4周及12周相比差异有显著性意义(4.17±0.39;2.39±0.99;2.04±0.98;2.0±1.04;P<0.01)。屈掌指肌改良Ashworth量表评分在治疗前与治疗后1周、4周及12周相比差异有显著性意义(4.0;2.22±0.83;1.89±0.78;2.0±0.87,P<0.01)。照料者主观评价任务评分在治疗前(穿衣0.83±0.39,清洁手掌剪指甲1.0)与治疗后1周(分别为2.52±0.95,2.56±0.88),4周(分别为2.78±0.95,2.78±1.09),12周(分别为2.96±0.93,2.67±1.12)相比差异有显著性意义(P<0.01)。所有患者没有发现明显不良反应。结论:局部注射A型肉毒毒素能有效缓解意识障碍患者的上肢肌痉挛,便于患者的护理和卫生,减少相关并发症发生,有利于患者的康复,具有一定的临床应用价值。

Objective：To evaluate the efficacy of intramuscular injection of botulinum toxin A for the treatment of severe upper limb muscle spasticity in patients with disorders of consciousness.Method：A total of 18 patients with disorders of consciousness associated with severe upper limb muscle spasticity received intramuscular injection of botulinum toxin A.The tone of elbow,wrist and finger flexors was assessed at pre-injection and at 1,4,and 12 weeks post-injection using modified Ashworth scale（MAS）;and disability in activities of daily living（ADL） was rated using the caregiver＇s subjective assessments for the tasks（putting arm through sleeve,cleaning palms and cutting fingernails）.Result：Spasticity of the treated muscles alleviated significantly.The mean MAS scores decreased significantly and the caregiver＇s subjective assessments for ADL tasks improved significantly：pre-injection：elbow flexors 4.17±0.39,wrist and finger flexors 4.0,putting arm through sleeve 0.83±0.39,cleaning palms and cutting fingernails 1.0,1 week post-injection（2.39±0.99,2.22±0.83,2.52±0.95,2.56±0.88,respectively）,4weeks（2.04±0.98,1.89±0.78,2.78±0.95,2.78±1.09,respectively）,12 weeks（2.0±1.04,2.0±0.87,2.96±0.93,2.67±1.12,respectively）（P0.01）.No adverse event was noted with the procedure in all patients.Conclusion：Intramuscular injections of botulinum toxin A could reduce spasticity of upper limb muscles in patients with disorders of consciousness and make easy for nursing care and hygiene,decrease the related complications,and promote the patients＇ rehabilitation.