A型肉毒毒素注射在临床脑卒中偏瘫患者中的临床应用及疗效评价

Clinical Application and Efficacy Evaluation of Botulinum Toxin A Injection in Patients with Clinical Cerebral Apoplexy Hemiplegia

目的通过对脑卒中偏瘫患者给予A型肉毒毒素注射屈肘肌与肩后伸肌群并进行康复训练,观察该治疗对中风偏瘫患者上肢功能的影响,探究A型肉毒毒素部位联合注射对改善脑卒中患者上肢功能的效果及临床治疗意义。方法选取2016年8月15日-2018年5月15日期间我院康复医学科收治的脑卒中偏瘫患者98例,按入院时间顺序分为两组,对照组(46例)给予单纯屈肘肌A型肉毒毒素注射,观察组(52例)在对照组治疗基础上另给予肩后伸肌群肉毒素注射。两组患者注射后均进行物理康复训练。在治疗1、2、3个月时进行改良Ashworth痉挛量表评分、Fugl-Meyer上肢运动功能评分及Barthel指数评分综合分析患者痉挛及运动状态,综合评价A型肉毒毒素的治疗效果及两种注射方式的临床疗效。结果两组患者在治疗1、2、3个月时Ashworth评分均显著降低,且观察组患者各时间点Ashworth评分均低于对照组;两组患者治疗后Fugl-Meyer评分显著增加,且在治疗3个月时观察组患者Fugl-Meyer量表评分显著高于对照组;两组患者治疗后日常生活能力Barthel评分均显著增加,在治疗3个月时观察组Barthel评分显著高于对照组,显示出良好的预后。结论 A型肉毒毒素可显著缓解脑卒中偏瘫患者的肌肉痉挛状态,提高患者日常生活能力,且屈肘肌与肩后伸肌群联合注射较单独屈肘肌注射表现出更好的临床疗效。

Objective To observe the therapeutic effect of botulism toxin type A injection on the upper extremity function of cerebral apoplexy patients with hemiplegia.Methods Ninety-eight patients with cerebral apoplexy hemiplegia treated in the Rehabilitation Medicine Division of our hospital between August 15,2016 and May 15,2018 were selected and divided into two groups according to the admission time. Forty-six cases in the control group were given botulism toxin type A injection alone in the elbow flexor muscle,while 52 cases in the observation group additionally received botulinum toxin injection in the extensor muscle mass in the back of the shoulder. Physical rehabilitation training was performed after injection in both groups. After 1 month,2 months,and 3 months of treatment,the improved Ashworth spasm scale,Fugl-Meyer upper extremity motor function score,and Barthel index scores were used to comprehensively analyze the spasticity and exercise status of patients. The clinical effect of botulinum toxin type A and the two injection methods was evaluated. Results The Ashworth score was significantly reduced in the two groups after treatment of one month,two months and three months,especially in the observation group.The Fugl-Meyer score was significantly increased after treatment in both groups,and it was significantly higher in the observation group than in the control group after 3 months of treatment. Barthel scores of both groups increased significantly after treatment.After 3 months of treatment,Barthel scores were significantly higher in the observation group than in the control group,indicating good prognosis.Conclusion Botulinum toxin type A can significantly relieve muscle spasm in cerebral apoplexy patients with hemiplegia and improve their ability to perform daily activities. The combined injection in the elbow flexor muscle and extensor muscle mass in the back of the shoulder shows better clinical efficacy than single elbow flexor muscle injection.