脑卒中后痉挛性瘫痪病理研究进展

The Advance of Pathophysiology in Post Stroke Spasticity

痉挛是脑卒中后常见的并发症,以牵张反射亢进后,肢体对被动伸展或屈曲出现速度依赖性抵抗为特征。到目前为止,痉挛产生的病理机制尚未明确,这导致目前对于脑卒中后痉挛并无良好的治疗方法。现有文献表明脑卒中后痉挛产生的相对明确病理机制有:网状脊髓束兴奋性升高导致的脊髓牵张反射亢进,Ia传入神经与脊髓运动神经元之间H反射激活后抑制减弱,α运动神经元兴奋性增高,肌肉特性的改变等。深入研究脑卒中后痉挛产生的病理机制将对痉挛临床症状的评估、治疗提供理论基础。

Spasticity is one of the most common complication of stroke,caused by hyperexcitability of the stretch reflex and characterized by velocity-dependent increase in resistance during passive reflexion or stretch.The poorly understanding of post-stroke spasticity resulting in the poorly treatment approaches.Untill now,there are several relatively clear mechanism of post-stroke spasticity,the excitability of reticulospinal(RST)which will lead to the hyperexcitability of the stretch reflex;the weakened post activation depression at the synapse between the Ia afferent and the motoneuron;hyperexcitability of the spinalαmotoneuron and changes in the muscle properties.The better understanding of post stroke spasticity will provide a theoretical basis for a better clinical assessment and management.