拮抗肌易化针刺结合主动肌A型肉毒毒素注射对脑梗死恢复期上肢痉挛患者临床疗效研究

Clinical efficacy of antagonistic facilitation acupuncture plus agonistic muscle botulinum toxin type A injection on upper extremity spasm in the recovery period of cerebral infarction

目的:观察拮抗肌易化针刺结合主动肌A型肉毒毒素注射对脑梗死恢复期上肢痉挛患者临床疗效。方法:72例脑卒中恢复期伴上肢痉挛患者随机分为A组24例(予以常规肢体运动康复训练),B组24例(予以A组基础上配合拮抗肌针刺),C组24例(予以B组基础上结合主动肌A型肉毒毒素注射),治疗前及疗程结束后2周、4周运用运动功能评估量表(Fugl-Meyer Assessment Scale,FMA),改良Ashworth痉挛评定量表(Modified Ashworth Scale,MAS),改良Bathel指数(Barthel Index,BI)及表面肌电图系统评价上肢运动、痉挛、日常生活活动能力、肌肉均方根(Root Mean Square,RMS)振幅差异。结果:治疗后2周、4周三组患者FMA、BI评分较本组治疗前均提高,MAS评级均降低,与A组、B组治疗后比较C组更加显著(P <0.05)。治疗后2周、4周三组患者RMS评分较本组治疗前均下降,与A组、B组治疗后比较C组下降更加显著(P <0.05)。结论:拮抗肌易化针刺结合主动肌A型肉毒毒素注射可有效改善脑梗死恢复期上肢痉挛患者痉挛状态,运动功能及日常生活能力,远期效果稳定,值得临床推广。

Objective:To observe the clinical efficacy of antagonistic facilitation acupuncture plus botulinum toxin A injection in active muscle on the patients with upper extremity spasm in the recovery stage of cerebral infarction.Methods:72 patients with upper extremity spasm during the recovery period of stroke were randomly divided into the group A(24 cases with routine limb exercise rehabilitation training),the group B(24 cases with antagonistic muscle acupuncture on the basis of group A) and the group C(24 cases with botulinum toxin injection on the basis of group B).Results:The scores of FMA and BI in the two weeks and four weeks after treatment were higher than those in the group before treatment,and the scores of MAS were lower than those in the group before treatment,which was more significant in the group C than those in the group A and B after treatment(P<0.05).After two weeks and four weeks of treatment,the RMS score of the patients in the group was lower than that in the group before treatment,and more significantly lower than that in the group A and B after treatment(P<0.05).Conclusion:Antagonistic facilitation acupuncture plus botulinum toxin A injection of active muscle can effectively improve the spasticity,motor function and daily life ability of patients with upper extremity spasm in the recovery period of cerebral infarction,and the long-term effect is stable,which is worthy of clinical promotion.