通经解痉汤结合肉毒毒素A对脑卒中后上肢痉挛状态的改善作用

Effect of Tongjing Jiejing Decoction(通经解痉汤)Combined with Botulinum Toxin A on Upper Limb Spasticity after Stroke

目的评价通经解痉汤结合肉毒毒素A对脑卒中后上肢痉挛状态的改善作用研究。方法选择2017年3月—2020年5月医院收治的102例脑卒中后上肢痉挛患者为研究对象,依据随机对照法将患者分为研究组和对照组,每组51例。两组患者均采用常规康复训练,对照组注射肉毒素A治疗,依据肉毒素治疗成人肢体肌肉痉挛指南建议,用B超监测靶肌肉,并在B超的引导下肌腹部进针,依据肌群大小及痉挛程度选择剂量。研究组在对照组治疗的基础上,口服通经解痉汤治疗。两组均持续治疗14 d。观察两组治疗前后口舌歪斜、半身不遂、言语謇涩、感觉减退、自汗、面色[白光]白、气短乏力等中医证候积分变化;比较两组治疗前、治疗2周、4周后和治疗后4周的上肢运动评估量表(the motor Assessment Scale,MAS)评分、肢体运动功能评定量表(fugel-meyer,FMA)和改良Barthel指数(massachusetts broadband institute,MBI)比较;比较两组治疗总有效率。结果研究组治疗总有效率高于对照组(P<0.05);经过14 d的治疗,两组患者口舌歪斜、半身不遂、言语謇涩、感觉减退、自汗、面色[白光]白、气短乏力等中医证候积分较治疗前降低,且研究组降低幅度优于对照组(P<0.05);两组治疗2周、4周后和治疗后4周的上肢MAS评分均较治疗前降低,且研究组降低幅度优于对照组(P<0.05);两组治疗2周、4周后和治疗后4周的上肢FMA评分均较治疗前升高,且研究组升高幅度优于对照组(P<0.05);两组治疗2周、4周后和治疗后4周的上肢MBI评分均较治疗前升高,且研究组升高幅度优于对照组(P<0.05)。结论通经解痉汤结合肉毒素A可显著改善脑卒中后上肢痉挛状态,提高运动功能和日常生活能力,提高治疗疗效,值得临床进一步研究探讨。

Objective To evaluate the effect of Tongjing Jiejing Decoction(通经解痉汤)combined with botulinum toxin A on upper limb spasticity after stroke.Methods A total of 102 patients with upper limb spasm after stroke treated in the hospital from March 2017 to May 2020 were selected as the research object.According to the random control method,the patients were divided into the study group and the control group,with 51 cases in each group.Both groups were treated with routine rehabilitation training,and the control group was treated with botulinum toxin A.According to the recommendations of the guidelines for botulinum toxin in the treatment of adult limb muscle spasm,the target muscle was monitored by B-ultrasound,and the needle was injected into the muscle abdomen under the guidance of B-ultrasound.The dose was selected according to the size of muscle group and the degree of spasm.The study group was treated with Tongjing Jiejing Decoction on the basis of the control group.Both groups were treated for 14 days.The changes of TCM symptom scores such as tongue deviation,hemiplegia,astringent speech,hypoesthesia,spontaneous sweating,pale complexion,shortness of breath and fatigue were observed before and after treatment.The upper limb Motor Assessment Scale(MAS)score,upper limb Simplified Fugl-Meyer Motor function(FMA)score and upper limb Massachusetts Broadband Institute(MBI)score were compared between the two groups before treatment,2 and 4 weeks of treatment and 4 weeks after treatment.The total effective rates of the two groups were compared.Results The total effective rate of the study group was higher than that of the control group(P<0.05).After 14 days of treatment,the TCM symptom scores of the two groups were lower than those before treatment,and the reduction range of the study group was better than that of the control group(P<0.05).The upper limb MAS scores of the two groups were lower than those before treatment at 2 and 4 weeks of treatment and 4 weeks after treatment,and the reduction range of the study group was better than that of the control group(P<0.05).The FMA scores of the upper limbs of the two groups at 2 and 4 weeks of treatment and 4 weeks after treatment were higher than those before treatment,and the increase range of the study group was better than that of the control group(P<0.05).The upper limb MBI scores of the two groups at 2 and 4 weeks of treatment and 4 weeks after treatment were higher than those before treatment,and the increase range of the study group was better than that of the control group(P<0.05).Conclusion Tongjing Jiejing Decoction combined with botulinum toxin A can significantly improve the spasticity of upper limbs after stroke,improve motor function and daily living ability,and improve the therapeutic effect,which is worthy of further clinical research.