巴氯芬联合早期神经肌肉电刺激对脑卒中患者高肌张力的临床疗效研究

Clinical analysis of baclofen combined with early neuromuscular electrical stimulation on hypertonia in patients with stroke

目的探讨巴氯芬联合早期神经肌肉电刺激对脑卒中患者高肌张力的临床疗效。方法选取上海市嘉定区安亭医院2021年1月~2023年1月收治的106例脑卒中后高肌张力患者,随机数表法分为联合组和电刺激组,各53例。电刺激组给予常规治疗并实施早期神经肌肉电刺激,联合组加用巴氯芬片,连续治疗4周。评估两组患者治疗前后肢体痉挛状况、肌张力情况、运动功能以及患者日常生活能力;观察两组患者血清炎症指标变化;统计两组患者治疗效果和不良反应。结果联合组患者总有效率为96.23%,高于电刺激组83.02%,差异有统计学意义(χ^(2)=4.970,P<0.05)。治疗后,两组患者临床痉挛指数(CSI)、Ashworth评分明显降低,Fugl-Meyer评分(FMA)、改良Barthel指数(mBI)升高,且联合组治疗后CSI、Ashworth评分低于电刺激组,FMA、mBI则高于电刺激组[(4.65±1.12)分vs.(7.73±1.63)分、(1.38±0.53)分vs.(1.81±0.46)分、(71.47±7.65)分vs.(68.08±6.44)分、(68.92±7.46)分vs.(64.89±7.09)分],差异有统计学意义(t=11.376、2.070、2.634、2.860,P<0.05)。治疗后,两组患者血清白细胞介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)、高迁移率族蛋白B1(HMGB1)水平显著降低,且联合组治疗后血清IL-1β、TNF-α、HMGB1水平显著低于电刺激组[(4.63±0.85)pg ml vs.(5.29±0.91)pg ml、(9.58±2.58)pg ml vs.(12.35±3.13)pg ml、(4.51±1.24)μg L vs.(5.68±1.51)μg L],差异有统计学意义(t=3.927、4.921、4.288,P<0.05)。两组患者不良反应发生率相当(16.98%vs.7.55%),差异无统计学意义(χ2=2.192,P>0.05)。结论巴氯芬联合早期神经肌肉电刺激治疗脑卒中患者高肌张力的疗效良好,可有效降低肢体高肌张力状况,提高患肢运动功能,抑制体内炎症反应水平。

Objective To investigate the clinical effect of baclofen combined with early neuromuscular electrical stimulation on hypertonia in patients with stroke.Methods A total of 106 patients with post-stroke hypertonia admitted to Anting Hospital in Jiading District of Shanghai were randomly divided into combination group and electric stimulation group,with 53 cases in each group.The electric stimulation group was given conventional treatment and early neuromuscular electrical stimulation,and the combination group was given baclofen tablets for 4 weeks in addition.Results The effective rate of combination group was higher than electric stimulation group(96.23%vs.83.02%,P<0.05).After treatment,the clinical spasticity index(CSI)and Ashworth scores were significantly decreased,while Fugl-Meyer assessment(FMA)and modified Barthel index(mBI)were increased in both groups,And the CSI and Ashworth scores of the combination group were lower than those of the electrical stimulation group,the FMA and mBI scores were higher than those of the electrical stimulation group,with a statistically significant difference(t=11.376,2.070,2.634,2.860,P<0.05).After treatment,the serum levels of interleukin-1β(IL-1β),tumor necrosis factor-α(TNF-α)and high mobility group protein B1(HMGB1)in 2 groups were significantly decreased,and the serum levels of IL-1β,TNF-αand HMGB1 in combination group were significantly lower than those in electrical stimulation group(t=3.927,4.921,4.288,P<0.05).The incidence of adverse reactions was similar between combination group and electric stimulation group(16.98%vs.7.55%),there was no significant difference(χ^(2)=2.192,P>0.05).Conclusion Baclofen combined with early neuromuscular electrical stimulation has good effect in the treatment of hypertonia of patients with stroke,which can effectively reduce hypertonia of limbs,improve motor function of affected limbs,and decrease the level of inflammation.