| 徐光青,兰 月,赵江莉,何小飞,张 群,张 涛,黄东锋.A型肉毒毒素溶于利多卡因或生理盐水治疗脑卒中患者上肢痉挛的对照研究[J].中国康复医学杂志,2015,(3):237~241 |
| A型肉毒毒素溶于利多卡因或生理盐水治疗脑卒中患者上肢痉挛的对照研究 点此下载全文 |
| 徐光青 兰 月 赵江莉 何小飞 张 群 张 涛 黄东锋 |
| 中山大学附属第一医院康复医学科，广州，510080 |
| 基金项目：国家自然科学基金面上资助项目（81071608，81372109）；广东省科技计划项目（2013B021800277） |
| DOI： |
| 摘要点击次数: 2069 |
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| 摘要： |
| 摘要
目的：本文通过评价和比较A型肉毒毒素（BTXA）溶入利多卡因与溶入生理盐水注射治疗脑卒中患者上肢肌痉挛，探讨BTXA联合利多卡因对脑卒中患者上肢肌肉痉挛及功能活动的影响。
方法：选择30例脑卒中后上肢肌痉挛患者，按照随机原则分为治疗组（BTXA+利多卡因组）和对照组（BTXA+生理盐水组），均接受常规康复治疗。治疗前、治疗后1d、2周、4周和12周进行功能评价，包括：改良Ashworth评分、Fugl-Meyer上肢功能部分、改良Barthel指数等。
结果：组内比较，两组患者治疗后2周、4周和12周时，上肢痉挛、运动功能和自理能力与治疗前相比，差异有显著性意义（P＜0.01）。治疗组患者治疗后1d，上肢痉挛和运动功能评价就有改善，差异有显著性意义（P＜0.01）。相反，对照组治疗后1d，肘关节痉挛却加重，差异有显著性意义（P＜0.05）。局部注射BTXA后，两组间疼痛评分差异有显著性意义（P＜0.01）。治疗后12周时，两组组间改良Ashworth评分、Fugl-Meyer评分、改良Barthel指数差异均有显著性意义（P＜0.05）。
结论：BTXA联合利多卡因局部注射治疗是一种安全有效的方法，能够更加快速、有效地降低脑卒中偏瘫上肢的肌痉挛，提高运动功能和日常生活活动能力，并且疗效维持更久，是一种值得推广应用的治疗方式。 |
| 关键词：脑卒中 痉挛 A型肉毒毒素 利多卡因 上肢 |
| Dilution of botulinum toxin A in lidocaine vs. in normal saline for the treatment of upper limb spasticity in stroke patients: a randomized, comparative study Download Fulltext |
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| Department of Rehabilitation Medicine, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080 |
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| Abstract: |
| Abstract
Objective: To compare the efficacy and tolerance profile of local injection of saline-diluted botulinum toxin type A (BTXA) and lidocaine-diluted botulinum toxin type A in poststroke patients with spasticity of upper limb.
Method: Thirty stroke patients with upper limb spasticity were involved in this study. Subjects were randomly divided into two groups as treatment group and control group. The subjects in the treatment group were injected with lidocaine-diluted BTXA, but subjects in the control group were injected with saline-diluted BTXA. All the patients performed a battery of functional test including modified Ashworth scale (MAS), Fugl-Meyer upper limb assessment (FMA) and modified Barthel index (MBI) before and 1d, 2 weeks, 6 weeks, and 12 weeks after the treatment. Moreover, the pain associated with BTXA injections was evaluated using a 100-mm visual analogue scale（VAS）.
Result: The average scores of elbow/wrist MAS before and 1d, 2 weeks, 6 weeks, and 12 weeks after the treatment were 2.73±0.80/2.93±0.80, 2.20±0.78/2.27±0.70, 1.73±0.59/1.87±0.74, 1.40±0.51/1.67±0.89, 1.27±0.46/1.40±0.51 in treatment group, and were 1.40±0.51/3.13±0.74, 2.93±0.96/3.20±1.01, 2.07±0.70/2.20±0.68, 1.87±0.64/1.93±0.70, 1.73±0.70/1.87±0.52 in control group, respectively. The average FMA scores before and 1d, 2 weeks, 6 weeks, and 12 weeks after the treatment in treatment/control group were 7.47±7.00/18.60±6.65, 20.93±5.46/18.87±5.60, 32.47±7.70/26.07±8.39, 35.40±8.91/29.87±9.26, 45.13±9.20/37.33±8.90, respectively. The average MBI scores before and 1d, 2 weeks, 6 weeks, and 12 weeks after the treatment in treatment/control group were 41.67±6.73/42.33±8.42, 42.67±7.04/43.00±7.02, 65.00±9.26/60.00±12.68, 70.33±9.54/66.01±9.48, 74.67±9.35/67.11±10.31, respectively. Compared with pretreatment, there were significant differences in MAS, FMA and MBI at 2, 4 and 12 weeks in two groups (P＜0.01). Moreover, the local injection of lidocaine-diluted BTXA had positive effects on upper limb spasticity at 1d after treatment (P＜0.01), but saline-diluted BTXA had negative effects on elbow spasticity (P＜0.05). The scores of MAS, FMA and MBI showed significant difference between two groups at 12 weeks after treatment (P＜0.05). The pain score VAS during the injections was significantly lower in the treatment group (43.33±15.99) than in control group (67.40±16.22) (P＜0.01).
Conclusion: BTXA diluted in lidocaine caused significantly less pain than BTXA diluted in saline, and it was effective and safe in treating spasticity. Moreover, the outcomes showed it was helpful for rapidly reducing muscle spasticity of upper limb and improving motor function and ADL ability in stroke patients. Therefore, lidocaine-diluted BTXA may be preferable for treating spasticity of upper limb in stroke patients. |
| Keywords:stroke spasticity botulinum toxin type A lidocaine upper limb |
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