徐霁华，谈跃，敖丽娟.A型肉毒毒素对偏瘫患者上肢Brunnstrom运动恢复阶段的影响[J].中华物理医学与康复杂志,2004,(10):
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| A型肉毒毒素对偏瘫患者上肢Brunnstrom运动恢复阶段的影响 |
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| DOI： |
| 中文关键词: A型肉毒毒素 脑卒中 上肢痉挛 |
| 英文关键词: BTXA Stroke Upper limb Spasticity |
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| 中文摘要: |
| 目的评价A型肉毒毒素结合康复治疗对脑卒中后偏瘫患者上肢Brunnstrom运动恢复阶段及对日常生活活动能力的影响。 方法选取脑卒中患者30例，随机分为A型肉毒毒素组（BTXA组）和对照组。所有患者患侧上肢Brunnstrom分级及Ashworth分级≥Ⅱ级。BTXA组注射BTXA后进行康复训练，对照组仅进行康复训练。在治疗前和治疗后1周，1，2，3个月进行Ashworth评测以评价痉挛状态，Brunnstrom及Fugl-Meyer上肢运动评测以评价运动功能恢复程度，功能独立性评测（FIM）以评价日常生活活动(ADL)能力。 结果BTXA组的痉挛程度较对照组显著降低（P<0.05），Brunnstrom分级提高（P<0.05），FIM评分无显著差异（P>0.05），但其2个月时的自理评分与对照组比较，差异有显著性意义（P<0.05）。治疗过程中未发现不良反应。 结论BTXA可缓解偏瘫上肢的痉挛状态，辅以康复治疗可以促进偏瘫患者上肢Brunnstrom运动恢复的等级，提高上肢运动能力和自理能力。 |
| 英文摘要: |
| Objective To investigate the effect of Botulinum toxin type A(BTXA)and rehabilitation intervention on upper limb Brunnstrom stages and ADL performance of stroke patients. MethodsIn a randomized controlled trial, 30 patients were allocated to either an experimental group (n=15) that received BTXA injection into muscles of the affected arm or to a controlled group (n=15). All patients Brunnstrom stage and MAS stage were ≥gradeⅡ. All the patients were treated with rehabilitative techniques. The intervention was applied for 3 months. All were evaluated for the severity of spasticity (Modified Ashworth Scale,MAS),the level of impairment (Brunnstrom assessment and Fugl-Meyer upper limb test) and disability(Functional Independence Measure,FIM) before and after 1 week, 1,2,3 months of treatment. ResultsPatients who received BTXA had significant reduction of muscle tone (P<0.01). Patients in the experimental group performed better on the Brunnstrom stages and Fugl-Meyer test at the end of 2 months of treatment (P<0.05). FIM score was not significantly changed, but self-care significantly improved at the end of 2 months. There were no major adverse events associated with injection of BTXA. ConclusionIntramuscular injection of BTXA is safe and useful in reducing spasticity of the affected arm and finger muscles in stroke patients. Combined with rehabilitation intervention,it can improve the patients upper limb Brunnstrom stages, motor ability and self-care. |
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