A型肉毒毒素联合磁刺激治疗脑卒中后上肢运动功能障碍疗效观察  

Observation on the curative effect of botulinum toxin-A combined with magnetic stimulation on upper extremity motor dysfunction after stroke

作　　者：郝淑芹[1] 王亚辉[1] 刘兆辉 赵保礼[1] 张立庄[1] 常丽静 邢军[1] 郭记宏[1] HAO Shuqin;WANG Yahui;LIU Zhaohui;ZHAO Baoli;ZHANG Lizhuang;CHANG Lijing;XING Jun;GUO Jihong(The First Hospital of Hebei Medical University,Shijiazhuang 050031,Hebei,China)

机构地区：[1]河北医科大学第一医院,河北石家庄050031

出　　处：《现代中西医结合杂志》2022年第14期1939-1944,1949,共7页Modern Journal of Integrated Traditional Chinese and Western Medicine

基　　金：2018年度河北省卫计委重点科技研究计划项目(20180216);2018年河北医科大学第一医院星火计划项目(XH201801)。

摘　　要：目的 探讨A型肉毒毒素联合磁刺激治疗脑卒中后上肢运动功能障碍的临床疗效。方法 选取2018年10月—2020年12月河北医科大学第一医院收治的脑卒中患者120例,按随机数字表法将上述患者分为对照组、A型肉毒毒素组、重复经颅磁刺激组、联合组,每组30例。4组患者均给予常规基础药物治疗及患侧肢体的康复干预,A型肉毒毒素组在对照组治疗基础上给予A型肉毒毒素治疗,重复经颅磁刺激组在对照组治疗基础上给予重复经颅磁刺激治疗,联合组在对照组治疗基础上给予重复经颅磁刺激和A型肉毒毒素治疗,4组均治疗4周。比较4组患者治疗前、治疗4周后及治疗8周后美国国立卫生研究院卒中量表(NIHSS)评分、改良Ashworth量表(MAS)评分、运动功能评定量表(FMA)评分、改良Barthel指数(MBI)评分以及运动诱发电位(MEP)波幅、中枢运动传导时间(CMCT)。结果 治疗4周、8周后,4组患者的NIHSS评分、MAS评分均明显低于治疗前(P均<0.05),FMA评分、 MBI评分及MEP波幅均明显高于治疗前(P均<0.05),CMCT均明显短于治疗前(P均<0.05),且联合组上述指标改善更明显,与其他组比较差异均有统计学意义(P均<0.05)。结论 A型肉毒毒素联合磁刺激治疗能够明显改善脑卒中后患者的上肢运动功能障碍,提高患者的生活质量,治疗效果较为持久。Objective It is to investigate the clinical efficacy of botulinum toxin-A combined with magnetic stimulation in the treatment of upper limb motor dysfunction after stroke.Methods A total of 120 stroke patients admitted to the First Hospital of Hebei Medical University from October 2018 to December 2020 were selected,and were divided into control group,botulinum toxin-A group,repetitive transcranial magnetic stimulation group and combination group according to the random number table method,30 cases in each group.The patients of the four groups were all given routine basic drug treatment and rehabilitation intervention of the affected limb.On the basis of the treatment of the control group,the botulinum toxin-A group was given botulinum toxin-A,the repetitive transcranial magnetic stimulation group was given repetitive transcranial magnetic stimulation,the combination group was given botulinum toxin-A and repetitive transcranial magnetic stimulation,and the four groups were treated for 4 weeks.The scores of National Institutes of Health Stroke Scale(NIHSS),Modified Ashworth Scale(MAS),Fugl-Meyer Assessment(FMA),Modified Barthel Index(MBI)score as well as motor evoked potential(MEP)amplitude and central motor conduction time(CMCT)before treatment,4 weeks after treatment and 8 weeks after treatment were compared among the 4 groups.Results After 4 weeks and 8 weeks of treatment,the scores of NIHSS and MAS of the four groups were significantly lower than those before treatment(all P<0.05),and the FMA score,MBI score and MEP amplitude were significantly higher than those before treatment(all P<0.05),CMCT was significantly shorter than that before treatment(all P<0.05),and the above indicators in the combination group were improved more significantly,and the differences were statistically significant compared with other groups(all P<0.05).Conclusion Botulinum toxin-A combined with magnetic stimulation therapy can significantly improve the upper limb motor dysfunction and improve the quality of life of patients after str

关 键 词：A型肉毒毒素 经颅磁刺激 脑卒中 痉挛 运动功能障碍 

分 类 号：R743.3[医药卫生—神经病学与精神病学]