鞘内灌注巴氯芬改善肌痉挛的临床研究  

Clinical research of intrathecal baclofen in improving spasticity

作　　者：曾文双 李勇杰 张振宇 陈富勇 林慧婷 洪朝翔 Zeng Wenshuang;Li Yongjie;Zhang Zhenyu;Chen Fuyong;Lin Huiting;Hong Zhaoxiang(Department of Neurology,Neuromedicine Center,Hong Kong University Shenzhen Hospital,Shenzhen 518053,China;Department of Neurosurgery,Neuromedicine Center,Hong Kong University Shenzhen Hospital,Shenzhen 518053,China)

机构地区：[1]香港大学深圳医院神经医学中心神经内科,深圳518053 [2]香港大学深圳医院神经医学中心神经外科,深圳518053

出　　处：《中华神经科杂志》2024年第11期1199-1205,共7页Chinese Journal of Neurology

基　　金：深圳市医疗卫生三名工程项目(SZSM202311022)。

摘　　要：目的探讨鞘内灌注巴氯芬改善中重度肌痉挛的治疗方法及其有效性和安全性。方法回顾性分析2022年8月至2023年8月在香港大学深圳医院接受鞘内灌注巴氯芬治疗的中重度肌痉挛患者的临床特征、鞘内灌注巴氯芬测试反应、巴氯芬泵植入术后的临床转归以及相关并发症的发生情况。结果研究纳入22例中重度肌痉挛患者,其中鞘内灌注巴氯芬测试有效者18例(81.8%)。18例鞘内灌注巴氯芬测试有效的患者鞘注后下肢肌群改良Ashworth量表(MAS)评分(单位:分)最低均值(1.29±0.81)较鞘注前基线均值(3.31±1.18)显著降低(t=11.364,P<0.001)。测试有效的患者鞘注后4 h比目鱼肌H反射M/H波幅比值(9.61±4.66)较鞘注前基线值(3.83±2.69)显著升高(t=7.780,P<0.001)。经患者或其监护人知情同意,18例鞘内灌注巴氯芬测试有效的患者中有10例接受了巴氯芬泵植入手术。10例接受手术的患者(3.71±1.06)与8例未接受手术的患者(2.83±1.16)比较,其下肢肌群MAS评分基线均值更高(F=5.645,P<0.05),鞘注后下肢肌群MAS评分均值的最大降幅也更大(分别为2.61±0.99和1.30±0.64,F=20.696,P<0.001)。10例接受巴氯芬泵植入手术的患者其术后第1、6个月下肢肌群MAS评分均值(分别为1.64±0.91、1.16±0.89)较术前基线均值(3.71±1.06)显著降低(F=39.946,P<0.001),其中2例患者随访至术后第12个月、2例患者随访至术后第18个月,其下肢肌群MAS均值均表现为持续改善状态,1例脑瘫合并下尿路过度活跃综合征的患者,术后急迫性尿失禁症状也明显改善。截至末次随访,10例接受巴氯芬泵植入手术患者的巴氯芬日剂量为(143.60±96.24)μg,尚未发生治疗相关并发症。结论鞘内灌注巴氯芬可以有效地改善中重度肌痉挛患者的痉挛症状及其他相关神经功能障碍,疗效可长期维持,且治疗相关并发症少见。术前的鞘内灌注巴氯芬测试有助于筛选出适合接受巴氯芬泵植入手�ObjectiveTo investigate the specific method,efficacy and safety of intrathecal baclofen(ITB)in the treatment of moderate and severe spasticity.MethodsThe clinical features,response to ITB trial,clinical outcomes and treatment-related complications after baclofen pump implantation surgery were retrospectively analyzed in patients with moderate to severe spasticity who received ITB treatment in Hong Kong University Shenzhen Hospital from August 2022 to August 2023.ResultsThe study included 22 patients with moderate to severe spasticity,of whom 18 patients(81.8%)were effective in ITB trial.For these patients with effective trial,the lowest mean Modified Ashworth Scale(MAS)score of lower extremity muscle groups after ITB bolus injection was decreased significantly compared with the baseline mean value before injection(1.29±0.81 vs 3.31±1.18,t=11.364,P<0.001),and the M/H amplitude ratio of soleus H-reflex at 4 hours after ITB bolus injection was significantly higher than the baseline value(9.61±4.66 vs 3.83±2.69,t=7.780,P<0.001).Among the 18 patients with effective ITB trial,10 patients received baclofen pump implantation surgery with the informed consent of the patients or their guardians.Compared with the 8 patients without surgery,the baseline mean MAS score of lower extremity muscle groups of the 10 patients who received surgery was higher(3.71±1.06 vs 2.83±1.16,F=5.645,P<0.05),the maximum reduction of mean MAS score of lower extremity muscle groups of the 10 patients who received surgery was greater(2.61±0.99 vs 1.30±0.64,F=20.696,P<0.001).In 10 patients who received baclofen pump implantation surgery,the mean MAS score of lower limb muscle groups was significantly decreased in the first and sixth months after surgery compared with the baseline mean value before surgery(1.64±0.91,1.16±0.89 and 3.71±1.06,F=39.946,P<0.001).Among them,2 patients were followed up to 12 months after surgery,2 patients were followed up to 18 months after surgery,and the mean MAS score of their lower limb muscle groups showed

关 键 词：巴氯芬 注射 肌痉挛 肌张力 H反射 

分 类 号：R745.12[医药卫生—神经病学与精神病学]