A型肉毒毒素联合重复经颅磁刺激对脑卒中后下肢痉挛状态的疗效观察

关键词：脑卒中  肌痉挛  A型肉毒毒素  重复经颅磁刺激

Keywords:stroke  spasticity  botulinum toxin type A  repetitive transcranial magnetic stimulation

摘要：

      摘要 目的：观察A型肉毒毒素（botulinum toxin type A， BTX-A）注射联合重复经颅磁刺激（repetitive transcranial magnetic stimulation， rTMS）对脑卒中后下肢肌肉痉挛状态的长期疗效和安全性。 方法：共选取80例脑卒中患者，均伴有下肢肌肉痉挛，随机分为常规治疗组、常规治疗+BTX-A治疗组、常规治疗+rTMS治疗组、常规治疗+BTX-A+rTMS治疗组，每组各20例患者。常规治疗组（A组）采用各种常规康复训练方法；常规治疗+BTX-A组（B组）的患者除了进行常规康复治疗外，还对下肢痉挛肌肉进行BTX-A注射；常规治疗+rTMS治疗组（C组）则除了常规康复训练，还进行rTMS治疗；而常规治疗+BTX-A+rTMS组（D组）除了进行常规康复治疗及注射BTX-A外，还给予患者rTMS治疗。治疗前和治疗后4周、8周和12周分别进行肌张力、下肢运动功能及ADL能力评定。 结果：①肌张力变化情况：4组患者治疗4周后，与治疗前相比，肌张力均有不同程度降低（P＜0.05），8周后，A组肌张力有所回升，而B组、C组以及D组未见明显回升；12周时，A组肌张力进一步增加，与此同时，B组也有所回升，而C组与D组仍与8周时无显著差异，同时D组肌张力显著低于其余3组（P＜0.05）。②运动及ADL能力变化情况：4组患者治疗4周后，运动功能和ADL能力均有所改善（P＜0.05）。8周后，A组患者的运动功能及ADL能力再次出现下降，而其余3组患者未见下降；而12周时，与8周时相比，B组也出现下降，C组与8周时相比无明显变化，而D组则有进一步改善并优于其余3组（P＜0.05）。 结论：A型肉毒毒素联合重复经颅磁刺激可以较持久地降低患者肌张力，也能够有效地提高患者的运动功能和ADL能力，为临床治疗脑卒中患者提供了新的思路。

Abstract:

      Abstract Objective: To investigate the effect of botulinum toxin type A (BTX-A) combined with repetitive transcranial magnetic stimulation (rTMS) on spasticity of lower limbs in stroke patients. Method: The stroke patients with spasticity of lower limbs were divided into four groups (n=20): conventional rehabilitation group (group A), conventional rehabilitation + BTX-A injection group (group B), conventional rehabilitation + rTMS group (group C), conventional rehabilitation + BTX-A injection + rTMS group (group D). Muscle tone, motor function and activities of daily living (ADL) were evaluated at 4 weeks, 8 weeks and 12 weeks after treatment. Result: ①Muscle tone: After 4 weeks treatment, muscle tone for all groups decreased comparing with those before treatment (P＜0.05). After 8 weeks, the muscle tone in group A increased again, while no change in group B, C and D. At 12 weeks, the muscle tone in group A increased further. At the same time, the muscle tone in group B also exhibited a gradually increasing tendency, while no change in group C and D. The muscle tone in group D was lower than that of the other three groups. ②Motor function and ADL: Motor function and ADL were ameliorated at 4 weeks after treatment in all groups (P＜0.05). After 8 weeks, in group A, the motor function and MBI decreased with no change in group B, C and D, which was similar to the changes of muscle tone. After 12 weeks, the motor function and MBI increase further for group D. Conclusion: These data support that BTX-A combined with rTMS has long-term efficacy for motor function amelioration and the improvement of ADL for stroke patients.