不同剂量A型肉毒毒素配合康复训练治疗痉挛性脑瘫患儿疗效评价
|
摘要
目的探讨不同剂量A型肉毒毒素(BTX-A)配合康复训练对痉挛性脑瘫患儿运动功能和肌痉挛程度的影响。方法选取医院2015年6月至2017年8月收治的痉挛性脑瘫患儿84例,按使用BTX-A的剂量不同分为A组(3 U/kg)、B组(4 U/kg)和C组(5 U/kg),各28例,同时配合康复训练。结果治疗后,3组患儿的粗大运动评价量表(GMFM)评分差异均有统计学意义(P <0. 05);不同时间点3组患儿的GMFM评分比较均无明显差异(P> 0. 05);治疗后,3组患儿的改良痉挛(Ashworth)量表评分比较无明显差异(P> 0. 05),但各组均明显低于其治疗前(P <0. 05); A组、B组患儿治疗有效率分别为92. 86%,96. 43%,均高于C组的85. 71%(P <0. 05); 3组患儿出现的注射局部炎症、皮疹和恶心呕吐等不适症状均无明显差异(P> 0. 05)。结论 BTX-A配合康复训练治疗痉挛性脑瘫疗效较好,推荐剂量为3～5 U/kg,可有效改善患儿的运动功能及肌痉挛症状,不良反应少,安全性较高。
Objective To investigate the effect of different doses of botulinum toxin A( BTX-A) combined with rehabilitation training on motor function and myospasm degree in children with spastic cerebral palsy. Methods Totally 84 children with spastic cerebral palsy admitted to our hospital from June 2015 to August 2017 were divided into group A( 3 U/kg),group B( 4 U/kg) and group C( 5 U/kg)according to the dosage of BTX-A,28 cases in each group,and all patients were given rehabilitation training. Results After treatment,the gross motor function measure( GMFM) scores of the three groups were significantly different from those before treatment( P < 0. 05).At different time points,there was no significant difference in GMFM scores among the three groups( P > 0. 05). After treatment,there was no significant difference in modified Ashworth scale scores among the three groups( P > 0. 05),but the scores of the three group were significantly lower than those before treatment( P < 0. 05). The effective rates of group A and group B were 92. 86% and96. 43%, respectively, which were higher than 85. 71% of group C( P < 0. 05). There were no significant differences in local inflammation, rash and nausea and vomiting among the three groups( P > 0. 05). Conclusion BTX-A combined with rehabilitation training in the treatment of children with spastic cerebral palsy has better clinical effect. The recommended dose is 3-5 U/kg,it can effectively improve the motor function and myospasm symptoms of children with spastic cerebral palsy, and it has fewer adverse reactions and higher safety.
Objective To investigate the effect of different doses of botulinum toxin A( BTX-A) combined with rehabilitation training on motor function and myospasm degree in children with spastic cerebral palsy. Methods Totally 84 children with spastic cerebral palsy admitted to our hospital from June 2015 to August 2017 were divided into group A( 3 U/kg),group B( 4 U/kg) and group C( 5 U/kg)according to the dosage of BTX-A,28 cases in each group,and all patients were given rehabilitation training. Results After treatment,the gross motor function measure( GMFM) scores of the three groups were significantly different from those before treatment( P < 0. 05).At different time points,there was no significant difference in GMFM scores among the three groups( P > 0. 05). After treatment,there was no significant difference in modified Ashworth scale scores among the three groups( P > 0. 05),but the scores of the three group were significantly lower than those before treatment( P < 0. 05). The effective rates of group A and group B were 92. 86% and96. 43%, respectively, which were higher than 85. 71% of group C( P < 0. 05). There were no significant differences in local inflammation, rash and nausea and vomiting among the three groups( P > 0. 05). Conclusion BTX-A combined with rehabilitation training in the treatment of children with spastic cerebral palsy has better clinical effect. The recommended dose is 3-5 U/kg,it can effectively improve the motor function and myospasm symptoms of children with spastic cerebral palsy, and it has fewer adverse reactions and higher safety.
引文
[1]王景刚,郭云龙,高艺文,等.肌内效贴联合运动控制训练对脑瘫患儿运动功能影响的研究[J].中国康复,2017,32(5):362-364.
[2]童鹏,王林中. BTX-A辅助常规康复功能锻炼对合并腓肠肌痉挛脑瘫患儿痉挛程度、肌张力及粗大神经功能的影响[J].检验医学与临床,2018,19(5):436-438.
[3]侯玉晋,单海军,介小素,等. A型肉毒毒素注射联合功能训练对痉挛型脑瘫患儿尖足畸形、粗大运动功能及智力发育的影响研究[J].中国全科医学,2017,20(31):3912-3917.
[4]刘建军,齐婧,张雁,等. A型肉毒毒素治疗痉挛型脑性瘫痪的疗效2年随访[J].中国康复理论与实践,2017,23(7):816-819.
[5]张艳娇,童光磊,周陶成,等.超声定位引导A型肉毒毒素注射联合常规康复训练治疗痉挛型脑瘫儿童下肢肌张力障碍的疗效观察[J].中国儿童保健杂志,2016,24(7):759-762.
[6]苏珍辉. A型肉毒毒素治疗痉挛型脑瘫的观察与护理[J].上海护理,2016,16(1):163-165.
[7]鲍首燕,阿米那·吾斯曼,金红芳. A型肉毒毒素不同注射定位方案联合综合康复锻炼对脑性瘫痪儿童下肢功能的影响[J].重庆医学,2016,45(28):3934-3936.
[8]苏珍辉,胡烨,丁玉莲,等. A型肉毒毒素治疗痉挛型脑瘫的护理配合及疗效观察[J].上海护理,2016,16(1):47-50.
[9]唐青松,李明,刘星,等. A型肉毒毒素局部注射治疗儿童痉挛型脑瘫马蹄足畸形有效性及安全性的Meta分析[J].重庆医科大学学报,2018,43(2):108-110.
[10]孙巍,王雪娇,柯耀棋. A型肉毒毒素治疗面肌痉挛的术中配合与护理[J].中国美容整形外科杂志,2016,27(2):113-115.
[11]刘小晓,王永芹. A型肉毒杆菌毒素治疗儿童脑瘫的研究进展[J].儿科药学杂志,2017,24(11):61-64.
[12]徐换,郝赤子,郑俊,等. A型肉毒素治疗卒中后上肢痉挛疗效的Meta分析[J].中国脑血管病杂志,2017,14(2):57-63.
[13]李亚斌,冯海霞,梁学镖,等.肌内效贴联合A型肉毒素局部注射和常规康复训练对脑卒中后下肢痉挛患者步行能力的影响[J].中华物理医学与康复杂志,2017,39(8):773-775.
[14]符小琴,杨梅,吕红梅.针灸配合康复训练对痉挛型脑瘫的疗效观察[J].中国优生与遗传杂志,2017,24(5):143-144.
[15]朱登纳,王明梅,王军,等. A型肉毒毒素注射治疗9~36月龄脑瘫患儿腓肠肌痉挛的前瞻性研究[J].中国当代儿科杂志,2016,18(2):123-129.
[16]山磊,崔利华,杨宇琦. A型肉毒毒素在脑卒中后肢体痉挛患者康复中的应用[J].神经损伤与功能重建,2016,11(3):236-237.
[17] MIETTON C,SCHAEFFER L,STREICHENBERGER N,et al.Physiological anatomy of botulinum toxin effect on the spastic muscle of children with cerebral palsy[J]. Annals of Physical&Rehabilitation Medicine,2016,59(8):972-974.
[18]李红波,魏松涛,马丙祥.多点靶肌注射与非多点靶肌注射A型肉毒毒素对小儿痉挛型脑性瘫痪临床效果比较[J].药物评价研究,2018,41(3):335-337.
[19] WEI L I,LIU X,SHAO Y J,et al. Effect of Botulinum Toxin A Injection Combined with Core Strength Training on the Gait of Children with Spastic Cerebral Palsy[J]. Journal of Gannan Medical University,2016,22(4):284-286.
[20]王虹,赵晨光,袁华,等. A型肉毒毒素联合冲击波疗法对脑卒中后下肢痉挛状态的疗效观察[J].中国康复医学杂志,2017,32(7):773-778.
[21]张玲,张瑞,张跃,等. A型肉毒毒素注射联合功能训练对痉挛型脑瘫患儿运动能力的影响[J].中国妇幼保健,2016,31(6):1292-1294.
[2]童鹏,王林中. BTX-A辅助常规康复功能锻炼对合并腓肠肌痉挛脑瘫患儿痉挛程度、肌张力及粗大神经功能的影响[J].检验医学与临床,2018,19(5):436-438.
[3]侯玉晋,单海军,介小素,等. A型肉毒毒素注射联合功能训练对痉挛型脑瘫患儿尖足畸形、粗大运动功能及智力发育的影响研究[J].中国全科医学,2017,20(31):3912-3917.
[4]刘建军,齐婧,张雁,等. A型肉毒毒素治疗痉挛型脑性瘫痪的疗效2年随访[J].中国康复理论与实践,2017,23(7):816-819.
[5]张艳娇,童光磊,周陶成,等.超声定位引导A型肉毒毒素注射联合常规康复训练治疗痉挛型脑瘫儿童下肢肌张力障碍的疗效观察[J].中国儿童保健杂志,2016,24(7):759-762.
[6]苏珍辉. A型肉毒毒素治疗痉挛型脑瘫的观察与护理[J].上海护理,2016,16(1):163-165.
[7]鲍首燕,阿米那·吾斯曼,金红芳. A型肉毒毒素不同注射定位方案联合综合康复锻炼对脑性瘫痪儿童下肢功能的影响[J].重庆医学,2016,45(28):3934-3936.
[8]苏珍辉,胡烨,丁玉莲,等. A型肉毒毒素治疗痉挛型脑瘫的护理配合及疗效观察[J].上海护理,2016,16(1):47-50.
[9]唐青松,李明,刘星,等. A型肉毒毒素局部注射治疗儿童痉挛型脑瘫马蹄足畸形有效性及安全性的Meta分析[J].重庆医科大学学报,2018,43(2):108-110.
[10]孙巍,王雪娇,柯耀棋. A型肉毒毒素治疗面肌痉挛的术中配合与护理[J].中国美容整形外科杂志,2016,27(2):113-115.
[11]刘小晓,王永芹. A型肉毒杆菌毒素治疗儿童脑瘫的研究进展[J].儿科药学杂志,2017,24(11):61-64.
[12]徐换,郝赤子,郑俊,等. A型肉毒素治疗卒中后上肢痉挛疗效的Meta分析[J].中国脑血管病杂志,2017,14(2):57-63.
[13]李亚斌,冯海霞,梁学镖,等.肌内效贴联合A型肉毒素局部注射和常规康复训练对脑卒中后下肢痉挛患者步行能力的影响[J].中华物理医学与康复杂志,2017,39(8):773-775.
[14]符小琴,杨梅,吕红梅.针灸配合康复训练对痉挛型脑瘫的疗效观察[J].中国优生与遗传杂志,2017,24(5):143-144.
[15]朱登纳,王明梅,王军,等. A型肉毒毒素注射治疗9~36月龄脑瘫患儿腓肠肌痉挛的前瞻性研究[J].中国当代儿科杂志,2016,18(2):123-129.
[16]山磊,崔利华,杨宇琦. A型肉毒毒素在脑卒中后肢体痉挛患者康复中的应用[J].神经损伤与功能重建,2016,11(3):236-237.
[17] MIETTON C,SCHAEFFER L,STREICHENBERGER N,et al.Physiological anatomy of botulinum toxin effect on the spastic muscle of children with cerebral palsy[J]. Annals of Physical&Rehabilitation Medicine,2016,59(8):972-974.
[18]李红波,魏松涛,马丙祥.多点靶肌注射与非多点靶肌注射A型肉毒毒素对小儿痉挛型脑性瘫痪临床效果比较[J].药物评价研究,2018,41(3):335-337.
[19] WEI L I,LIU X,SHAO Y J,et al. Effect of Botulinum Toxin A Injection Combined with Core Strength Training on the Gait of Children with Spastic Cerebral Palsy[J]. Journal of Gannan Medical University,2016,22(4):284-286.
[20]王虹,赵晨光,袁华,等. A型肉毒毒素联合冲击波疗法对脑卒中后下肢痉挛状态的疗效观察[J].中国康复医学杂志,2017,32(7):773-778.
[21]张玲,张瑞,张跃,等. A型肉毒毒素注射联合功能训练对痉挛型脑瘫患儿运动能力的影响[J].中国妇幼保健,2016,31(6):1292-1294.