摘要
目的:研究利多卡因诊断性阻滞在脑卒中患者足下垂内翻A型肉毒毒素注射中的作用。方法:将符合标准的45例患者随机分为两组,其中25例组患者先进行彩超引导下利多卡因注射,注射完成后观察10min,如无特殊不适,徒手检查患者踝关节肌张力,并让患者行走,肌张力明显下降,目测足下垂内翻明显改善者有19例,这19例患者为利多卡因诊断性阻滞组(诊断性阻滞组),48h后进行彩超引导下A型肉毒毒素注射治疗。另一组20例患者为A型肉毒毒素直接注射组(直接注射对照组),不进行利多卡因注射,直接进行彩超引导下A型肉毒毒素注射治疗。以上两组患者在进行A型肉毒毒素阻滞治疗24h后进行常规康复训练,训练内容包括Bobath方法、运动再学习和日常生活活动(ADL)训练等,训练每次40min,每日2次。所有患者训练至少持续2个月。两组39例患者于治疗前、治疗后1周、2周、4周、8周由未参与注射及康复训练的医师进行肌张力、步速、步长的评价、下肢运动功能的评价(MAS,FMA,FIM评分)、ADL能力评分。结果:治疗后1周两组患者肌张力有下降趋势,但差异无显著性意义,治疗2周、4周、8周后肌张力的下降MAS评分较治疗前差异有显著性意义,在治疗2周、4周、8周后两组间踝关节跖屈肌肌张力差异无显著性意义;两组患者治疗1周后步长、步速、FMA评分、FIM评分无明显变化,直接注射组治疗2周后步长、步速、FMA评分、FIM评分较治疗前有增加趋势,但差异无显著性意义,诊断性阻滞组治疗2周后步长、步速、FMA评分、FIM评分较治疗前增加(P<0.05),治疗4周及8周后两组患者步长、步速、FMA评分、FIM评分较治疗前均增加(P<0.05),在治疗4周和8周后诊断性阻滞组步长、步速、FMA评分、FIM评分均较直接注射组高(P<0.05)。结论:在脑卒中患者足下垂内翻的治疗中,先用利多卡因进行诊断性阻滞后再行A型肉毒毒素
Objective： To study the effect of lidocaine diagnostic block in botulinum toxin type A（BTXA） injection technique for stroke patients＇ spastic equinovarus.Method：A total of 45 stroke patients were divided into 2 groups： one group（n=25） was applied ultrasound-guided technique for location of hdocaine diagnostic block, at lOmin after lidocain injection, of which 19 stroke patients＇muscular tension decreased after 48h these 19 patients（diagnostic injection group） received injection of botulinum toxin type A（BTXA）; the other group（n=20,control group） was only applied ultrasound-guided technique for locationof botulinum toxin type A injection without lidocain. At 24h after BTXA injection both groups received routine rehabilitation training, including Bobath technique, motor relearning program and activities of daily living（ADL） training, 40min/time, twice daily for 2 months. The outcome after BTXA injection was assessed with modifiedAshworth scale（MAS）,Fugl-Meyer assessment-lower limb（FMA-lower limb）, moter-functional independence measurement-lower limb（FIM-lower limb）,and measurement of step length and velocity,at before treatment,1 weeks,2weeks,4 weeks and 8 weeks after treatment. Result：Compared the scores of MAS, FMA-lower limb, FIM-lower limb, step length and velocity in the twogroups at 1 week,2 weeks,4 weeks and 8 weeks after treatment,there was no significant difference at 1 week after treatment（P〉0.05）, there were significant differences at 2 weeks, 4 weeks and 8 weeks after treatment（P〈0.05）,there were significant differences at 4 weeks and 8 weeks after treatment between diagnostic injection group and control group （P〈0.05）.Conclusion： Before injection of botulinum toxin type A lidocaine diagnostic block could shorten the course of treatment for spastic equinovarus in stroke patients,and it＇s long-term effect, in gait, activities of daily livingand motor function were better than only ultrasound-guided technique for location of botulinum t
出处
《中国康复医学杂志》
CAS
CSCD
北大核心
2013年第3期224-228,共5页
Chinese Journal of Rehabilitation Medicine
