脑卒中后痉挛的发生机制及治疗研究进展
Research Progress on the Occurrence Mechanism and Treatment of Spasm after Stroke
DOI: 10.12677/acm.2026.163966, PDF,    科研立项经费支持
作者: 杨惠婷, 蔡泽霖*：杭州市临安区中医院康复科，浙江 杭州
关键词: 脑卒中后痉挛；发病机制；治疗；康复；Post-Stroke Spasm； Pathogenesis； Treatment； Rehabilitation
摘要: 脑卒中后痉挛(Post-stroke spasm, PSS)是脑卒中后的常见并发症，严重影响脑卒中患者的康复进程及生活质量，目前PSS的发病机制尚不完全明确，但有研究对此进行探讨及实验，关于PSS的治疗，国内外研究者从多方面对治疗PSS展开实验室及临床研究。本文对PSS的发病机制及治疗的研究进展进行文献检索及综述。
Abstract: Post-stroke spasm (PSS) is a common complication after stroke, which seriously affects the rehabilitation process and quality of life of stroke patients. Currently, the pathogenesis of PSS is not fully understood, but some studies have explored and experimented with it. Regarding the treatment of PSS, researchers at home and abroad have conducted laboratory and clinical studies on the treatment of PSS from multiple aspects. This article conducts a literature retrieval and review on the research progress of the pathogenesis and treatment of PSS.
文章引用：杨惠婷, 蔡泽霖. 脑卒中后痉挛的发生机制及治疗研究进展[J]. 临床医学进展, 2026, 16(3): 1804-1811. https://doi.org/10.12677/acm.2026.163966

参考文献

[1] Rakers, F., Weise, D., Hamzei, F., Musleh, R., Schwab, M., Jacob, J., et al. (2023) The Incidence and Outpatient Medical Care of Patients with Post-Stroke Spasticity. Deutsches Ärzteblatt International, 120, 284-285. [Google Scholar] [CrossRef] [PubMed]
[2] 杨俊驰, 王东岩, 谭信哲, 等. 针刺调控mTOR相关信号通路治疗脑卒中后痉挛作用机制研究进展[J]. 针灸临床杂志, 2025, 41(8): 100-105.
[3] Wissel, J., Manack, A. and Brainin, M. (2013) Toward an Epidemiology of Poststroke Spasticity. Neurology, 80, S13-S19. [Google Scholar] [CrossRef] [PubMed]
[4] Urban, P.P., Wolf, T., Uebele, M., Marx, J.J., Vogt, T., Stoeter, P., et al. (2010) Occurence and Clinical Predictors of Spasticity after Ischemic Stroke. Stroke, 41, 2016-2020. [Google Scholar] [CrossRef] [PubMed]
[5] Malhotra, S., Pandyan, A., Rosewilliam, S., Roffe, C. and Hermens, H. (2010) Spasticity and Contractures at the Wrist after Stroke: Time Course of Development and Their Association with Functional Recovery of the Upper Limb. Clinical Rehabilitation, 25, 184-191. [Google Scholar] [CrossRef] [PubMed]
[6] Parikh, R.J., Sutaria, J.M., Ahsan, M., Nuhmani, S., Alghadir, A.H. and Khan, M. (2022) Effects of Myofascial Release with Tennis Ball on Spasticity and Motor Functions of Upper Limb in Patients with Chronic Stroke: A Randomized Controlled Trial. Medicine, 101, e29926. [Google Scholar] [CrossRef] [PubMed]
[7] Doussoulin, A., Rivas, C., Bacco, J., Sepúlveda, P., Carvallo, G., Gajardo, C., et al. (2020) Prevalence of Spasticity and Postural Patterns in the Upper Extremity Post Stroke. Journal of Stroke and Cerebrovascular Diseases, 29, Article ID: 105253. [Google Scholar] [CrossRef] [PubMed]
[8] Thibaut, A., Chatelle, C., Ziegler, E., Bruno, M., Laureys, S. and Gosseries, O. (2013) Spasticity after Stroke: Physiology, Assessment and Treatment. Brain Injury, 27, 1093-1105. [Google Scholar] [CrossRef] [PubMed]
[9] Li, S. and Francisco, G.E. (2015) New Insights into the Pathophysiology of Post-Stroke Spasticity. Frontiers in Human Neuroscience, 9, Article 192. [Google Scholar] [CrossRef] [PubMed]
[10] Chen, C., Chen, C., Chen, H., Wu, C., Lin, K., Hsieh, Y., et al. (2020) Responsiveness and Minimal Clinically Important Difference of Modified Ashworth Scale in Patients with Stroke. European Journal of Physical and Rehabilitation Medicine, 55, 754-760. [Google Scholar] [CrossRef] [PubMed]
[11] Ri, S., Kivi, A., Urban, P., Wolf, T. and Wissel, J. (2020) Site and Size of Lesion Predict Post-Stroke Spasticity: A Retrospective Magnetic Resonance Imaging Study. Journal of Rehabilitation Medicine, 52, jrm00065. [Google Scholar] [CrossRef] [PubMed]
[12] 陈楠, 华艳, 白玉龙. 卒中后痉挛状态发生机制的研究进展[J]. 中国康复理论与实践, 2021, 27(5): 588-594.
[13] 伍潇潇. 基于神经电生理技术探讨太极推拿治疗脑卒中后上肢肌张力增高状态的临床观察及机制研究[D]: [硕士学位论文]. 武汉: 湖北中医药大学, 2024.
[14] Lee, K.B., Hong, B.Y., Kim, J.S., Sul, B., Yoon, S.C., Ji, E., et al. (2019) Which Brain Lesions Produce Spasticity? An Observational Study on 45 Stroke Patients. PLOS ONE, 14, e0210038. [Google Scholar] [CrossRef] [PubMed]
[15] Qin, Y., Qiu, S., Liu, X., Xu, S., Wang, X., Guo, X., et al. (2022) Lesions Causing Post-Stroke Spasticity Localize to a Common Brain Network. Frontiers in Aging Neuroscience, 14, Article 1011812. [Google Scholar] [CrossRef] [PubMed]
[16] Chen, B., Yang, T., Liao, Z., Sun, F., Mei, Z. and Zhang, W. (2025) Pathophysiology and Management Strategies for Post-Stroke Spasticity: An Update Review. International Journal of Molecular Sciences, 26, Article 406. [Google Scholar] [CrossRef] [PubMed]
[17] Ri, S., Glaess-Leistner, S. and Wissel, J. (2021) Early Brain Imaging Predictors of Post-Stroke Spasticity. Journal of Rehabilitation Medicine, 53, jrm00169. [Google Scholar] [CrossRef] [PubMed]
[18] Cho, M.J., Yeo, S.S., Lee, S.J. and Jang, S.H. (2023) Correlation between Spasticity and Corticospinal/Corticoreticular Tract Status in Stroke Patients after Early Stage. Medicine, 102, e33604. [Google Scholar] [CrossRef] [PubMed]
[19] 何思佳, 杨信才. 脑卒中偏瘫患者肌肉痉挛治疗的研究进展[J]. 医学研究与教育, 2021, 38(2): 26-31.
[20] 谢敏, 陈伟, 周小炫, 等. 电子灸联合乙哌立松治疗中风后上肢痉挛的疗效观察[J]. 按摩与康复医学, 2022, 13(13): 1-3, 7.
[21] 郭天龙, 刘景隆, 郭宇. 3种口服抗痉挛药物对脑卒中后肢体痉挛的疗效比较[J]. 中国康复理论与实践, 2012, 18(5): 453-455.
[22] Prazeres, A., Lira, M., Aguiar, P., Monteiro, L., Vilasbôas, Í. and Melo, A. (2018) Efficacy of Physical Therapy Associated with Botulinum Toxin Type a on Functional Performance in Post-Stroke Spasticity: A Randomized, Double-Blinded, Placebo-Controlled Trial. Neurology International, 10, Article No. 7385. [Google Scholar] [CrossRef] [PubMed]
[23] Muresanu, D.F., Heiss, W., Hoemberg, V., Bajenaru, O., Popescu, C.D., Vester, J.C., et al. (2016) Cerebrolysin and Recovery after Stroke (CARS): A Randomized, Placebo-Controlled, Double-Blind, Multicenter Trial. Stroke, 47, 151-159. [Google Scholar] [CrossRef] [PubMed]
[24] Ercelen, N., Karasu, N., Kahyaoglu, B., Cerezci, O., Akduman, R.C., Ercelen, D., et al. (2023) Clinical Experience: Outcomes of Mesenchymal Stem Cell Transplantation in Five Stroke Patients. Frontiers in Medicine, 10, Article 1051831. [Google Scholar] [CrossRef] [PubMed]
[25] Zhang, Y., Dong, N., Hong, H., Qi, J., Zhang, S. and Wang, J. (2022) Mesenchymal Stem Cells: Therapeutic Mechanisms for Stroke. International Journal of Molecular Sciences, 23, Article 2550. [Google Scholar] [CrossRef] [PubMed]
[26] 骆伟, 王坤, 李小萍. 物理疗法为主的综合康复治疗对脑卒中后肌张力增高患者的疗效[J]. 心血管康复医学杂志, 2020, 29(3): 272-276.
[27] 伍丹丹, 严隽陶. 振动疗法在康复临床中的应用及研究进展[J]. 现代中西医结合杂志, 2020, 29(4): 452-456.
[28] 沈显山. 局部振动在脑卒中偏瘫康复的应用及神经机制研究[D]: [博士学位论文]. 合肥: 安徽医科大学, 2024.
[29] Vieira, D., Silva, M.B., Melo, M.C. and Soares, A.B. (2016) Effect of Myofeedback on the Threshold of the Stretch Reflex Response of Post-Stroke Spastic Patients. Disability and Rehabilitation, 39, 458-467. [Google Scholar] [CrossRef] [PubMed]
[30] 郑晓钰. 针刺联合BCI脑机接口康复技术对脑型肝豆状核变性患者上肢痉挛性肌张力障碍的干预作用及对血清Glu、GABA的影响[D]: [硕士学位论文]. 合肥: 安徽中医药大学, 2024.
[31] Pennati, G.V., Da Re, C., Messineo, I., et al. (2015) How Could Robotic Training and Botolinum Toxin Be Combined in Chronic Post Stroke Upper Limb Spasticity? A Pilot Study. European Journal of Physical and Rehabilitation Medicine, 51, 381-387.
[32] 开心, 吕晓琳, 孙美琦, 等. 针刺治疗脑卒中后痉挛性偏瘫的分子生物学机制研究进展[J]. 湖北中医杂志, 2024, 46(1): 55-58.
[33] 杨慧琳, 胡纪可. 牵引技术结合针刺治疗脑梗塞后肌痉挛的临床疗效及作用机制研究[J]. 四川中医, 2017, 35(12): 213-216.
[34] 钱跃, 谢波, 闫显栋. 醒脑开窍针法对缺血性脑卒中患者皮质脊髓束及运动功能影响的临床观察[J]. 中国中医药现代远程教育, 2024, 22(22): 133-136.
[35] 何鑫, 赵健, 景伟, 等. 电针阳陵泉和曲池穴调控JAK2/STAT3信号通路改善大鼠脑卒中肢体痉挛[J]. 广州中医药大学学报, 2025, 42(2): 430-436.
[36] 易丽贞. 基于IL-6/JAK2/STAT3信号通路探讨电针调控铁代谢对脑卒中肢体痉挛大鼠的机制研究[D]: [博士学位论文]. 长沙: 湖南中医药大学, 2024.
[37] 黄麟荇. 基于CKLF1/CCR4轴研究针刺调控小胶质细胞极化对大鼠脑卒中肢体痉挛的作用[D]: [博士学位论文]. 长沙: 长沙: 湖南中医药大学, 2024.
[38] 吴晓燕. 基于甘氨酸能神经递质信号传递相关因子探讨电针跷脉腧穴改善脑卒中后大鼠肢体痉挛的中枢机制研究[D]: [硕士学位论文]. 成都: 成都中医药大学, 2021.
[39] 张琼帅. 头穴丛刺治疗中风后肢体痉挛的临床观察及其抗痉挛效应机理研究[D]: [博士学位论文]. 长春: 长春中医药大学, 2021.
[40] 王雪飞, 赵因, 王麟鹏. 早期针刺夹脊穴治疗脑卒中后痉挛的机制探讨[J]. 吉林中医药, 2015, 35(4): 421-424.
[41] 张铤彬. 基于网络药理学和分子对接探讨大秦艽汤治疗脑梗死后肌张力障碍的作用机制[D]: [硕士学位论文]. 南宁: 广西中医药大学, 2025.
[42] 李丽丽. 血府逐瘀汤治疗脑卒中后肌张力增高疗效及对患者运动功能的影响[J]. 陕西中医, 2021, 42(4): 449-451.
[43] 陈文煜, 胡杰, 郑贺彬. 血府逐瘀汤熏蒸联合振动疗法治疗脑卒中恢复期下肢肌张力增高临床研究[J]. 新中医, 2022, 54(10): 51-54.
[44] 李宇霄, 李润桥, 付思慧, 等. 基于网络药理学和分子对接探讨芍药甘草汤治疗脑梗死后痉挛性偏瘫的作用机制[J]. 中西医结合心脑血管病杂志, 2021, 19(23): 4027-4035.
[45] 韩珂, 张郧涛, 王晓鹏, 等. 芍甘木瓜汤通过BDNF/TrkB/CREB信号通路改善脑卒中偏瘫痉挛状态大鼠神经行为学研究[J]. 药物评价研究, 2021, 44(10): 2161-2169.
[46] 胡斌, 柴德君. 甘草甜素通过调节PI3K/Akt/GSK3β信号通路对脑卒中偏瘫痉挛状态大鼠的痉挛状态的影响[J]. 中国临床药理学杂志, 2024, 40(12): 1779-1783.
[47] 谢乐. 白芍络石方治疗脑梗死后痉挛性瘫痪的临床疗效及其对突触可塑性、BDNF/TrKB-KCC2信号通路影响的研究[D]: [博士学位论文]. 长沙: 湖南中医药大学, 2017.
[48] 郑雅, 王博龙. 栝楼桂枝汤治疗脑卒中后下肢痉挛的网络药理学研究[J]. 中草药, 2019, 50(22): 5499-5507.
[49] 严连凤, 金宏柱. 推拿治疗脑卒中后痉挛[J]. 长春中医药大学学报, 2015, 31(2): 311-312.
[50] 刘明辉. 针刀通过Sdc1介导MAPK/Erk通路缓解痉挛性偏瘫的疗效与机制研究[D]: [博士学位论文]. 广州: 广州中医药大学, 2023.
[51] 高歌, 葛汝丽. 中医药治疗多发性硬化的研究进展[J]. 山东医学高等专科学校学报, 2026, 48(1): 11-13.

为你推荐