A型肉毒毒素注射联合康复综合护理治疗痉挛型脑性瘫痪患儿的随机对照研究

A Randomized Controlled Study of Botulinum Toxin Type A Combined with Comprehensive Rehabilitation Nursing in the Treatment of Children with Spastic Cerebral Palsy

摘要: 目的：本研究旨在探讨A型肉毒毒素(Botulinum toxin A, BTX-A)注射配合康复护理对痉挛型脑瘫患儿粗大运动及痉挛改善的影响。方法：选取天津市儿童医院康复科2020年1月~2021年6月期间住院的痉挛型脑瘫患儿44例，根据排除标准，最终有40名患儿入组，随后采用抽签法将40例患儿随机分为单独注射A型肉毒毒素20例和注射A型肉毒毒素(BTX-A)结合康复护理组20例，均完成2周后随访。对照组予以BTX-A注射，观察组在对照组基础上予注射前、中、后综合护理，予家长及患儿宣教在药效持续期间内，强化学习正确的运动模式，充分发挥患儿及家长的主观能动性。两周后，对比两组患儿粗大运动功能量表(Gross Motor Function Measure, GMFM-88)，改良Tardieu量表(Modified Tardieu Scale, MTS)评分。结果：两组治疗后痉挛的比较：两组大腿内收肌、屈膝肌、踝跖屈肌肌肉痉挛程度较治疗前均有所改善(p < 0.05)，但两组对比，内收肌、双侧屈膝肌、右足踝跖屈肌肌肉(腓肠肌、比目鱼肌)及左足跖屈肌(比目鱼肌)均未见统计学意义(p > 0.05)；治疗后，BTX-A + 康复护理组左足跖屈肌(腓肠肌)痉挛的改善大于单独注BTX-A组(p < 0.05)。两组治疗后粗大运动功能的比较：两组GMFM评分均高于治疗前，且有统计学意义(p < 0.05)，两组比较5个能区，均未见明显差异(p > 0.05)。结论：BTX-A结合康复综合护理，可提高痉挛型脑瘫患儿的运动能力，改善下肢痉挛。

Abstract: Background: The aim of this study is to explore the effect of botulinum toxin A (BTX-A) injection combined with rehabilitation nursing on the improvement of gross motor and spasticity in children with spastic cerebral palsy. Methods: A total of 44 children with spastic cerebral palsy hospitalized in the Rehabilitation Department of Tianjin Children’s Hospital from January 2020 to June 2021 were selected. According to the exclusion criteria, 40 children were finally included in the group. Subsequently, 40 children were randomly divided into two groups by lot: 20 cases were injected with botulinum toxin A alone and 20 cases were injected with botulinum toxin A (BTX-A) combined with rehabilitation nursing group. All of them were followed up after 2 weeks. The control group was given BTX-A injection, and the observation group was given comprehensive care before, during and after injection on the basis of the control group. During the duration of the drug effect, parents and children were taught to strengthen learning the correct exercise mode and give full play to the subjective initiative of children and parents. Two weeks later, Gross Motor Function Measure (GMFM-88) and Modified Tardieu Scale (MTS) scores were compared between the two groups. Re-sults: Comparison of spasticity between the two groups after treatment: The spasticity degree of thigh adductor, knee flexor and ankle plantar flexor in the two groups was improved compared with that before treatment (p < 0.05), but there was no significant difference in adductor, bilateral knee flexor, right ankle plantar flexor (gastrocnemius and soleus) and left plantar flexor (soleus) be-tween the two groups (p > 0.05); after treatment, the improvement of left plantar flexor (gas-trocnemius) spasm in BTX-A + rehabilitation nursing group was greater than that in BTX-A alone group (p < 0.05). Comparison of gross motor function between the two groups after treatment: The GMFM scores of the two groups were significantly higher than those before treatment (p < 0.05). There was no significant difference between the two groups in five energy areas (p > 0.05). Conclu-sion: BTX-A combined with comprehensive rehabilitation nursing can improve the motor ability and lower limb spasm of children with spastic cerebral palsy.