Dehnadi Moghadam Anoush, Hasanzadeh Hamed, Dehnadi Moghadam Fatemeh
Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran.
Razi Clinical Research Development Unit, Guilan University of Medical Sciences, Rasht, Iran.
Anesth Pain Med. 2021 Aug 15;11(4):e115849. doi: 10.5812/aapm.115849. eCollection 2021 Aug.
Spasticity following traumatic brain injury (TBI) is one of the most significant barriers of returning patients to their normal life. Spasticity caused by TBI does not have a specific or definitive treatment, and the clinical effect of pharmacologic treatments has not been significant.
In this single-arm study, we evaluated 15 patients. For each patient with spasticity, treatment with oral baclofen 25 mg was started three times a day as a part of standard therapy. After 48 hours, if the spasticity did not decrease by at least one score in the Modified Tardieu or Ashworth scales, lidocaine 0.5% was administered as a continuous intranasal infusion. The initial dose of lidocaine was 1 mg/min, which was gradually increased to 2 mg/min. Spasticity and the frequency of spasms were assessed by Ashworth and modified tardieu scales (MTS) and Spasm Frequency Score (SFS), respectively. Heart rate (HR), respiratory rate (RR), mean arterial blood pressure (MAP), Richmond Agitation-Sedation Scale (RASS), Glasgow Coma Scale (GCS), and arterial oxygen saturation (SP) of patients were recorded during nine days of treatment. All data were analyzed by SPSS version 21. P-value less than 0.05 was considered as statistically significant.
Out of 15 participants in this study, 13 (86.7%) were male, and 2 (13.3%) were female (mean age: 29.26 ± 12.5 years). There were no significant differences in Ashworth Scale, Modified Tradieu Scale, RASS Score, GCS Score, MAP, SP percentage, HR, RR, and the number of spasms per day between the time of initiation of treatment and the second day of baclofen treatment (P > 0.05). Evaluation of spasticity using Ashworth scale on the first and last days of lidocaine treatment showed a significant decrease in the mean spasticity (3.46 ± 0.51 and 1.46 ± 0.91, respectively; P < 0.001). Spasticity assessment using the MTS showed a significant reduction in the mean of the last day of treatment compared to the mean of the first day of treatment (3.6 ± 0.5 and 1.26 ± 0.51, respectively; P < 0.001). This decrease was also seen in the mean of the last day of treatment compared to the first day in SFS (13.3 ± 3.88 and 3.8 ± 0.51, respectively; P < 0.001). Comparison of HR, RR, MAP, RASS, GCS, and SP on the first and last days of treatment did not show any statistical differences.
Although continuous intranasal treatment with lidocaine can be effective in spasm reduction of patients with TBI, further studies with larger sample sizes and longer follow-up periods are required.
创伤性脑损伤（TBI）后的痉挛是患者恢复正常生活的最主要障碍之一。TBI 所致的痉挛尚无特异性或确定性治疗方法，药物治疗的临床效果并不显著。
在这项单臂研究中，我们评估了 15 例患者。对于每例痉挛患者，作为标准治疗的一部分，开始每日 3 次口服 25 mg 巴氯芬。48 小时后，如果痉挛在改良塔迪厄或阿什沃思量表中未降低至少一个评分，则给予 0.5%利多卡因持续鼻内输注。利多卡因的初始剂量为 1 mg/min，逐渐增加至 2 mg/min。分别采用阿什沃思量表、改良塔迪厄量表（MTS）和痉挛频率评分（SFS）评估痉挛及痉挛频率。在治疗的 9 天内记录患者的心率（HR）、呼吸频率（RR）、平均动脉血压（MAP）、里士满躁动镇静量表（RASS）、格拉斯哥昏迷量表（GCS）和动脉血氧饱和度（SP）。所有数据采用 SPSS 21 版进行分析。P 值小于 0.05 被认为具有统计学意义。
本研究的 15 名参与者中，13 名（86.7%）为男性，2 名（13.3%）为女性（平均年龄：29.26±12.5 岁）。治疗开始时与巴氯芬治疗第 2 天之间，阿什沃思量表、改良塔迪厄量表、RASS 评分、GCS 评分、MAP、SP 百分比、HR、RR 及每日痉挛次数均无显著差异（P>0.05）。在利多卡因治疗的第 1 天和最后 1 天使用阿什沃思量表评估痉挛情况，结果显示平均痉挛程度显著降低（分别为 3.46±0.51 和 1.46±0.91；P<0.001）。使用 MTS 评估痉挛情况，与治疗第 1 天的平均值相比，治疗最后 1 天的平均值显著降低（分别为 3.6±0.5 和 1.26±0.51；P<0.001）。在 SFS 中，与第 1 天相比，治疗最后 1 天的平均值也出现了这种降低（分别为 13.3±3.88 和 3.8±0.51；P<0.001）。治疗第 1 天和最后 1 天的 HR、RR、MAP、RASS、GCS 和 SP 比较未显示任何统计学差异。
尽管持续鼻内给予利多卡因可有效减轻 TBI 患者的痉挛，但需要进行更大样本量和更长随访期的进一步研究。
