Meythaler J M, DeVivo M J, Hadley M
Department of Rehabilitation Medicine, University of Alabama-Birmingham School of Medicine 35233-7330, USA.
Arch Phys Med Rehabil. 1996 May;77(5):461-6. doi: 10.1016/s0003-9993(96)90034-9.
To determine if the intrathecal delivery of baclofen will decrease spastic hypertonia caused by brain injury.
Eleven patients more than 1 year after their brain injury with disabling lower extremity spastic hypertonia.
University tertiary care outpatient rehabilitation clinic.
Patients were a consecutive sample randomized in a double blind, placebo-controlled crossover study.
Bolus intrathecal injection of either normal saline or 50 micrograms baclofen.
Data for Ashworth rigidity scores, spasm scores, and deep tendon reflex scores were collected for both the upper extremities (UE) and lower extremities (LE). Changes over time were assessed via Friedman's test. Differences between the placebo and active drug at any given time were assessed via Wilcoxon signed-rank.
Four hours after injection with the active drug (maximum effect) the average LE Ashworth score decreased from 4.2 +/- 0.8 (SD) to 2.2 +/- 0.6 (p = .0033), spasm score from 3.1 +/- 1.0 to 1.0 +/- 0.7 (p = .0032), and reflex score from 3.3 +/- 0.5 to 1.0 +/- 1.3 (p = .0033). The average UE Ashworth score decreased from 3.3 +/- 1.3 to 1.9 +/- 0.8 (p = .0033), spasm score from 1.8 +/- 1.3 to 0.6 +/- 1.0 (p = .007), and reflex score from 2.7 +/- 0.5 to 1.7 +/- 0.6 (p = .0111). No trend was observed over time with placebo administration. There were significant reductions in the average for LE Ashworth (p < .0001), spasm (p < .0001), and reflex (p < .0001) scores and for UE Ashworth (p < .0001) and spasm (p < .0004) scores observed over 4 hours (maximum effect) with active drug administration. No significant differences were noted between the active drug and placebo groups before administration in LE and UE Ashworth, spasm, or reflex scores. There were significant differences between the active drug and placebo groups at 4 hours after administration for LE and UE Ashworth, spasm, and reflex scores (p < or = .0272).
Intrathecal injection of baclofen is capable of reducing the spastic hypertonia associated with brain injury.
确定鞘内注射巴氯芬是否会降低脑损伤所致的痉挛性肌张力亢进。
11例脑损伤1年以上且伴有致残性下肢痉挛性肌张力亢进的患者。
大学三级医疗门诊康复诊所。
患者为连续样本，采用双盲、安慰剂对照交叉研究。
鞘内推注生理盐水或50微克巴氯芬。
收集上肢（UE）和下肢（LE）的Ashworth强直评分、痉挛评分和深部腱反射评分数据。通过Friedman检验评估随时间的变化。在任何给定时间，通过Wilcoxon符号秩检验评估安慰剂与活性药物之间的差异。
注射活性药物4小时后（最大效应），平均下肢Ashworth评分从4.2±0.8（标准差）降至2.2±0.6（p = 0.0033），痉挛评分从3.1±1.0降至1.0±0.7（p = 0.0032），反射评分从3.3±0.5降至1.0±1.3（p = 0.0033）。平均上肢Ashworth评分从3.3±1.3降至1.9±0.8（p = 0.0033），痉挛评分从1.8±1.3降至0.6±1.0（p = 0.007），反射评分从2.7±0.5降至1.7±0.6（p = 0.0111）。给予安慰剂时未观察到随时间的变化趋势。给予活性药物4小时（最大效应）后，观察到下肢Ashworth（p < 0.0001）、痉挛（p < 0.0001）和反射（p < 0.0001）评分以及上肢Ashworth（p < 0.0001）和痉挛（p < 0.0004）评分的平均值显著降低。给药前，活性药物组与安慰剂组在下肢和上肢的Ashworth、痉挛或反射评分方面无显著差异。给药后4小时，活性药物组与安慰剂组在下肢和上肢的Ashworth、痉挛和反射评分方面存在显著差异（p≤0.0272）。
鞘内注射巴氯芬能够降低与脑损伤相关的痉挛性肌张力亢进。
