本文選題：腦性癱瘓 + 肌張力障礙��； 參考：《南昌大學(xué)》2017年碩士論文

【摘要】：目的:從結(jié)構(gòu)與功能、活動(dòng)與參與兩個(gè)維度探討苯海索聯(lián)合物理治療對(duì)腦性癱瘓兒童肌張力障礙的臨床治療效果,分析該治療方法的影響因素,并記錄該治療方法的安全性及藥物耐受情況,為腦癱患兒肌張力障礙找到新的治療方法。方法:將滿(mǎn)足入組條件的研究對(duì)象依據(jù)機(jī)數(shù)字分組表隨機(jī)分為3組:(1)苯海索聯(lián)合物理治療治療組(A組,22例),接受苯海索及物理治療;(2)物理治療組(B組,22例),接受物理治療,口服安慰劑對(duì)照;(3)苯海索治療組(C組,11例),接受苯海索口服治療。三組患兒在以上治療基礎(chǔ)上接受常規(guī)作業(yè)療法、言語(yǔ)訓(xùn)練、矯形器及輔助器具、家庭護(hù)理。最終進(jìn)入數(shù)據(jù)分析的有51例患兒(男性41例,女性10例)�；純喝虢M年齡范圍為18個(gè)月至72個(gè)月(32個(gè)月±9)。三組患兒于分別于入組時(shí)、治療中期(8周)及治療末期(16周)進(jìn)行以下項(xiàng)目評(píng)定:BarryAlbright肌張力障礙量表(Barry-Albright Dystonia scale,BADs)、88項(xiàng)腦癱兒童粗大運(yùn)動(dòng)功能評(píng)估量表(Gross Motor Function Measuer-88,GMFM-88)、腦癱兒童粗大運(yùn)動(dòng)功能分級(jí)系統(tǒng)(Gross Motor Function Classification System,GMFCS)、腦癱兒童精細(xì)運(yùn)動(dòng)功能測(cè)試量表(Fine Motor Function Measure,FMFM)。同時(shí)監(jiān)測(cè)實(shí)驗(yàn)對(duì)象的流涎好轉(zhuǎn)情況、苯海索使用劑量及耐受情況。實(shí)驗(yàn)數(shù)據(jù)采用SPSS19.0統(tǒng)計(jì)軟件包進(jìn)行統(tǒng)計(jì)學(xué)分析,比較每組患兒治療前后組內(nèi)以及組間數(shù)據(jù)差異(協(xié)變量為基線(xiàn)數(shù)據(jù)),同時(shí)對(duì)BADs得分改善幅度的影響因素進(jìn)行多元線(xiàn)性回歸分析。設(shè)定P0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:1、三組患兒基線(xiàn)數(shù)據(jù)對(duì)比均無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。2、A組患兒治療末期(16周)BADs得分降低幅度平均值為3.76±2.914;B組患兒為0.71±3.288;C組患兒為3.22±2.863。經(jīng)重復(fù)度量方差分析,差異有統(tǒng)計(jì)學(xué)意義(F=6.570,P0.01)。在治療后各時(shí)間點(diǎn)BADs得分變化率(記錄時(shí)間點(diǎn)得分-入組時(shí)間點(diǎn)得分)組間對(duì)比,經(jīng)協(xié)方差分析差異有統(tǒng)計(jì)學(xué)意義(治療8周F=4.258,P0.05;治療16周F=5.289,P0.01)。A、C組患兒的BADs得分改善幅度優(yōu)于B組患兒(P0.05)。3、治療末期(16周)A組患兒GMFM-88總目標(biāo)得分提高幅度平均值為8.01±5.760;B組患兒為3.88±3.309;C組患兒為3.88±3.799。治療末期(16周)A組患兒FMFM能力分改善幅度平均值為8.45±6.083;B組為4.63±3.922;C組為4.22±2.746。經(jīng)重復(fù)度量方差分析差異有統(tǒng)計(jì)學(xué)意義(FMFM能力分方差分析P0.05,其余兩項(xiàng)觀測(cè)指標(biāo)P0.01)。治療16周GMFM-88總目標(biāo)分得分的提高幅度組間比較,經(jīng)協(xié)方差分析有統(tǒng)計(jì)學(xué)差異(F=4.493,P0.05),A組GMFM-88總目標(biāo)分得分提高幅度優(yōu)于B、C組(p0.05)。治療后各時(shí)間點(diǎn)三組患兒組間粗大運(yùn)動(dòng)功能分級(jí)(GMFCS)對(duì)比無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。治療16周FMFM目標(biāo)分提高幅度組間對(duì)比,經(jīng)協(xié)方差分析有統(tǒng)計(jì)學(xué)差異(F=4.117,P0.05)。A組FMFM能力分提高幅度優(yōu)于B、C組(P0.05)。4、A組患兒流涎改善率為87.5%;B組為4.7%;C組為83.3%。三組患兒流涎好轉(zhuǎn)率組間對(duì)比有統(tǒng)計(jì)學(xué)差異(P0.05)。A、C組流涎好轉(zhuǎn)率優(yōu)于B組(P0.05)。5、研究對(duì)象最終藥物劑量平均值為2.8±0.368mg/d,單位體重最終藥物劑量平均值為0.25±0.012mg/kg/d�；純簩�(duì)藥物耐受良好,未發(fā)生嚴(yán)重不良反應(yīng)事件。6、A組患兒BADs得分提高幅度與入組月齡無(wú)相關(guān)性(調(diào)整后R~2=0.135,β=0.067,P=0.362),與過(guò)度運(yùn)動(dòng)癥狀存在正相關(guān)性(β=0.464,p=0.017)。存在過(guò)度運(yùn)動(dòng)癥狀的患兒BADs改善幅度低于無(wú)過(guò)度運(yùn)動(dòng)的患兒(F值=5.271,P0.05)。結(jié)論:1.苯海索聯(lián)合物理治療可以早期有效改善腦癱兒童肌張力障礙的嚴(yán)重程度,相對(duì)于常規(guī)物理治療及苯海索治療能更好提高患兒的粗大運(yùn)動(dòng)功能、精細(xì)運(yùn)能力。2.苯海索聯(lián)合物理治療相對(duì)于常規(guī)物理治療及苯海索治療不能進(jìn)一步提高肌張力障礙腦癱患兒的粗大運(yùn)動(dòng)功能分級(jí)。3.苯海索聯(lián)合物理治療相對(duì)苯海索治療不能更好的改善肌張力障礙腦癱患兒流涎癥狀。4.過(guò)度運(yùn)動(dòng)癥狀可能是影響苯海索治療腦癱兒童肌張力障礙療效的不利因素。
[Abstract]:Objective : To study the effect of combined physical therapy of benzene and sea cable on the muscular tension disorder of children with cerebral palsy from two dimensions : structure and function , activity and participation . The age ranged from 18 months to 72 months ( 32 months 鹵 9 ) . Among the three groups , the following items were evaluated at medium - term ( 8 - week ) and end - of - treatment ( 16 weeks ) : Barrymore Dystonia scale ( BCE ) , 88 patients with cerebral palsy ( Gross Motor Function Classification System , GMFM - 88 ) , Gross Motor Function Classification System ( GMFCS ) , Fine Motor Function Measure ( FMFM ) . Results : 1 . There was no statistical difference in baseline data between group A and group B ( P 0.05 ) . Results : 1 . There was no statistical difference in baseline data between group A and group B ( P 0.05 ) . Results : 1 . There was no significant difference in baseline data between group A and group B ( P 0.05 ) . Results : 1 . There was no significant difference in baseline data between group A and group B ( P < 0.05 ) . Results : 1 . There was significant difference in baseline data between group A and group B ( 3.22 鹵 2.863 ) . There was a significant difference in the rate of change of the score ( score - entry time point score ) between the points of time after treatment ( the score of recording time point score - entry time point ) . The difference of covariance analysis was significant ( 8 weeks F = 4.258 , P 0.05 ; treatment 16 weeks F = 5.289 , P0.01 ) . Compared with group B ( P0.05 ) , the average score of GMFM - 88 was 8.01 鹵 5.760 in group A and 3.88 鹵 3.799 in group B , 3.88 鹵 3.922 in group B , 4.63 鹵 3.922 in group B , 4.22 鹵 2.746 in group B , 4.63 鹵 3.922 in group B , 4.22 鹵 2.746 in group B and 4.22 鹵 2.746 in group B . There was significant difference between the two groups ( F = 4.493 , P < 0.05 ) , and the total score of GMFM - 88 in group A was better than that of group B and C ( P < 0.05 ) . There was no statistical difference between group A GMFM - 88 ( P0.05 ) . In group A , the rate of improvement of FMFM was better than that of group B and C ( P0.05 ) . The rate of improvement of salivary mucosaltation in group A was 87.5 % ; group B was 4.7 % ; group C was 83.3 % ; the mean drug dose of group A was 2.8 鹵 0.36mg / d , and the mean value of final drug was 0 . 25 鹵 0 . 012mg / kg / day . In children with excessive exercise symptoms , the improvement was lower than that in children without excessive exercise ( F = 5.271 , P0.05 ) . Conclusion : 1 . The combined physical therapy of benzene and sea cable can effectively improve the severity of dystonia in children with cerebral palsy .
【學(xué)位授予單位】：南昌大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R742.3

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