化痰通络汤与头皮针联合西药治疗急性脑梗死(痰瘀阻络)随机平行对照研究  

Randomized Parallel Control Study of Huatan Tongluo Decoction(化痰通络汤) combined with Scalp Acupuncture and Western Medicine in Treating Acute Cerebral Infarction(Tanyu Zuluo/痰瘀阻络)

作　　者：幸蓉 刘志鹏 XING Rong;LIU Zhipeng(Liling Hospital of Traditional Chinese Medicine,Liling 412200,Hunan,China)

机构地区：[1]湖南省醴陵市中医院脑病科,湖南醴陵412200

出　　处：《实用中医内科杂志》2018年第10期25-28,共4页Journal of Practical Traditional Chinese Internal Medicine

摘　　要：[目的]观察化痰通络汤与头皮针联合西药治疗急性脑梗死(痰瘀阻络)疗效。[方法]使用随机平行对照方法,将80例住院患者按病志号抽签方法随机分为两组。对照组40例阿司匹林,300mg/次,1次/d;长春西汀20mg+0.9%氯化钠注射液500mL,1次/d,静滴;依达拉奉30mg+生理盐水100mL,2次/d,滴注。治疗组40例(1)化痰通络汤(茯苓、党参、丹参各15g,半夏法、枳壳、橘红、川芎、红花、石菖蒲、远志各10g,甘草炙6g),阴虚加麦冬、白芍;气虚加黄芪;肝阳偏亢加天麻、钩藤,加水800mL,水煎2次,取汁300mL,1剂/d,早晚分服;(2)头皮针:取病变部位顶颞前斜线、顶中线和额中线,酒精消毒,使用28号1.5寸毫针先由前顶刺向百会1寸,之后在顶颞前斜线由上向下以接力针法依次刺3～4针,使针沿皮向下推进至帽状腱膜下层,深度约为1寸,每针进针点间距保持1寸,医者感到指下松紧适宜且有吸针感时行抽气手法,使针体保持平卧,一手捏紧针柄,另一只手按压进针点处固定头皮,以爆发力将针迅速向外抽提3次后再缓慢退回原处,以紧提慢插为主,反复运针10次,共5min,休息5min,指导患者患肢行被动、主动运动,上述治疗反复3次后出针,1次/d;西药治疗同对照组。连续治疗2周为1疗程。观测临床表现、全血高切黏度、全血低切黏度、红细胞压积、神经功能评分(NIHSS)、不良反应。治疗1疗程(2周),判定疗效。[结果]治疗组基本痊愈10例,显著进步22例,进步7例,无效1例,总有效率97.50%;对照组基本痊愈8例,显著进步5例,进步20例,无效7例,总有效率82.50%;治疗组疗效优于对照组(P<0.05)。全血高切黏度、全血低切黏度、红细胞压积、NHISS评分两组均有改善(P<0.05,P<0.01),治疗组改善优于对照组(P<0.01)。[结论]化痰通络汤与头皮针联合西药治疗急性脑梗死(痰瘀阻络),疗效满意,无严重不良反应,值得推广。[Objective] To observe the curative effect of Huatan Tongluo decoction combined with scalp acupuncture and western medicine on acute cerebral infarction(phlegm and blood stasis blocking collaterals).[Methods] 80 inpatients were randomly divided into two groups.40 cases in control group were treated with aspirin 300 mg/time,once a day;vinpocetine 20 mg+0.9% sodium chloride injection 500 mL,once a day,intravenous drip;edaravone 30 mg+normal saline,100 mL,twice a day,drip.40 cases in the treatment group were treated with Huatan Tongluo decoction(Fuling,Dangshen,Danshen each 15 g,Fabanxia,Zhqiao,Juhong,Chuanxiong,Honghua,Shicangpu,Yuanzhi eaach 10 g,Zhigancao 6 g),Yin deficiency plus Ophiopogon japonicus and Radix Paeoniae alba,Qi deficiency plus Astragali,Liver Yang hyperactivity plus Gastrodia elata and Uncaria Rubus rhizoma,decocted twice with water,juice 300 mL,1 dose per day,(2)Scalp needle:take the lesion part of the anterior parietal-temporal oblique line,the middle parietal line and the frontal line,alcohol disinfection,using No.28 1.5 inch filiform needle first from the anterior parietal needle to Baihui 1 inch,then in the anterior parietal-temporal oblique line from top to bottom in succession with a relay needle method of 3-4 needles,so that the needle along the skin down to the cap-like subfascial layer,the depth ofabout 1 inch,each needle between the points when the distance is 1 inch,the doctor feels that the needle is tight under the finger and the needle is sucked,the needle body is kept in a horizontal position,the needle handle is tightened in one hand,and the scalp is fixed at the needle insertion point by pressing the needle handle in the other hand.For 5 minutes,the patient was instructed to perform passive and active movement of the affected limb.The above treatment was repeated three times and then the needle was given once a day.Continuous treatment for 2 weeks was 1 courses.Clinical manifestations,whole blood high shear viscosity,whole blood low shear viscosity,hematocrit,neurological functio

关 键 词：急性脑梗死 中风 痰瘀阻络 化痰通络汤 头皮针 阿司匹林 长春西汀 依达拉奉 全血高切黏度 全血低切黏度 红细胞压积 神经功能评分 中药复方 随机平行对照研究 

分 类 号：R743.3[医药卫生—神经病学与精神病学]