益气活血降浊汤在短暂性脑缺血发作二级预防中的疗效观察  

Clinical observation of Tonifying qi- activating blood- reducing turbid decoction on secondary prevention of transient ischemic attack

作　　者：任健民[1] 

机构地区：[1]天津中医药大学第二附属医院内科,天津300150

出　　处：《河北中医》2016年第6期825-830,共6页Hebei Journal of Traditional Chinese Medicine

摘　　要：目的观察益气活血降浊汤在短暂性脑缺血发作(TIA)二级预防中的作用。方法将96例TIA患者随机分为2组。对照组46例予西医常规治疗,治疗组50例在西药常规治疗基础上联合益气活血降浊汤治疗。2组均治疗3个月,随访3个月统计临床疗效,并比较2组治疗前后脑动脉血流速度(Vm)变化,包括双侧大脑中动脉(MCA)、大脑后动脉(PCA)、椎动脉(VA)及基底动脉(BA);应用颈动脉超声测定颈总动脉内径、血流速度及斑块面积;检测凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)及血小板聚集率(PAR),并进行比较。结果治疗组总有效率92.0%,对照组总有效率82.6%,2组比较差异有统计学意义(P<0.05),治疗组疗效优于对照组;其中治疗组1例(2.0%)、对照组3例(6.5%)进展为脑梗死,治疗组脑梗死发生率明显低于对照组(P<0.05)。治疗组治疗后PT、APTT、TT、FIB及PAR均显著改善(P<0.05),且与对照组治疗后比较差异均有统计学意义(P<0.05);对照组治疗后仅APTT、PAR降低(P<0.05)。2组治疗后双侧MCA、PCA、VA及BA血流速度均显著加快(P<0.05),且2组组间比较差异有统计学意义(P<0.05),治疗组明显优于对照组。2组治疗后均颈总动脉内径扩大,血流速度均加快,斑块面积缩小(P<0.05),且2组组间比较差异有统计学意义(P<0.05)。结论益气活血降浊汤在TIA二级预防中疗效确切,能明显加快椎基底动脉系统及颈动脉系统血流速度,缩小斑块,降低血管内阻力,增加脑灌注,从而改善脑缺血、缺氧状态,有效预防卒中的发生。Objective To observe the effects of Tonifying qi- activating blood- reducing turbid decoction on secondary prevention of transient ischemic attack（ TIA）. Methods 96 TIA patients were randomly divided into two groups. 46 cases in control group received western routine therapy,and 50 cases in treatment group were treated by Tonifying qi- activating blood- reducing turbid decoction combined with western routine therapy,continuously for3 months. The clinical effect was evaluated after 3 months follow- up. The changes flow velocity（ Vm） of middle cerebral artery（ MCA）,posterior cerebral artery（ PCA）,bilateral vertebral artery（ VA） and basilar artery（ BA）before and after treatment were observed in two groups. The diameter,flow velocity and plaque area of carotid artery were detected by carotid artery ultrasound. The prothrombin time（ PT）,activated partial thromboplastin time（ APTT）,thrombin time（ TT）,fibrinogen（ FIB） and platelet aggregation rate（ PAR） were monitored. Results The total effective rate in treatment group（ 92. 0%） was superior to that in control group（ 82. 6%,P 〈 0. 05）.There were 1 case（ 2. 0%） and 3 cases（ 6. 5%） developed cerebral infarction in treatment and control groups,respectively. The occurrence rate of cerebral infarction in treatment group was obviously lower than that in control group（ P 〈 0. 05）. The PT,APTT,TT,FIB and PAR after treatment were obviously improved in two groups（ P 〈 0. 05）,and there were statistical differences on the improvements between two groups（ P 〈 0. 05）. Only APTT,PAR after treatment were decreased in control group（ P 〈 0. 05）. The Vm of cerebral artery after treatment was significantly increased in two groups（ P 〈 0. 05）,and the increase in treatment group was superior to that in control group（ P 〈 0.05）. After treatment,the carotid artery diameter enlarged,the flow velocity accelerated and the plaque area reduced（ P〈 0. 05）,and the improvements of each index in trea

关 键 词：脑缺血发作 短暂性 中药疗法 汤剂 

分 类 号：R242[医药卫生—中医临床基础] R743.310.531[医药卫生—中医学]