涤痰汤加减治疗中青年急性缺血性脑卒中合并OSAHS痰瘀互结证的疗效观察  

Efficacy of Modified Ditantang in Treating Acute Ischemic Stroke and OSAHS Phlegm and Stasis Syndrome in Young and Middle-aged Patients

作　　者：王彦华[1] 路永坤[1] 张燕平[1] 刘向哲[1] 周红霞[1] 杨国防[1] 姜秀云[2] WANG Yan-hua;LU Yong-kun;ZHANG Yan-ping;LIU Xiang-zhe;ZHOU Hong-xia;YANG Guo-fang;JIANG Xiu-yun(The First Hospital Affiliated of Henan University of Traditional Chinese Medicine, Zhengzhou 450003, China;Zhengzhou Central Hospital, Zhengzhou 450008, China)

机构地区：[1]河南中医药大学第一附属医院,郑州450003 [2]郑州市中心医院,郑州450008

出　　处：《中国实验方剂学杂志》2018年第15期204-209,共6页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：河南省中医药科学研究专项(2017ZY2020)

摘　　要：目的：观察涤痰汤加减治疗中青年急性缺血性脑卒中合并阻塞型睡眠呼吸暂停低通气综合征（OSAHS）痰瘀互结证的疗效。方法：将140例符合条件的患者随机分为对照组和观察组,各70例。对照组给予吡拉西坦片,观察组在对照组治疗基础上给予涤痰汤加减,疗程均为2个月。比较两组治疗前后阿森斯失眠量表（AI）,简易智力筛查量表（MMSE）,美国国立卫生院脑卒中神经功能缺损评分量表（NIHSS）和急性缺血性脑卒中合并OSAHS痰瘀互结证的中医辨证量表（中医量表）的评分;检测两组患者治疗前后血清5-羟色胺（5-HT）,去甲肾上腺素（NE）,同型半胱氨酸（Hcy）,C-反应蛋白（CRP）的含量;连续7 h行呼吸暂停低通气指数（AHI）,最低血氧饱和度（LSaO2）,平均血氧饱和度（MSaO2）,氧检指数（ODI）监测;比较两组有效率和不良反应发生率。结果：对照组完成试验65例,观察组完成68例。治疗后观察组总有效率97.06%,明显高于对照组的78.46%（P〈0.05）;与对照组治疗后比较,观察组AI,NIHSS和中医量表积分降低（P〈0.05）,MMSE积分升高（P〈0.05）;观察组血清5-HT含量升高（P〈0.05）,NE,HCY和CRP含量降低（P〈0.05）;观察组AHI和ODI降低（P〈0.05）,LSaO2和MSaO2升高（P〈0.05）。观察组安全性评价优于对照组（P〈0.05）。结论：涤痰汤加减可有效改善中青年急性缺血性脑卒中合并OSAHS痰瘀互结证患者的临床症状,且可降低吡拉西坦片的不良反应。其作用机制可能与升高血清5-HT的含量,降低NE,HCY,CRP含量;升高睡眠期间的LSaO2和MSaO2指数,降低AHI和ODI指数有关。Objective： To explore the efficacy of modified Ditantang in treating the acute ischemic stroke and obstructive sleep apnea hypopnea syndrome（OSAHS） phlegm and stasis syndrome in young and middle-aged patients. Method： A total of 140 eligible patients were randomly divided into control group and treatment group,with 45 cases in each group. The control group was treated with piracetam tablet,and modified Ditantang and alprazolam tablet were provided to the treatment group. One course of treatment was 2 months. Scores of the athens insomnia scale（AI）,the simple intelligence screening scale（MMSE）, the USA national institutes of health neural function defect scale stroke scale scores（NIHSS）,the acute ischemic stroke and OSAHS phlegm and stasis syndrome on the traditional Chinese medicine（TCM） syndrome differentiation scale in two groups before and after treatment were compared. Serum hydroxytryptamine（5-HT）,dopamine（DA）,homocysteine（Hcy）,C-reactive protein（CRP） were detected before and after treatment. The sleep apnea hypopnea syndrome（AHI）,low blood oxygen saturation（LSaO2）,medium blood oxygen saturation（MSaO2）,oxygen detection index（ODI） were monitored for 7 hours. The total effective rate and incidence of adverse reactions were compared between the 2 groups. Result： The 65 cases were assayed in control group,and 68 cases were assayed in treatment group. The total effective rate of the treatment group was 97. 06%,which was higher than 78. 46% of the control group（P 〈0. 05）. After treatment,the scores of the AI,MMSE,NIHSS,TCM scale in treatment group improved significantly（P 〈0. 05） in two groups. Serum 5-HT,NE,HCY and CRP in treatment group were better than those of control group（P 〈0. 05）. The treatment group showed better AHI,LSaO2,MSaO2 and ODI for 7 hours than control group（P 〈0. 05）. The safety in the western medicine group was better than that of the control group. Conclusion：Modified Ditantang can effectively treat the acute i

关 键 词：涤痰汤加减 缺血性脑卒中 阻塞型睡眠呼吸暂停低通气综合征 痰瘀互结证 

分 类 号：R22[医药卫生—中医基础理论] R24[医药卫生—中医学]