加味化痰通络汤治疗急性脑梗塞临床疗效分析  

Analysis of Clinical Efficacy of Modified Huatan Tongluo Decoction for Treatment of Acute Cerebral Infarction

作　　者：王林[1] 李红波 吴粤湘 刘永瑞[1] 叶伯鑫[1] WANG Lin;LI Hong-Bo;WU Yue-Xiang;LIU Yong-Rui;YE Bo-Xin(The First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510405 Guangdong,China;Guangzhou University of Chinese Medicine,Guangzhou 510405 Guangdong,China)

机构地区：[1]广州中医药大学第一附属医院,广东广州510405 [2]广州中医药大学,广东广州510405

出　　处：《广州中医药大学学报》2021年第2期261-266,共6页Journal of Guangzhou University of Traditional Chinese Medicine

摘　　要：【目的】观察加味化痰通络汤治疗风痰瘀阻型急性脑梗塞患者的临床疗效。【方法】将370例风痰瘀阻型急性脑梗塞患者随机分为治疗组204例和对照组166例。2组患者均给予常规西医治疗,治疗组在此基础上给予加味化痰通络汤口服治疗,2组均以治疗7 d为1个疗程,共治疗3个疗程。观察2组患者治疗前后中医证候积分、神经功能缺损量表(NFDS)评分、日常生活能力(ADL)量表(Barthel指数)评分、血脂指标[总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)及低密度脂蛋白胆固醇(LDL-C)]及红细胞沉降率(ESR)、超敏C反应蛋白(hs-CRP)、一氧化氮(NO)和内皮素1(ET-1)等的变化情况,并评价2组的临床疗效及安全性。【结果】(1)观察期间,治疗组退出11例,对照组无脱落退出病例,最终共359例患者完成试验,其中治疗组193例,对照组166例。(2)治疗3周后,治疗组的总有效率为90.5%(175/193),对照组为80.1%(133/166);组间比较(秩和检验),治疗组的疗效明显优于对照组,差异有统计学意义(P<0.05)。(3)治疗7 d、14 d和21 d后,2组患者的中医证候积分和NFDS评分均较治疗前明显降低(P<0.05),ADL评分均较治疗前明显升高(P<0.05),且治疗组对中医证候积分和NFDS评分的降低作用及对ADL评分的升高作用均明显优于对照组(P<0.05)。(4)治疗后,2组患者血清TC、TG、LDL-C水平较治疗前明显降低(P<0.05),HDL-C水平较治疗前明显升高(P<0.05),且治疗组对血清TC、TG、LDL-C水平的降低作用及对HDL-C水平的升高作用均明显优于对照组(P<0.05)。(5)治疗后,2组患者的ESR、hsCRP、ET-1及NO水平均较治疗前明显降低(P<0.05),且治疗组对ESR、hs-CRP、ET-1及NO水平的降低作用均明显优于对照组(P<0.05)。(6)治疗过程中,2组患者均未出现严重的不良反应,治疗组有3例患者出现恶心症状,对照组有2例患者出现恶心症状,1例出现腹泻症状,给予对症处理后症状均缓解。Objective To observe the clinical efficacy of modified Huatan Tongluo Decoction for the treatment of patients with acute cerebral infarction differentiated as the syndrome of obstruction of wind-phlegm and blood stasis.Methods A total of 370 acute cerebral infarction patients differentiated as the syndrome of obstruction of wind-phlegm and blood stasis were randomly divided into treatment group(204 cases)and control group(166 cases).Both groups were treated with conventional western medicine therapy,and additionally the treatment group was given oral use of modified Huatan Tongluo Decoction.Seven days constituted one course of treatment,and the treatment for the two groups lasted for a total of 3 courses of treatment.Before and after treatment,we observed the changes in traditional Chinese medicine(TCM)syndrome scores,neurological functional deficit scale(NFDS)scores,the scores of activities of daily life(ADL)evaluated with Barthel index,serum levels of blood lipids such as total cholesterol(TC),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C)and lowdensity lipoprotein cholesterol(LDL-C),erythrocyte sedimentation rate(ESR),hypersensitive C-reactive protein(hs-CRP),nitric oxide(NO)and endothelin 1(ET-1)in the two groups.After treatment,the clinical efficacy and safety in the two groups were also evaluated.Results(1)During the trial,11 cases of the treatment group while none case of the control group dropped out,and a total of 359 cases finished the trial,of which 193 cases were from the treatment group and 166 cases were from the control group.(2)After treatment for 3 weeks,the total effective rate in the treatment group was 90.5%(175/193),significantly higher than that of the control group(80.1%,133/166).The intergroup comparison by rank sum test showed that the clinical efficacy of the treatment group was superior to that of the control group,the difference between the two groups being statistically significant(P<0.05).(3)After treatment for 7,14,and 21 days,the TCM syndrome scores and NFDS scores we

关 键 词：急性脑梗塞 风痰瘀阻型 加味化痰通络汤 炎症因子 血液流变学 一氧化氮 内皮素 

分 类 号：R277.7[医药卫生—中医学] R743.33[医药卫生—神经病学与精神病学]