涤痰汤合桃红四物汤加减对脑梗死恢复早期痰瘀阻络证脑神经的保护作用  

Protection of Addition and Subtraction Therapy of Ditantang Combined with Taohong Siwutang to Brain Nerve of Patients with Cerebral Infarction and(Syndrome of Phlegm and Blood Stasis Blocking Collaterals)During Early Recovery

作　　者：常永霞[1] 李姣[1] 侯文丽[1] 戈蕾[1] 王殷 王腾 马秋云[1] 孟海超[1] 左小宏[1] 崔万森[1] CHANG Yong-xia;LI Jiao;HOU Wen-li;GE Lei;WANG Yin;WANG Teng;MA Qiu-yun;MENG Hai-chao;ZUO Xiao-hong;CUI Wan-seng(The First Affiliated Hospital of Hebei North University,Zhangjiakou 075000,China)

机构地区：[1]河北北方学院附属第一医院,河北张家口075000

出　　处：《中国实验方剂学杂志》2021年第1期135-140,共6页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：河北省中医药管理局科研计划项目(2015120);张家口市科学技术攻关计划项目(1421130D)。

摘　　要：目的:评价涤痰汤合桃红四物汤加减治疗恢复早期脑梗死(痰瘀阻络证)的临床疗效及对脑神经保护作用研究。方法:将152例患者按随机数字法分为对照组和观察组各76例,对照组除去脱落/失访和剔除,完成71例,观察组完成70例。两组均给予综合康复。对照组口服中风回春丸,1.5 g/次,3次/d。观察组内服涤痰汤合桃红四物汤加减,1剂/d,早晚2次。两组连续治疗12周。进行治疗前后神经功能缺损程度评分,Barthel(BI)指数评分,Fugl-Meyer量表(FMA)评分、改良Rankin量表(MRS)评分和痰瘀阻络证评分;检测治疗前后丙二醛(MDA),谷胱甘肽过氧化物酶(GSH-Px),超氧化物歧化酶(SOD),晚期氧化蛋白产物(AOPP),血管内皮生长因子(VEGF),脑源性神经营养因子(BDNF)和神经元特异性烯醇化酶(NSE)水平,进行治疗前后脑血流动力学检查,记录最大峰值流速(Vs),血管阻力指数(RI)和搏动指数(PI)和脑血管储备功能(CVR);并进行安全性评价。结果:治疗后6周和12周,观察组神经功能缺损程度评分均低于同期对照组(P<0.01);观察组BI,FMA,MRS和痰瘀阻络证评分均低于对照组(P<0.01);观察组AOPP,MDA,NSE水平均低于对照组(P<0.01),SOD,GSH-Px,BDNF和VEGF水平均高于对照组(P<0.01);观察组Vs和CVR均高于对照组(P<0.01),RI和PI均低于对照组(P<0.01);观察组临床疗效优于对照组(Z=2.109,P<0.05);未发现服用涤痰汤合桃红四物汤不良反应。结论:涤痰汤合桃红四物汤治疗恢复早期脑梗死痰瘀阻络证患者,可减轻神经功能缺损程度,提高日常生活能力和运动能力,有较好的临床疗效,且安全,其作用机制可能与改善血流动学,减轻脂质过氧化损伤,调节神经血管修复因子,从而促进神经组织和功能的修复有关。Objective: To discuss clinical effect of addition and subtraction therapy of Ditantang combined with Taohong Siwutang to cerebral infarction and syndrome of phlegm and blood stasis blocking collaterals during early recovery,and to study protection to brain nerve. Method: One hundred and fifty-two patients were randomly divided into control group(76 cases)and observation group(76 cases)by random number table,71 patients in control group completed the therapy(5 patients were falling off,missing visit or eliminated), and 70 patients in observation group completed the therapy. Both groups’ patients got comprehensive rehabilitation measures. Patients in control group got Zhongfeng Huichun pills,1.5 g/time,3 times/day. Patients in observation group got addition and subtraction therapy of Ditantang combined with Taohong Siwutang in the morning and at night,1 dose/day. The treatment was continued for 12 weeks. Before and after treatment,scores of degree of neurological deficit,Barthel(BI)index,Fugl-Meyer scale(FMA),modified Rankin scale(MRS)and syndrome of phlegm and blood stasis blocking collaterals were graded. And levels of malondialdehyde(MDA), glutathione peroxidase(GSH-Px), superoxide dismutase(SOD),advanced oxidation protein products(AOPP),vascular endothelial growth factor(VEGF),brain-derived neurotrophic factor(BDNF)and neuron specific enolase(NSE). And cerebral hemodynamics were detected,and peak flow velocity(VS),vascular resistance index(RI),pulsatility index(PI)and cerebrovascular reserve function(CVR)were recorded. Safety was evaluated. Result: After the 6 thweek and 12 thweek of treatment,scores of degree of neurological deficit,BI,FMA,MRS,syndrome of phlegm and blood stasis blocking collaterals,AOPP,MDA,NSE,RI and PI were lower than those in control group(P<0.01),levels of SOD,GSH-Px,BDNF,VEGF,Vs and CVR were higher than those in control group(P<0.01). The clinical effect was better than which in control group(Z=2.109,P<0.05). Besides,there was no adverse reaction caused by Ditantang combined with Taoho

关 键 词：脑梗死 痰瘀阻络证 恢复期 桃红四物汤 涤痰汤 脑血流动力学 氧化应激 神经修复 

分 类 号：R289[医药卫生—方剂学] R743[医药卫生—中药学]