天麻钩藤饮加味结合西医常规疗法治疗脑出血肝阳化风证临床研究  

Clinical study of modified Tianma-Gouteng Decoction combined with conventional western medicine in the treatment of cerebral hemorrhage with syndrome of hyperactive liver yang causing wi

作　　者：张传金 孟祥奎 于欣平 Zhang Chuanjin;Meng Xiangkui;Yu Xinping(No.1 Department of Encephalopathy,Ju County Hospital of Traditional Chinese Medicine,Rizhao 276500,China;No.2 Department of Encephalopathy,Ju County Hospital of Traditional Chinese Medicine,Rizhao 276500,China)

机构地区：[1]山东省日照市莒县中医医院脑病一科,276500 [2]山东省日照市莒县中医医院脑病二科,276500

出　　处：《国际中医中药杂志》2021年第5期446-451,共6页International Journal of Traditional Chinese Medicine

基　　金：山东省中医药科技发展计划项目(2019-0826)。

摘　　要：目的评价天麻钩藤饮加味结合西医常规疗法治疗脑出血肝阳化风证的疗效。方法将本院2017年5月-2019年12月收治的120例脑出血肝阳化风证患者采用随机数字表法分为2组,每组60例。对照组给予西医常规疗法治疗,观察组在对照组基础上服用天麻钩藤饮加味治疗。分别于治疗前后进行中医症状评分,采用ELISA法检测血清去甲肾上腺素(norepinephrine,NE)、肾上腺素、多巴胺(dopamine,DA)及血清MDA,采用比色法检测血清SOD,采用全自动免疫分析仪以荧光偏振免疫分析法检测血清同型半胱氨酸(homocysteine,Hcy)、内皮素(endothelin,ET);采用美国国立卫生研究院卒中量表(National Institudes of Health Stroke Scale,NIHSS)评估神经功能受损程度,采用Barthel指数评估日常生活活动能力;观察并记录治疗期间的再出血情况,评价临床疗效。结果观察组总有效率为90.0%(54/60)、对照组为70.0%(42/60),2组比较差异有统计学意义(χ^(2)=7.500,P=0.006)。治疗后3、6周,观察组中医症状评分低于对照组(t值分别为10.670、14.022,P值均<0.001)。治疗组治疗后NIHSS评分低于对照组(t=5.736,P<0.01),Barthel指数评分高于对照组(t=10.559,P<0.01)。治疗后,观察组血清NE[(2897.51±241.65)pmol/L比(6309.25±394.16)pmol/L,t=57.160]、肾上腺素[(1352.45±234.15)pmol/L比(4131.20±431.55)pmol/L,t=43.839]、DA[(623.59±45.61)pmol/L比(950.61±51.39)pmol/L,t=36.866]水平,SOD[(4.08±1.05)C/μg·mgHb比(3.16±1.02)C/μg·mgHb,t=4.868]、MDA[(3.15±1.41)μmol/L比(5.86±1.31)μmol/L,t=10.907]水平,Hcy[(12.98±2.41)μmol/L比(17.68±2.26)μmol/L,t=11.019]、ET[(51.36±5.29)ng/L比(79.58±7.65)ng/L,t=23.502]水平均低于对照组(P<0.01);血清NO[(63.19±3.87)μmol/L比(51.26±3.59)μmol/L,t=17.506]水平高于对照组(P<0.01)。观察组再出血发生率为1.7%(1/60)、对照组为15.0%(9/60),2组比较差异有统计学意义(χ^(2)=6.982,P=0.008)。结论天麻钩藤饮加味结合西医常规疗法可较好保护�Objective To evaluate the effect of modified Tianma-Gouteng Decoction combined with conventional western medicine in the treatment of cerebral hemorrhage with syndrome of hyperactive liver yang causing wind.Methods From May 2017 to December 2019,120 patients of cerebral hemorrhage with syndrome of hyperactive liver yang causing wind were randomly divided into two groups,60 in each group.The control group was treated with conventional western medicine treatment,and the observation group was with modified Tianma-Gouteng Decoction on the basis of the control group.Before and after treatment,the TCM symptom scores were evaluated.Serum norepinephrine(NE),epinephrine(E),dopamine(DA)were detected by ELISA.Serum MDA was detected by ELISA.Serum homocysteine(Hcy),endothelin(ET)were detected by fluorescence polarization immunoassay,the National Institutes of Health Stroke Scale(NIHSS)was used to assess the degree of neurological impairment,and Barthel index was used to assess activities of daily living.The rebleeding during the treatment was observed and recorded to evaluate the clinical efficacy.Results The total effective rate was 90.0%(54/60)in the observation group and 70.0%(42/60)in the control group,with significant difference between the two groups(χ^(2)=7.500,P=0.006).After 3 and 6 weeks of treatment,the TCM syndrome score of the observation group were significantly lower than those in the control group(t=10.670,14.022,P<0.001).After treatment,NIHSS score of treatment group was significantly lower than that of control group(t=5.736,P<0.01),Barthel index score of treatment group was significantly higher than that of control group(t=10.559,P<0.01).After treatment,serum NE[(2897.51±241.65)pmol/L vs.(6309.25±394.16)pmol/L,t=57.160],E[(1352.45±234.15)pmol/L vs.(4131.20±431.55)pmol/L,t=43.839]and DA[(623.59±45.61)pmol/L vs.(950.61±51.39)pmol/L,t=36.866]levels,serum SOD[(4.08±1.05)C/μg·mgHb vs.(3.16±1.02)C/μg·mgHb,t=4.868],MDA[(3.15±1.41)μmol/L vs.(5.86±1.31)μmol/L,t=10.907]levels,serum Hcy[(12.98±2.41)μ

关 键 词：颅内出血 高血压性 出血性脑梗死 肝阳化风证 天麻钩藤饮 中西医结合疗法 

分 类 号：R743.34[医药卫生—神经病学与精神病学]