炙黄芪-水蛭治疗阿替普酶静脉溶栓的气虚血瘀型急性脑梗死的临床疗效观察  

Clinical Effect of Honey-Fried Astragalus-Leech Granule on AIS of Qi Deficiency and Blood Stasis after Intravenous Thrombolysis by Alteplase

作　　者：乔天慈 吴宏赟[2] 李浩然 彭伟[2] QIAO Tianci;WU Hongyun;LI Haoran;PENG Wei(Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200080, China;Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250013, China;Shandong University of Traditional Chinese Medicine, Jinan 250355, China)

机构地区：[1]上海中医药大学附属岳阳中西医结合医院,上海200080 [2]山东中医药大学附属医院,山东济南250013 [3]山东中医药大学,山东济南250355

出　　处：《中医药学报》2022年第4期63-67,共5页Acta Chinese Medicine and Pharmacology

基　　金：山东省中医药科技发展计划(2019-0172,2019-0968,2019-0057)。

摘　　要：目的:观察炙黄芪-水蛭对气虚血瘀证急性脑梗死(AIS)患者阿替普酶(rt-PA)静脉溶栓后的疗效作用和安全性。方法:选取2019年1月—2020年9月在山东中医药大学附属医院、山东中医药大学第二附属医院和蓬莱市中医医院收治的气虚血瘀证急性脑梗死患者64例,随机分为对照组和治疗组,每组32例,对照组采用静脉溶栓等临床常规治疗,治疗组在对照组用药基础上加用炙黄芪-水蛭中药颗粒口服,疗程14 d,观察并记录两组患者溶栓前后各时相的NIHSS、mRS、Barthel评分和中医证候评分,统计分析观察数据,记录不良事件发生情况。结果:两组患者溶栓后各项评分均随时间进展显著改善,溶栓后14 d和90 d治疗组各项评分明显优于对照组(P<0.05),且mRS 0~2分预后良好人数比例治疗组明显多于对照组(P<0.01)。整个观察过程两组均无严重不良事件发生,对照组出现牙龈出血和再次梗死患者各1例。结论:炙黄芪-水蛭颗粒可一定程度上辅助rt-PA静脉溶栓改善气虚血瘀型急性脑梗死患者早期神经功能、中医证候和预后,提高患者生活自理能力,可能减少其出血和再梗死等不良反应的发生,且未见安全性差异。Objective:To evaluate the clinical effect and safety of honey-fried Astragalus-Leech granule on acute ischemic stroke(AIS)of Qi deficiency and blood stasis after intravenous thrombolysis(IVT)by alteplase.Methods:64 patients with AIS of Qi deficiency and blood stasis were randomly divided into the control group and the treatment group,with 32 patients in each group.The control group was treated with routine thrombolysis treatment;on which basis,the treatment group was also treated with honey-fried Astragalus-Leech granule.The treatment duration was 14 days.The scores of NIHSS,mRS,Barthel and TCM syndrome were recorded and evaluated before and after IVT respectively.The incidence of adverse reactions was observed in the two groups.Results:The scores of NIHSS,mRS,Barthel and TCM syndrome were significantly improved after IVT in the two groups as time went by,the scores of 14 d after IVT and 90 d after IVT were better in the treatment group than those in the control group(P<0.05).The number of patients from 0-2 of mRS was more in the treatment group than that in the control group(P<0.01).During the entire observation process,there was no severe adverse reactions in the two groups.In the control group,there were one case of gum bleeding and one case of re-infarction during the follow-up.Conclusion:Honey-fried Astragalus-Leech granule can assist alteplase IVT to improve neural function,self-care ability,prognosis and TCM symptoms of AIS patients with Qi deficiency and blood stasis.The therapy can reduce the incidence of bleeding and re-infarction with high safety.

关 键 词：急性脑梗死 炙黄芪 水蛭 阿替普酶 静脉溶栓 

分 类 号：R255.2[医药卫生—中医内科学]