基于“脑肠互动”理论星蒌承气汤治疗痰热腑实型缺血性中风后认知障碍的临床疗效观察  

Clinical efficacy of Xinglou Chengqi Decoction in treatment of cognitive impairment after ischemic stroke with phlegm-heat and bowel-repletion type based on “brain-gut interaction” theory

作　　者：陈世宣 程一升 林初勇 陈温慈 王策 黄琪瑶 朱斌[1] 徐青青[1] 姜霞 计静[1] CHEN Shixuan;CHENG Yisheng;LIN Chuyong;CHEN Wenci;WANG Ce;HUANG Qiyao;ZHU Bin;XU Qingqing;JIANG Xia;JI Jing(Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Zhejiang University of Traditional Chinese Medicine,Wenzhou 325000,Zhejiang,China)

机构地区：[1]浙江中医药大学附属温州市中西医结合医院,浙江温州325000

出　　处：《上海中医药大学学报》2022年第5期12-16,共5页Academic Journal of Shanghai University of Traditional Chinese Medicine

基　　金：浙江省中医药科技计划项目(2021ZB276);温州市科技局科研项目(Y2020856)。

摘　　要：目的:基于“脑肠互动”理论,观察星蒌承气汤治疗痰热腑实型缺血性中风后认知障碍的临床疗效。方法:纳入痰热腑实型缺血性中风后认知障碍患者144例,随机分为治疗组和对照组,每组各72例。所有患者均给予缺血性中风的基础治疗和盐酸多奈哌齐片口服,在此基础上,对照组患者给予乳果糖口服液口服治疗,治疗组患者给予星蒌承气汤口服治疗,疗程均为30 d。于治疗前及治疗30、90 d后,评价两组患者的简易智能状态检查量表(MMSE)评分;治疗90 d后,比较两组患者的认知功能改善疗效;治疗前及治疗30、90 d后,检测所有患者的血清5-羟色胺(5-HT)、降钙素基因相关肽(CGRP)、胃动素(MTL)表达水平。结果:研究过程中,对照组5例患者剔除或脱落,治疗组7例患者剔除或脱落,最终纳入统计分析者对照组67例、治疗组65例。(1)治疗90 d后,两组患者的MMSE评分较治疗前均升高(P<0.05),且治疗组患者的评分高于对照组(P<0.05)。(2)治疗90 d后,治疗组患者的认知功能改善疗效总有效率为89.23%,对照组为74.63%,治疗组的疗效优于对照组(P<0.05)。(3)治疗30 d后,两组患者的5-HT、CGRP、MTL水平较治疗前均升高(P<0.05),且治疗组患者的上述指标水平高于对照组(P<0.05);治疗90 d后,治疗组患者的5-HT、CGRP、MTL水平较治疗前均升高(P<0.05),对照组患者的5-HT、MTL水平较治疗前亦升高(P<0.05),且治疗组患者的5-HT、CGRP、MTL水平均高于对照组(P<0.05)。结论:在西医常规治疗的基础上,星蒌承气汤可有效改善痰热腑实型缺血性中风后认知障碍患者的认知功能,调节血清脑肠肽指标的表达水平,发挥“脑肠互动”之功效。Objective:To observe the clinical efficacy of Xinglou Chengqi Decoction in the treatment of cognitive impairment after ischemic stroke with phlegm-heat and bowel-repletion type based on the theory of“brain-gut interaction”.Methods:A total of 144 patients of cognitive impairment after ischemic stroke with phlegm-heat and bowel-repletion type were included,and randomly divided into the treatment group and control group,72 cases in each group. All the patients were treated with basic treatment of ischemic stroke and donepezil hydrochloride tablets orally. Based on above,the patients in the control group were orally treated with lactulose oral solution and the patients in the treatment group were orally treated with Xinglou Chengqi Decoction,with a course of 30 d. Before treatment and after 30and 90 d of treatment,the scores of mini-mental state examination(MMSE)in the two groups were evaluated. After 90 d of treatment,the effect of cognitive function improvement was compared between the two groups. Before treatment and after 30 and 90 d of treatment,the expression levels of serum 5-hydroxytryptamine(5-HT),calcitonin gene-related peptide(CGRP)and motilin(MTL)were detected.Results:During the course of research,5 patients in the control group and 7 patients in the treatment group were eliminated and shed off,finally 67 patients in the control group and 65 patients in the treatment group were included in the statistical analysis.(1) After 90 d of treatment,the scores of MMSE in the two groups were increased compared with those before treatment(P<0.05),and the score of the treatment group was higher than that of the control group(P<0.05).(2)After 90 d of treatment,the total effective rates on cognitive function improvement of the treatment group and the control group were 89.23% and 74.63% respectively,and the effect of the treatment group was better than that of the control group(P<0.05).(3) After 30 d of treatment,the levels of 5-HT,CGRP and MTL in the two groups were increased compared with those before treatment(

关 键 词：缺血性中风 认知障碍 星蒌承气汤 脑肠互动 脑肠肽 

分 类 号：R277.7[医药卫生—中医学]