补阳还五汤联合灸刺督脉疗法治疗急性缺血性脑卒中的疗效观察  

Effect Observation of Buyang Huanwu Decoction Combined with Acupuncture and Moxibustion at the Goernor Vessel in Treatment of Acute Ischemic Stroke

作　　者：蔡志玲[1] 梁明坤 陈家冠 曹康 朱良柱 朱其凤[1] Cai Zhiling;Liang Mingkun;Chen Jiaguan;Cao Kang;Zhu Liangzhu;Zhu Qifeng(Ruikang Hospital Afiliated to Guangxi University of Chinese Medicine,Guangxi,Nanning 530000,China)

机构地区：[1]广西中医药大学附属瑞康医院,广西南宁530000 [2]广西壮族自治区北海市中医院,广西北海536000 [3]广西壮族自治区崇左市中医壮医医院,广西崇左532200

出　　处：《中国中医急症》2023年第5期845-850,共6页Journal of Emergency in Traditional Chinese Medicine

基　　金：广西高校中青年教师基础能力提升项目(2018KY0288);广西壮族自治区卫计委自筹经费科研课题(Z2016224)。

摘　　要：目的探讨补阳还五汤联合灸刺督脉疗法治疗气虚血瘀型急性缺血性脑卒中(AIS)患者的临床疗效。方法将94例AIS患者随机分为对照组与观察组各47例。对照组患者接受西医综合治疗,在此基础上,观察组患者应用补阳还五汤内服联合灸刺督脉疗法治疗,两组的疗程均为2周。对比两组治疗效果,评价中医证候积分与美国国立卫生院卒中量表(NIHSS)评分,检测血清神经生长因子(NGF)、脑源性神经营养因子(BDNF)、血管内皮生长因子(VEGF)、基质金属蛋白酶-2(MMP-2)、基质金属蛋白酶-9(MMP-9)、同型半胱氨酸(Hcy)、白介素-1β(IL-1β)和肿瘤坏死因子-α(TNF-α),检测全血高切黏度(HSV)、低切黏度(LSV)、血浆黏度(PV)和纤维蛋白原(FIB),检测大脑中动脉(MCA)、大脑前动脉(ACA)和大脑后动脉(PCA)的平均血流速度(Vm)。结果两组患者治疗后中医证候积分及NIHSS评分均明显降低,且观察组的评分较对照组更低(P<0.05);两组治疗后血清NGF、BDNF和VEGF均较治疗前明显升高,且观察组较对照组更高(P<0.05);两组治疗后MMP-2、MMP-9、Hcy、IL-1β、TNF-α、HSV、LSV、PV和FIB均降低,且观察组较对照组更低(P<0.05)。治疗后,两组MCA、ACA和PCA的Vm均较治疗前明显升高,且观察组较对照组更高(P<0.05)。观察组的总有效率明显高于对照组(P<0.05)。结论补阳还五汤联合灸刺督脉疗法治疗气虚血瘀型AIS患者能够改善神经功能缺损症状,提高近期疗效,机制可能与抗炎、抗血栓及改善血流动力学等有关。Objective:To explore the clinical efficacy of Buyang Huanwu Decoction combined with acupuncture and moxibustion at the governor vessel in treatment of acute ischemic stroke(AIS)with syndrome of qi deficiency and blood stasis.Methods:A total of 94 patients with AIS were randomly divided into the control group(n=47)and observation group(n=47).The control group was treated with western medicine,while the observation group was treated with Buyang Huanwu Decoction combined with acupuncture and moxibustion at the governor vessel for 2 weeks.The effects of the two groups was compared,the traditional Chinese medical syndrome score and NIHSS score were evaluated,the serum nerve growth factor(NGF),brain derived neurotrophic factor(BDNF),vascular endothelial growth factor(VECF),matrix metalloproteinase-2(MMP-2),matrix metalloproteinase-9(MMP-9),homocysteine(Hcy),interleukin-1β(IL-1β)and tumor necrosis factor-α(TNF-α)were detected,the whole blood high shear viscosity(HSV),low shear viscosity(LSV),plasma viscosity(PV)and fibrinogen(FIB)were measured,and the mean blood flow velocity(Vm)of middle cerebral artery(MCA),anterior cerebral artery(ACA)and posterior cerebral artery(PCA)were measured.Results:The traditional Chinese medical syndrome score and NIHSS score in the two groups after treatment were significantly lower than those before treatment(P<0.05),and compared with the control group,the scores of the observation group decreased more significantly(P<0.05).The levels of serum NGF,BDNF and VEGF in the two groups after treatment were significantly higher than those before treatment,and those in the observation group were higher than those in the control group(P<0.05).The serum levels of MMP-2,MMP-9,Hcy,IL-1β,TNF-α,HSV,LSV,PV and FIB in the two groups after treatment were significantly lower than those before treatment(P<0.05);compared with the control group,those indicators of the observation group decreased more significantly(P<0.05).After treatment,the Vm of MCA,ACA and PCA in the two groups were significantly incre

关 键 词：急性缺血性脑卒中 气虚血瘀 补阳还五汤 针灸 督脉 

分 类 号：R743.3[医药卫生—神经病学与精神病学]