基于“久病入络”理论探讨通窍活血汤对缺血性卒中后继发性癫痫的疗效及脑血流动力学的影响  

Exploring Therapeutic Effect and Cerebral Hemodynamic Effects of Tongqiao Huoxue Decoction(通窍活血汤) on Secondary Epilepsy Patients after Ischemic Stroke Based on Theory of“Chronic Diseases Involving Collaterals”

作　　者：郭明迪 刘姿瑶[2] 张小倩[1] 阎丽媚 GUO Mingdi;LIU Ziyao;ZHANG Xiaoqian;YAN Limei(The First Affiliated Hospital of China Medical University,Shenyang 110001,Liaoning,China;Affiliated Hospital of Liaoning University of Traditional Chinese Medicine,Shenyang 110032,Liaoning,China)

机构地区：[1]中国医科大学附属第一医院,辽宁沈阳110001 [2]辽宁中医药大学附属医院,辽宁沈阳110032

出　　处：《辽宁中医杂志》2024年第2期106-110,共5页Liaoning Journal of Traditional Chinese Medicine

基　　金：国家自然科学基金项目(81801053)。

摘　　要：目的基于“久病入络”理论探讨通窍活血汤对缺血性卒中后继发性癫痫患者的疗效及脑血流动力学的影响。方法选取2018年1月—2020年1月该院收治的缺血性卒中后继发性癫痫患者80例,依据随机数字表分两组,各40例。对照组给予卡马西平;在此基础上,观察组给予通窍活血汤,持续治疗2周。比较两组患者的临床疗效,治疗前后测定脑血流动力学、血液流变学及氧化应激指标,记录不良反应。结果对照组患者的总有效率[85.00%(34/40)]低于观察组[97.50%(39/40)],对比有统计学意义(P<0.05)。与治疗前对比,两组治疗后双侧大脑动脉平均血流速度(Vm)、最大峰值流速(Vs)均升高,阻力指数(RI)降低;而且观察组治疗后双侧大脑动脉Vm、Vs均高于对照组,RI低于对照组,对比有统计学意义(P<0.05)。与治疗前对比,两组患者治疗后全血黏度高切、全血黏度低切及血浆黏度均降低;而且观察组患者治疗后全血黏度高切、全血黏度低切及血浆黏度均低于对照组,对比有统计意义(P<0.05)。与治疗前对比,两组患者治疗后血清超氧化物歧化酶(SOD)水平升高,血清丙二醛(MDA)水平降低;而且观察组治疗后血清SOD水平高于对照组,血清MDA水平低于对照组,对比有统计意义(P<0.05)。对照组患者的总不良反应率[25.00%(11/40)]与观察组[15.00%(6/40)]对比,无统计学意义(P>0.05)。结论基于“久病入络”理论使用通窍活血汤对缺血性卒中后继发性癫痫患者的疗效显著,可以改善脑血流动力学和血液流变学,抑制氧化应激,且安全性高,值得推广。Objective To explore the effect of Tongqiao Huoxue Decoction(通窍活血汤)on the efficacy and cerebral hemodynamics of patients with secondary epilepsy after ischemic stroke based on the theory of“chronic diseases involving collaterals”.Methods Eighty patients with secondary epilepsy after ischemic stroke from January 2018 to January 2020 were randomly divided into two groups with 40 cases in each group.The control group was given carbamazepine.On this basis,the observation group was given Tongqiao Huoxue Decoction for 2 weeks.The clinical effects of the two groups were compared.The indexes of cerebral hemodynamics,hemorheology and oxidative stress were measured before and after treatment,and the adverse reactions were recorded.Results The total effective rate(85.00%,34/40)in the control group was lower than that(97.50%,39/40)in the observation group(P<0.05).Compared with that before treatment,the values of blood flow velocity(Vm),maximum peak flow velocity(Vs)of bilateral cerebral arteries increased and resistance index(RI)decreased in both groups after treatment.After treatment,the values of Vm and Vs of bilateral cerebral arteries in the observation group were higher than those in the control group,and RI was lower than that in the control group(P<0.05).Compared with those before treatment,the levels of the whole blood viscosity high shear,whole blood viscosity low shear and plasma viscosity of the two groups decreased after treatment.Moreover,the levels of the whole blood viscosity high shear,whole blood viscosity low shear and plasma viscosity in the observation group were lower than those in the control group after treatment(P<0.05).Compared with those before treatment,the level of serum SOD increased and the level of serum MDA decreased in the two groups after treatment.After treatment,the level of serum SOD in the observation group was higher than that in the control group,and the level of serum MDA was lower than that in the control group(P<0.05).The total adverse rate of patients in the control g

关 键 词：久病入络 通窍活血汤 继发性癫痫 脑血流动力学 血液流变学 氧化应激 

分 类 号：R255.2[医药卫生—中医内科学]