芪蛭活血通絡飲聯合西醫常規療法治療老年急性腦梗死臨床研究

薛瑞文　侯文　路亞娥　呂予

摘要：目的 ?探討芪蛭活血通絡飲治療老年急性腦梗死氣虛血瘀證患者臨床療效，觀察其對患者炎性指標、纖維化指標、神經功能恢復的影響。方法 ?采用隨機數字表法將94例患者分為觀察組和對照組各47例。對照組采用西醫常規治療，觀察組在對照組基礎上予芪蛭活血通絡飲，每日1劑，每次150 mL，每日2次，口服（吞咽困難者胃管給藥），2組均連續治療2周。觀察2組治療前后血液流變學指標、轉化生長因子-β1（TGF-β1）、同型半胱氨酸（Hcy）、超敏C反應蛋白（hs-CPR）、血管內皮生長因子（VEGF）水平，及神經功能（NIHSS）評分、日常生活能力（ADL）評分，比較2組臨床療效及不良反應。結果 ?與本組治療前比較，2組治療后全血高切黏度、全血低切黏度、纖維蛋白原、hs-CPR、Hcy水平明顯下降，TGF-β1、VEGF水平明顯升高（P<0.05）;2組治療后比較，觀察組上述實驗室指標改善明顯優于對照組（P<0.05）。與本組治療前比較，2組治療后NIHSS評分明顯降低，ADL評分明顯升高（P<0.05）;2組治療后比較，觀察組NIHSS評分低于對照組，ADL評分高于對照組（P<0.05）。觀察組總有效率為93.62%（44/47），對照組為74.47%（35/47），2組比較差異有統計學意義（P<0.05）。觀察組不良反應率為14.89%（7/47），對照組為19.15%（9/47），2組比較差異無統計學意義（P>0.05）。結論 ?芪蛭活血通絡飲聯合西醫常規療法治療老年急性腦梗死氣虛血瘀證療效滿意，可有效減輕患者炎癥反應，改善機體高凝狀態，促進神經功能修復。

關鍵詞：芪蛭活血通絡飲;氣虛血瘀證;急性腦梗死;血液流變學;炎癥反應;神經功能

中圖分類號：R277.733.3 ???文獻標識碼：A??? 文章編號：1005-5304（2020）01-0024-05

DOI：10.3969/j.issn.1005-5304.201907351

Clinical Study on Qizhi Huoxue Tongluo Decoction Combined with Conventional Western Medicine Therapy for Elderly Patients with Acute Cerebral Infarction

XUE Ruiwen， HOU Wen， LU Yae， LYU Yu

Affiliated Hospital of Shaanxi University of Chinese Medicine， Xianyang 712000， China

Abstract： Objective To investigate the clinical efficacy of Qizhi Huoxue Tongluo Decoction for the treatment of elderly patients with acute cerebral infarction （qi-deficiency and blood-stasis syndrome）; To observe its effects on inflammatory indicators， fibrosis indicators and neurological function recovery. Methods Totally 94 elderly patients with acute cerebral infarction were divided into observation group and control group according to random number table method， with 47 cases in each group. Control group received conventional Western medicine therapy， and observation group received Qizhi Huoxue Tongluo Decoction on the basis of the control group， one dosage per day， 150 mL each time， twice a day， orally （gastrointestinal administration in patients with dysphagia）; treatment for both groups lasted for two weeks. The blood rheology indexes and transforming growth factor-β1 （TGF-β1）， homocysteine （Hcy）， high-sensitivity C-reactive protein （hs-CPR） and vascular endothelial growth factor （VEGF） levels were observed before and after treatment， as well as neurological function （NIHSS） score， daily living ability （ADL） score. Clinical efficacy and adverse reactions of the two groups were compared. Results Compared with before treatment， the whole blood high-shear viscosity， whole blood low-shear viscosity， fibrinogen， hs-CPR and Hcy levels significantly decreased， and TGF-β1 and VEGF levels significantly increased （P<0.05）; after treatment， the

improvement of the above laboratory indexes in the observation group was significantly better than that in the control group （P<0.05）. Compared with before treatment， the NIHSS scores of the two groups were significantly lower after treatment， and the ADL scores were significantly higher （P<0.05）; after treatment， the NIHSS score of the observation group was lower than that of the control group， and the ADL score was higher than the control group （P<0.05）. The total effective rate was 93.62% （44/47） in the observation group and 74.47% （35/47） in the control group， with statistical significance （P<0.05）. The adverse reaction rate was 14.89% （7/47） in the observation group and 19.15% （9/47） in the control group， without statistical significance （P>0.05）. Conclusion Qizhi Huoxue Tongluo Decoction combined with conventional Western medicine therapy for the treatment of elderly patients with acute cerebral infarction （qi-deficiency and blood-stasis syndrome） can achieve satisfactory efficacy， which can effectively alleviate inflammatory response and fibrosis indicators， and promote neurological function repair.

Keywords： Qizhi Huoxue Tongluo Decoction; qi-deficiency and blood-stasis syndrome; acute cerebral infarction; hemorheology; inflammatory response; neurological function

急性腦梗死以突然發生肢體偏癱、意識障礙、口眼歪斜等為主要表現，在腦血管病中發病率約70%，老年人是高發人群^[1]。其發病機制復雜，目前認為腦血管突然中斷供血引起相應供血區腦組織急性缺血缺氧是發病關鍵，隨之引起的神經細胞受損會對患者生活質量造成嚴重影響。目前，西醫治療主要以調脂、抗血小板、營養神經為主，但由于神經損傷嚴重，患者仍可發生失語、偏癱、癡呆等后遺癥^[2]。……