摘要
【目的】观察半夏白术天麻汤合桃红四物汤治疗急性期颅内大动脉粥样硬化型卒中风痰瘀阻型患者的临床疗效。【方法】将60例存在颅内大动脉狭窄(大脑中动脉MI段中重度狭窄)的急性缺血性卒中风痰瘀阻型患者随机分为研究组和对照组,每组各30例。2组患者均给予常规营养神经、调脂稳斑、改善微循环等治疗,对照组同时给予阿司匹林和氯吡格雷的双重抗血小板治疗(简称双抗),研究组在对照组的基础上加用半夏白术天麻汤合桃红四物汤治疗,疗程为2周。观察2组患者治疗前后美国国立卫生研究院卒中量表(NIHSS)评分和磁共振灌注加权成像的灌注参数的变化情况,并评价2组患者的临床疗效和安全性。【结果】(1)疗效方面,治疗2周后,研究组的总有效率为93.33%(28/30),对照组为90.00%(27/30),组间比较(秩和检验),研究组的疗效优于对照组,差异有统计学意义(P<0.05)。(2)神经功能评分方面,治疗后,2组患者的NIHSS评分均较治疗前明显降低(P<0.01),且研究组的降低程度明显优于对照组,差异有统计学意义(P<0.05)。(3)磁共振灌注加权成像的灌注参数方面,治疗后,2组患者的局部脑血容量(rCBV)、局部脑血流量(rCBF)均较治疗前升高(P<0.05),局部达峰时间(rTTP)、局部平均通过时间(rMTT)均较治疗前缩短(P<0.05),且研究组的r CBV、r CBF升高程度及rTTP、rMTT缩短程度均明显优于对照组,差异均有统计学意义(P<0.05或P<0.01)。(4)安全性方面,2组患者的不良反应均以肝肾功能损伤为主,无皮疹、恶心呕吐、腹泻等,组间比较,差异无统计学意义(P>0.05)。【结论】半夏白术天麻汤合桃红四物汤治疗急性期颅内大动脉粥样硬化型卒中风痰瘀阻型患者疗效显著,可有效加快神经功能恢复,改善脑灌注。
Objective To observe the clinical efficacy of the combination of Banxia Baizhu Tianma Decoction plus Taohong Siwu Decoction combined with dual anti-platelet therapy(DAPT)in treating patients with acute stroke of intracranial atherosclerotic stenosis(ICAS) with wind-phlegm and blood stasis obstruction syndrome. Methods Sixty patients with acute ischemic stroke of ICAS(moderate to severe stenosis of the MI segment of the middle cerebral artery)were randomly divided into the study group and the control group,with 30 patients in each group.Both groups of patients were given conventional neurotrophic treatment,lipid-regulating and plaque-stabilizing treatment,and treatment for improving microcirculation. Additionally,the control group was simultaneously given DAPT with Aspirin and Clopidogrel, and the study group was given Banxia Baizhu Tianma Decoction plus Taohong Siwu Decoction based on the treatment for the control group. The course of treatment covered 2 weeks. The changes in the National Institutes of Health Stroke Scale(NIHSS) scores and perfusion parameters of magnetic resonance perfusion-weighted imaging(MR-PWI)in the two groups were observed before and after treatment,and the clinical efficacy and safety of the two groups were also evaluated. Results(1)After 2 weeks of treatment,the overall effective rate of the study group was 93.33%(28/30)and that of the control group was 90.00%(27/30). The intergroup comparison showed that the efficacy of the study group was significantly superior to that of the control group,and the difference was statistically significant(P<0.05).(2)After treatment,the NIHSS scores for the neurological function in both groups were significantly lower than those before treatment(P<0.01), and the reduction in the study group was significantly superior to that in the control group,the difference being statistically significant(P<0.05).(3)In terms of the perfusion parameters of MR-PWI,the regional cerebral blood volume(rCBV) and regional cerebral blood flow(r CBF)in both groups were increased(P<0.05),and the regional time to peak(rTTP) and regional mean transit time(rMTT) were shortened after treatment compared with those before treatment(P<0.05). The intergroup comparison showed that the study group had stronger effect on increasing rCBV and rCBF and on decreasing rTTP and r MTT than the control group,and the differences were statistically significant(P<0.05 or P<0.01).(4)The adverse reactions in the two groups were mainly associated with liver and kidney function damage,no rash,nausea and vomiting,or diarrhea occurred during the trial,and the difference of the adverse reaction incidence between the two groups was not statistically significant(P>0.05). Conclusion The combination of Banxia Baizhu Tianma Decoction plus Taohong Siwu Decoction combined with dual antiplatelet therapy exerts certain effect in treating patients with acute stroke of ICAS with wind-phlegm and blood stasis obstruction syndrome, and the therapy is effective on accelerating neurological recovery and improving cerebral perfusion.
作者
邹傲霜
刘建仁
ZOU Ao-Shuang;LIU Jian-Ren(Guangzhou University of Chinese Medicine,Guangzhou 510405 Guangdong,China;The First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510405 Guangdong,China)
出处
《广州中医药大学学报》
CAS
2023年第3期582-587,共6页
Journal of Guangzhou University of Traditional Chinese Medicine
关键词
颅内大动脉狭窄
急性缺血性卒中
风痰瘀阻
半夏白术天麻汤
桃红四物汤
神经功能
脑灌注
intracranial atherosclerotic stenosis(ICAS)
acute ischemic stroke(AIS)
wind-phlegm and blood stasis obstruction syndrome
Banxia Baizhu Tianma Decoction
Taohong Siwu Decoction
neurological function
cerebral perfusion
