| 牛永义,王芸生.清热熄风活血汤合葛根素注射液治疗急性脑梗死风阳上扰证疗效观察[J].安徽医药,2020,24(1):27-32. |
| 清热熄风活血汤合葛根素注射液治疗急性脑梗死风阳上扰证疗效观察 |
| Clinical effects investigation of Qingre Xifeng Huoxue Decoction combined with Puerarin injection in the treatment of patients with acute cerebral infarction for Fengyang Shangzu syndrome and influence on laboratory index |
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| DOI：10.3969/j.issn.1009?6469.2020.01.008 |
| 中文关键词: 脑梗死 疏风清热 活血 葛根素 内皮生长因子 血管紧张素 Ⅰ 过氧化氢酶 血液黏度 血细胞比容 纤维蛋白 清热熄风活血汤 风阳上扰 |
| 英文关键词: Brain infarction Dispelling wind clearing heat Activating blood Puerarin Endothelial growth factors Angiotensin I Catalase Blood viscosity Hematocrit Fibrin Qingre Xifeng Huoxue Decoction Fengyang Shangzu |
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| 目的探讨清热熄风活血汤合葛根素注射液治疗急性脑梗死风阳上扰证疗效及对实验室指标水平的影响。方法选取平煤神马医疗集团总医院 2016年5月至 2018年5月收治急性脑梗死风阳上扰证病人共 116例，以随机抽签法分为对照组(58例)和观察组(58例)，对照组单纯西医方案:采用阿司匹林 100 mg/d口服和阿托伐他汀 20 mg/d口服为主的包括降低颅内压、抗血小板、降血糖、稳定血压及稳定斑块等治疗措施；观察组则在此基础上辅以清热熄风活血汤合葛根素注射液治疗，包括: ①清热熄风活血汤［组分:石决明(先煎)、夜交藤、茯神等］煎汁，分早晚 2次服用； ②葛根素注射液 400毫克 /次， 1次/天；两组疗程均为 14 d。比较两组近期疗效、远期改良 RANKIN量表(mRS)评分良好率、治疗前后中医证候积分、美国国立卫生研究院卒中量表(NIHSS)评分、缺血半暗带体积、工具性日常生活活动能力(IADL)评分、血脂指标水平、血液流变学指标、血管内皮生长因子(VEGF)、血管紧张素 Ⅰ(Ang?I)及过氧化氢酶(CAT)水平。结果观察组近期疗效和远期 mRS评分良好率均优于对照组(P＜0.05)；观察组治疗后中医证候积分、 NIHSS评分、缺血半暗带体积及 IADL评分均优于对照组及治疗前( P＜0.05)；中医症候积分包括:偏身瘫痪［(1.09±0.12)比( 1.53±0.40)比(4.21±1.10)分］；舌强语謇［(1.12±0.17)比(1.67±0.32)比(4.30±0.92)分］；口眼斜［(0.97±0.19)比(4.12±0.94)比( 1.44±0.37)分］；耳鸣目眩［(0.93±0.20)比(1.35±0.32)比( 3.90±0.82)分］； NIHSS评分:(9.15±1.37)比( 12.80±1.80)比(20.90±2.65)分；缺血半暗带体积:(21.92±4.65)比(33.60±6.80)比(83.90±14.98)mL；IADL评分:(19.15±4.79)比(15.80±3.44)比(5.30±1.05)分；观察组治疗后血脂指标和血液流变学指标水平均低于对照组及治疗前( P＜0.05)；血脂指标包括:总胆固醇( TC)［(3.97±0.51)比( 4.51±0.64)比( 5.59±0.83)mmol/L］；三酰甘油( TG)［(1.19±0.30)比( 1.54±0.45)比( 2.11±0.68)mmol/L］；低密度脂蛋白胆固醇( LDL?C)［(1.92±0.30)比( 2.39±0.37)比( 4.52±0.61)mmol/L］；载脂蛋白 B(APo?B)［(1.07±0.31)比(1.33±0.40)(1.72±0.52)g/L］；血液流变学指标包括:血浆黏度［(1.73±0.53)比(2.09±0.68)比(2.53±0.79)mPa·s］；纤维蛋白原( FIB)［(3.19±0.43/L比)g比(4.65±0.58)比(6.23±0.70)g/L］；红细胞压积( Hct)［(27.37±2.07)比(43.71±3.32)比( 54.88±4.79)%］；同时观察组治疗后血管内皮生长因子( VEGF)、血管紧张素 Ⅰ(Ang?I)及过氧化氢酶( CAT)水平均高于对照组及治疗前( P＜0.05)［VEGF:(322.41±70.36)比(287.93±61.84)比(245.19±55.43)pg/mL；Ang?I:(33.47±8.36)比(25.90±6.14)比( 17.29±4.38)pg/mL；CAT:(20.89±5.45)比( 17.64±3.97)比(13.55±2.81)pg/mL］。结论清热熄风活血汤合葛根素注射液治疗急性脑梗死风阳上扰证可有效改善近远期预后，促进病灶缩小，提高生活自理能力，调节血脂指标，降低血液黏稠度，并有助于刺激 VEGF、Ang?I及CAT合成。 |
| 英文摘要: |
| Objective To investigate the clinical effects of Qingre Xifeng Huoxue Decoction combined with Puerarin injection in the treatment of patients with acute cerebral infarction for Fengyang Shangzu syndrome and influence on laboratory index.Meth? ods 116 patients with acute cerebral infarction for Fengyang Shangzu syndrome were chosen from May 2016 to May 2018 in Gen?eral Hospital of Pingmei Shenma Medical Group and randomly divided into 2 groups including control group(58 patients)with western medicine used alone and observation group(58 patients)with Qingre Xifeng Huoxue Decoction combined with Puerarin in? jection on the basis of control group including:① Qingre Xifeng Huoxue Decoction［Shijueming for 20 g(decocting first)，Nightin? gale，Tuckahen，etc.，taken twice in the morning and evening；② Puerarin injection 400 mg / time，1 time / day；and the short?term clinical efficacy，long?term good rate of modifed Rankin Scale(MRS)score，TCM syndrome score，National Institutes of Health Stroke Scale(NIHSS)score，ischemic penumbra volume，instrumental activities of daily living(IADL)score，the levels of blood lipid index，hemorheology index，vascular endothelial growth factor(VEGF)，Angiotensin I(Ang?I)and Catalase(Cat)before and af? ter treatment of 2 groups were compared.Results The clinical effects for short?term and good and excellent rate of mRS score forlong?term of observation group was significantly better than control group(P＜0.05).The TCM syndrome score，NIHSS score，isch? emic penumbra volume and IADL score of observation group after treatment were significantly improved than control group and be?fore treatment(P＜0.05).(1.09±0.12)points vs.(1.53±0.40)points，(1.12±0.17)points［TCM syndrome score:(4.21±1.10)points；vs.(1.67±0.32)points，(4.30±0.92)points；(0.97±0.19)points vs.(1.44±0.37)points，(4.12±0.94)points；(0.93±0.20)points vs.(1.35±0.32)points，(3.90±0.82)points；NIHSS scores:(9.15±1.37)points vs.(12.80±1.80)points，(20.90±2.65)points；ischemic pen? umbra volume:(21.92±4.65)ml vs.(33.60±6.80)ml，(83.90±14.98)ml；IADLscore:(19.15±4.79)points vs.(15.80±3.44)points，(5.30±1.05)points］.The levels of blood lipid index and hemorheological index of observation group after treatment were significant?ly better than control group and before treatment(P＜0.05)［blood lipid index:(3.97±0.51)mmol/L vs.(4.51±0.64)mmol/L，(5.59±0.83)mmol/L；(1.19±0.30)mmol/L vs.(1.54±0.45)mmol/L，(2.11±0.68)mmol/L；(1.92±0.30)mmol/L vs.(2.39±0.37)mmol/L，(4.52±0.61)mmol/L；(1.07±0.31)g/L vs.(1.33±0.40)g/L，(1.72±0.52)g/L；hemorheological index:(1.73±0.53)mPa·s vs.(2.09±0.68)mPa·s，(2.53±0.79)mPa·s；(3.19±0.43)g/L vs.(4.65±0.58)g/L，(6.23±0.70)g/L；(27.37±2.07)% vs.(43.71±3.32)%，(54.88±4.79)%］.The levels of VEGF，Ang?I and CAT of observation group after treatment was significantly better than control group and before treatment(P＜0.05)［VEGF:(322.41±70.36)pg/mL vs.(287.93±61.84)pg/mL，(245.19±55.43)pg/mL；Ang?I:(33.47±8.36) pg/mL vs.(25.90±6.14)pg/mL，(17.29±4.38)pg/mL；CAT:(20.89±5.45)pg/mL vs.(17.64±3.97)pg/mL，(13.55±2.81)pg/mL］.Con? clusion Compared with western medicine standardized intervention program，Fumai Zishen Huatan Qingre Xifeng Huoxue Decoc? tion combined with Puerarin injection in the treatment of patients with acute cerebral infarction for Fengyang Shangzu syndromeand influence on laboratory index can efficiently improve clinical prognosis for short?term and long?term，promote lesion shrinkage， improve self?care ability，regulate the levels of blood lipid index and blood viscosity and be helpful to stimulate the expression of VEGF，Ang?I and CAT. |
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