本文選題：腦卒中偏癱 + 化痰通遂湯�。� 參考：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:本研究以痰濁壅塞、瘀阻經(jīng)絡(luò)型腦卒中偏癱患者為研究對象,觀察化痰通遂湯聯(lián)合康復(fù)訓(xùn)練對腦卒中偏癱患者的臨床療效,并初步探討其可能的作用機(jī)制。方法:選取河北以嶺醫(yī)院康復(fù)醫(yī)學(xué)科2015年1月—2016年12月住院治療的符合納入標(biāo)準(zhǔn)的腦卒中偏癱患者(痰濁壅塞、瘀阻經(jīng)絡(luò)型)120例,按照患者住院病歷號隨機(jī)分為對照組與治療組,各60例,并依據(jù)患者的病情給予相對應(yīng)的抗血小板聚集、降血壓、降血糖等基礎(chǔ)治療。在基礎(chǔ)治療的基礎(chǔ)上,將Brunnstrom、Bobath及運(yùn)動再學(xué)習(xí)等康復(fù)療法進(jìn)行結(jié)合,主要用于改善患者的上下肢功能、運(yùn)動功能、平衡能力、日常生活能力。對照組患者給予基礎(chǔ)治療與康復(fù)訓(xùn)練;治療組在對照組的基礎(chǔ)上,口服化痰通遂湯,1劑/天,早晚各一次。兩組療程均為45天,治療前后分別采用《中風(fēng)病診斷與療效評定標(biāo)準(zhǔn)》對腦卒中偏癱患者的臨床癥狀進(jìn)行評分,并采用簡化Brunnstrom量表、Fugl-Meyer量表、FIM量表以及Berg量表,對患者的上下肢功能、運(yùn)動功能、平衡能力及日常生活能力等進(jìn)行評估。同時(shí)檢測兩組患者治療前后的血液流變學(xué)指標(biāo)(包括全血黏度、纖維蛋白原及血漿粘度)及血清總膽固醇(TC)、甘油三酯(TG)、IL-6、IL-1β、TNF-α含量。數(shù)據(jù)分析采用SPSS17.0統(tǒng)計(jì)軟件進(jìn)行,計(jì)數(shù)資料采用X2檢驗(yàn),計(jì)量資料采用t檢驗(yàn),等級資料采用Ridit檢驗(yàn),以P0.05為具有顯著性差異。結(jié)果:1兩組患者基線資料比較基線資料如性別、年齡、病程等無明顯差異(P0.05),具有可比性。2兩組患者臨床療效及癥狀評分比較對照組有效率為78.94%,治療組有效率為93.22%,治療組有效率明顯高于對照組(P0.05)。臨床癥狀評分比較結(jié)果顯示,兩組患者治療后臨床癥狀較治療前均顯著改善(P0.05);兩組患者治療后的臨床癥狀評分比較,無顯著性差異(P0.05)。3兩組患者的上下肢功能、運(yùn)動功能、平衡能力及生活能力評分的比較治療后,兩組患者的上下肢功能評分、運(yùn)動功能評分、平衡能力評分及生活能力評分均顯著高于治療前(P0.05);且治療后兩組患者各項(xiàng)評分均具有顯著差異(P0.05)。4兩組患者血液流變學(xué)指標(biāo)的比較治療后,對照組患者的全血黏度、血漿黏度及纖維蛋白原含量與治療前相比無明顯差異(P0.05);治療組患者的全血黏度、血漿黏度及纖維蛋白原含量較治療前均顯著降低(P0.05);與對照組相比,治療組患者的全血黏度、血漿黏度及纖維蛋白原含量出現(xiàn)顯著降低(P0.05)。5兩組患者血清TC及TG指標(biāo)比較兩組患者血清TC與TG指標(biāo)較治療前均顯著降低(P0.05)。治療后,治療組患者血清TC與TG水平的降低更為顯著(P0.05),優(yōu)于對照組。6兩組患者治療前后血清IL-6、IL-1β及TNF-α水平的比較治療后,對照組患者的血清IL-6、IL-1β及TNF-α水平與治療前相比無明顯差異(P0.05);治療組患者的IL-6、IL-1β及TNF-α水平均顯著低于治療前(P0.05)。與對照組相比,治療組患者的血清IL-6、IL-1β及TNF-α水平均顯著低于對照組(P0.05)。結(jié)論:1本研究以化痰開竅、活瘀通絡(luò)為原則自擬的化痰通遂湯聯(lián)合康復(fù)訓(xùn)練,能顯著改善患者的臨床癥狀、上下肢功能、運(yùn)動功能、平衡功能、日常生活能力,提高患者的生存生活質(zhì)量,對于痰濁壅塞、瘀阻經(jīng)絡(luò)型腦卒中偏癱患者表現(xiàn)出了良好的治療效果。2本研究進(jìn)一步對化痰通遂湯治療痰濁壅塞、瘀阻經(jīng)絡(luò)型腦卒中偏癱患者的作用機(jī)制進(jìn)行探討。結(jié)果顯示,本方對腦卒中偏癱的治療,可能與降低血脂水平,抑制炎癥因子,改善血液流變學(xué)指標(biāo)密切相關(guān)。
[Abstract]:Objective: To observe the clinical effect of phlegm Tong Sui decoction combined with rehabilitation training on stroke hemiplegic patients with phlegm congestion and stagnation of meridian type cerebral apoplexy, and to preliminarily discuss the possible mechanism of action. Methods: the treatment of rehabilitation medicine in Hebei Yiling hospital from January 2015 to December 2016 was selected. 120 patients with cerebral apoplexy hemiplegia (phlegm congestion and stasis meridian) were randomly divided into the control group and the treatment group according to the patient's medical record number, and 60 cases each were given the corresponding anti platelet aggregation, blood pressure reduction and blood sugar reduction according to the patient's condition. On the basis of basic treatment, Brunnstrom, Bobath and exercise restudy were carried out. A combination of rehabilitation therapy, mainly used to improve the patients' upper and lower limbs function, exercise function, balance ability and daily life ability. The control group was given basic treatment and rehabilitation training; on the basis of the control group, the treatment group took oral phlegm Tong Sui decoction, 1 doses / days, each time in the morning and evening. The two groups were 45 days, before and after the treatment, < The clinical symptoms of stroke patients with hemiplegia were evaluated and the simplified Brunnstrom scale, the Fugl-Meyer scale, the FIM scale and the Berg scale were used to evaluate the upper and lower limbs function, the exercise function, the balance ability and the daily living ability of the patients. The blood of two groups of patients before and after treatment were measured. The hemorrheology index (including whole blood viscosity, fibrinogen and plasma viscosity) and serum total cholesterol (TC), triglyceride (TG), IL-6, IL-1 beta, TNF- alpha content. The data analysis was carried out by SPSS17.0 statistical software, the counting data were tested by X2 test, the measurement data were tested with T, and the grade data were tested with Ridit test, with P0.05 as significant difference. Results: 1 the baseline data of the two groups were compared with the baseline data such as sex, age, and course of disease (P0.05). The clinical curative effect and symptom score of the group.2 two were compared with the control group, the effective rate was 78.94%, the treatment group was 93.22%, and the treatment group was significantly higher than the control group (P0.05). The clinical symptom score comparison results showed that the treatment group was more effective than the control group (P0.05). The clinical symptoms of the two groups were significantly improved after treatment (P0.05), and there was no significant difference between the two groups after treatment (P0.05) the upper and lower limbs function, motor function, balance ability and life ability score of the two groups of the two groups were compared, and the scores of upper and lower limbs, motor function score, and the score of motor function in the two groups of patients were compared. The score of balance and life ability were significantly higher than that before the treatment (P0.05), and the scores of the two groups after the treatment were significantly different (P0.05) after the comparison of hemorheological indexes in the group.4 two, the total blood viscosity, plasma viscosity and the content of fibrous egg white in the control group were not significantly different from those before the treatment (P0.05). The whole blood viscosity, plasma viscosity and fibrinogen in the treatment group were significantly lower than those before the treatment (P0.05). Compared with the control group, the total blood viscosity, plasma viscosity and fibrinogen content in the treatment group were significantly decreased (P0.05).5 two groups of serum TC and TG indexes compared with the two groups of serum TC and TG indexes were significantly higher than those before treatment. Decrease (P0.05). After treatment, the level of serum TC and TG decreased more significantly (P0.05) in the treatment group than in the control group, compared with the serum IL-6, IL-1 beta and TNF- alpha levels before and after treatment in the.6 two groups of the control group, and the serum IL-6, IL-1 beta and TNF- alpha levels in the control group were not significantly different from those before the treatment (P0.05). The level of 1 beta and TNF- alpha was significantly lower than that before the treatment (P0.05). Compared with the control group, the levels of serum IL-6, IL-1 beta and TNF- alpha in the patients in the treatment group were significantly lower than those of the control group (P0.05). Conclusion: the clinical symptoms of the patients and the upper and lower extremities can be significantly improved by using the phlegm opening and activating the phlegm and dredging collaterals as the principle of the combined rehabilitation training. Ability, exercise function, balance function, daily life ability, improve the quality of life and life of patients, have good therapeutic effect on patients with hemiplegic paralysis of phlegm obstruction and stasis meridian type cerebral apoplexy.2. This study further studies the mechanism of the effect of huatatsu Tong Sui Decoction in treating phlegm congestion and blood stasis meridian type stroke hemiplegic patients. It shows that the treatment of hemiplegia after stroke may be related to lowering blood lipid level, inhibiting inflammatory factors and improving hemorheological indexes.

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R743.3

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 趙菁;徐純鑫;方棟;趙義;沈敏;;NPT系統(tǒng)訓(xùn)練對腦卒中患者平衡及運(yùn)動功能的影響[J];中國康復(fù)理論與實(shí)踐;2017年02期

2 劉豐;洪士聰;劉吉良;;腦梗死超早期溶栓療法的研究進(jìn)展[J];醫(yī)學(xué)綜述;2017年03期

3 金煜;;補(bǔ)陽還五湯加減治療缺血性中風(fēng)后遺癥臨床療效觀察[J];世界中西醫(yī)結(jié)合雜志;2017年01期

4 龔萬歐;;針刺結(jié)合中藥與現(xiàn)代康復(fù)治療中風(fēng)偏癱痙攣狀態(tài)的臨床研究[J];四川中醫(yī);2017年01期

5 張宗勝;石祥飛;;大腦半球大面積腦梗死的手術(shù)治療21例臨床分析[J];中國實(shí)用神經(jīng)疾病雜志;2017年01期

6 高翱;;針灸療法應(yīng)用于急性腦梗死患者康復(fù)治療中對患肢功能恢復(fù)影響[J];遼寧中醫(yī)藥大學(xué)學(xué)報(bào);2017年02期

7 陳斌;龍發(fā)青;蘇慶杰;吳映曼;代鳴明;王德生;張余輝;王布飛;萬忠琴;;提高缺血性腦卒中患者二級預(yù)防中抗血小板藥物治療的依從性研究[J];中華老年心腦血管病雜志;2017年01期

8 吳相春;王少卿;唐璐;朱文浩;高穎;;地黃飲子加減方與化痰通絡(luò)湯對MCAO大鼠神經(jīng)功能的影響[J];中國中西醫(yī)結(jié)合雜志;2016年11期

9 張小芳;周甜;孫惠萍;;益腎桂枝湯治療中風(fēng)恢復(fù)期氣虛血瘀兼陰虛證的臨床療效[J];遼寧中醫(yī)雜志;2016年10期

10 康雄;;針灸結(jié)合中藥治療對腦中風(fēng)患者后期肢體功能恢復(fù)的影響[J];臨床醫(yī)學(xué)研究與實(shí)踐;2016年19期

，

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