本文選題：芎芍膠囊 + 椎基底動(dòng)脈�。� 參考：《中國(guó)中醫(yī)科學(xué)院》2017年碩士論文

【摘要】：目的近年來(lái)隨著介入治療技術(shù)的發(fā)展、推廣及應(yīng)用,其創(chuàng)傷小、副作用少,總體治療效果好等特點(diǎn)被臨床認(rèn)可并被廣泛應(yīng)用。椎基底動(dòng)脈支架術(shù)后存在著的血栓形成、腦出血、支架置入術(shù)后再狹窄以及過度灌注等并發(fā)癥,特別是支架置入術(shù)后再狹窄(ISR)的發(fā)生,不僅發(fā)生率高,還同樣影響著腦血流動(dòng)力學(xué),從而導(dǎo)致缺血性腦血管病(ICVD)的發(fā)生,如短暫性腦缺血發(fā)作(TIA)、癥狀性腦梗死等疾病。芎芍膠囊作為血府逐瘀湯中的兩味主藥,具有活血化瘀的效果,經(jīng)過多年的臨床研究,能明顯降低冠狀動(dòng)脈介入治療后再狹窄的發(fā)生。依從中醫(yī)“心腦同治”的原則,將芎芍膠囊運(yùn)用于缺血性腦血管病-椎基底動(dòng)脈支架置入術(shù)后的患者,觀察其對(duì)于預(yù)防局部血管再狹窄的療效,為治療椎基底動(dòng)脈術(shù)后再狹窄探索出新的方法途徑,防止發(fā)生缺血性腦血管病。方法(1)檢索、收集相關(guān)文獻(xiàn)及報(bào)道,使用的檢索工具有中國(guó)學(xué)術(shù)期刊全文數(shù)據(jù)庫(kù)(CNKI)、萬(wàn)方數(shù)據(jù)庫(kù)、中國(guó)生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫(kù)(Chinese Biomedical Literature Database,CBM)、電子檢索 MEDLINE 數(shù)據(jù)庫(kù)、EMBASE 數(shù)據(jù)庫(kù)等。整理所收集數(shù)據(jù)及資料,分析椎基底動(dòng)脈支架術(shù)后再狹窄的發(fā)生率、產(chǎn)生原理、相關(guān)因素及相關(guān)措施;中藥類藥物對(duì)冠狀動(dòng)脈支架術(shù)后再狹窄的臨床研究,擴(kuò)展至中藥類藥物對(duì)椎基底動(dòng)脈支架置入術(shù)后再狹窄的預(yù)防研究。(2)制定相應(yīng)的臨床研究方案、方法、流程及具體實(shí)行措施,設(shè)計(jì)“芎芍膠囊臨床觀察表格”并應(yīng)用到此次課題中,將美國(guó)國(guó)立衛(wèi)生研究院卒中量表(NIHSS)及日常生活能力量表—巴氏指數(shù)(Brath指數(shù))作為神經(jīng)功能評(píng)分;同時(shí)與合作醫(yī)院(首都醫(yī)科大學(xué)宣武醫(yī)院)積極聯(lián)系及配合,共同協(xié)調(diào)完成此項(xiàng)臨床研究。(3)選取標(biāo)準(zhǔn):年齡在18-80歲之間、在椎基底動(dòng)脈系統(tǒng)(包括椎動(dòng)脈顱內(nèi)、顱外段及基底動(dòng)脈)成功接受球囊擴(kuò)張和/或支架置入、術(shù)后均常規(guī)口服阿司匹林腸溶片100mgqd+氯吡格雷片75mgqd共6個(gè)月、中醫(yī)辨證分型屬于“血瘀證和/或氣虛證”的患者,預(yù)計(jì)選取80例患者。將80例經(jīng)皮椎動(dòng)脈支架置入成功的缺血性腦血管病患者,通過隨機(jī)數(shù)字表的方法,為西藥常規(guī)治療加安慰劑組(對(duì)照組)、西藥常規(guī)加芎芍膠囊(中藥組)。觀察6個(gè)月后隨訪,有7例患者不符合錄入標(biāo)準(zhǔn)(自動(dòng)脫落、未規(guī)律口服抗凝及抗血小板藥物、未規(guī)律口服配給藥物),最后總計(jì)73例患者入選,分別為西藥常規(guī)加安慰劑組(對(duì)照組)40例和西藥常規(guī)加芎芍膠囊(中藥組)33例。通過對(duì)血管超聲檢查(TCD)、經(jīng)顱彩色多普勒(TCCD)、DSA等檢查,了解兩組支架術(shù)后再狹窄情況及程度。(4)嚴(yán)格按照設(shè)計(jì)要求收集資料,認(rèn)真核對(duì),保證資料的真實(shí)可靠,數(shù)據(jù)應(yīng)用ACCESS進(jìn)行兩遍入機(jī),進(jìn)行統(tǒng)計(jì)分析,比較中藥組與對(duì)照組椎動(dòng)脈支架術(shù)后再狹窄發(fā)生情況及程度、癥狀性腦梗及短暫性腦缺性發(fā)作情況、高危因素對(duì)支架術(shù)后再狹窄的影響。結(jié)果(1)通過對(duì)文獻(xiàn)搜索、整理及分析,發(fā)現(xiàn)以下幾個(gè)特征:①圍手術(shù)期的抗凝及抗血小板聚集治療是預(yù)防椎基底動(dòng)脈ISR的主要措施,常規(guī)應(yīng)用抗凝及抗血小板聚集藥物,6個(gè)月后改為阿司匹林長(zhǎng)期口服,因?yàn)闀r(shí)間一旦超過6個(gè)月,發(fā)生ISR的原因主要是由血管內(nèi)膜的過度增生所致,延長(zhǎng)波立維的口服時(shí)間對(duì)預(yù)防ISR的意義不大。②糖尿病、病變血管成角扭曲、術(shù)后殘余狹窄、長(zhǎng)段(10mmm)的狹窄是發(fā)生椎基底動(dòng)脈ISR的獨(dú)立危險(xiǎn)因素。而高血壓病、高脂血癥、高同型半胱氨酸癥及吸煙等是ISR的高危因素。③年齡相對(duì)較小的患者更容易發(fā)生ISR,考慮是其內(nèi)膜增生能力強(qiáng)、增生速度更快相關(guān);另外,相對(duì)年齡較長(zhǎng)的患者斑塊鈣化居多,淋巴細(xì)胞浸潤(rùn)少,年少的患者斑塊中纖維成分及淋巴浸潤(rùn)更多。④有研究顯示,應(yīng)用自膨式支架與球囊擴(kuò)張支架再狹窄發(fā)生率的差異無(wú)統(tǒng)計(jì)學(xué)意義。雖然自膨式支架6個(gè)月內(nèi)易發(fā)生再狹窄,但其后期穩(wěn)定性較球囊擴(kuò)張支架更好。但仍有研究顯示,徑向應(yīng)力大小影響著ISR的發(fā)生,如柔韌性較好的自膨式支架會(huì)增加動(dòng)脈硬化斑塊突入到支架管腔的風(fēng)險(xiǎn),因其較大的徑向應(yīng)力可促進(jìn)內(nèi)膜增生導(dǎo)致再狹窄的發(fā)生;而球囊擴(kuò)張支架恰恰相反,其相對(duì)較小的徑向應(yīng)力能減少再狹窄的發(fā)生。⑤從祖國(guó)傳統(tǒng)醫(yī)學(xué)的角度來(lái)看,無(wú)論支架置入術(shù)后無(wú)論有無(wú)并發(fā)癥的出現(xiàn),此項(xiàng)治療都屬于外源性創(chuàng)傷,作為一種治標(biāo)及損傷性的手段,雖然可以解決“標(biāo)實(shí)”的問題,但是“本虛”的介入治療后依舊存在,正是這種外源性的創(chuàng)傷,加之支架置入術(shù)的過程是耗氣傷血的過程,從而導(dǎo)致氣虛無(wú)力推動(dòng)血行,血行不暢,久而久之瘀積于脈管中,形成了術(shù)后的再狹窄,符合中醫(yī)學(xué)中“血瘀證”的范疇,治療宜活血化瘀。把中醫(yī)藥運(yùn)用在椎基底動(dòng)脈支架置入術(shù)后治療,不但能降低患者出現(xiàn)消化道潰瘍或者誘發(fā)出血等嚴(yán)重并發(fā)癥,還可以減少ISR的風(fēng)險(xiǎn),縮短患者的住院時(shí)間,提高手術(shù)的成功率。⑥在芎芍膠囊干預(yù)冠心病介入治療后再狹窄的研究中,芎芍膠囊可明顯降低血漿血管緊張素Ⅱ(AngⅡ)水平,促進(jìn)平滑肌細(xì)胞(SMC)凋亡,從而抑制動(dòng)脈粥樣硬化(AS)的發(fā)生發(fā)展;內(nèi)膜增生、病理性血管重構(gòu)協(xié)同作用可造成動(dòng)脈粥樣硬化過程中管腔的缺失,膠原在病理性血管重構(gòu)過程中起到了關(guān)鍵作用,芎芍膠囊可通過調(diào)節(jié)動(dòng)脈粥樣硬化過程中血管壁膠原的含量改善病理性血管重構(gòu)和抑制內(nèi)膜增生,起到預(yù)防管腔狹窄的作用,芎芍膠囊可明顯增強(qiáng)MMP-1mRNA在損傷血管部位的表達(dá),提示芎芍膠囊預(yù)防支架后再狹窄可能與上調(diào)MMP-1mRNA的表達(dá),增加膠原的降解,減少膠原在血管壁的沉積有關(guān)。對(duì)冠心病介入后的臨床研究也表明,芎芍膠囊可明顯降低冠狀動(dòng)脈介入治療后的冠脈造影隨訪再狹窄的發(fā)生(減少45%的再狹窄),能減少心絞痛復(fù)發(fā)并有效改善患者的血瘀狀態(tài)。(2)將2012年12月到2016年6月間,在中國(guó)中醫(yī)科學(xué)院西苑醫(yī)院及首都醫(yī)科大學(xué)宣武醫(yī)院成功進(jìn)行椎動(dòng)脈支架置入術(shù)的患者,隨機(jī)分為西藥常規(guī)治療+安慰劑(對(duì)照組)和西藥常規(guī)+芎芍膠囊(中藥組)。其中對(duì)照組40例,男性33例,女性7例。有高血壓病史25例,糖尿病病史16例,吸煙者17例;其中置入左側(cè)椎動(dòng)脈支架23個(gè),右側(cè)椎動(dòng)脈支架20個(gè)(40例患者安裝椎動(dòng)脈支架43個(gè),其中3人為左右側(cè)椎動(dòng)脈支架各一個(gè));西藥常規(guī)加芎芍膠囊(中藥組)33例,男性26例,女性7例;有高血壓病史患者27例,糖尿病病史14例,吸煙者15例;置入左側(cè)椎動(dòng)脈支架17個(gè),右側(cè)椎動(dòng)脈支架18個(gè)(33例患者安裝椎動(dòng)脈支架35個(gè),其中2人為左右側(cè)椎動(dòng)脈支架各一個(gè))。患者在一般情況、基線方面基本相似,具有可比性。(3)入選病例73例,隨訪6個(gè)月后,芎芍膠囊中藥組的椎動(dòng)脈再狹窄率為12.12%(4例/33例),對(duì)照組椎動(dòng)脈狹窄率為32.5%(13例/40例),通過SPSS20.0統(tǒng)計(jì)軟件包對(duì)所收集的數(shù)據(jù)進(jìn)行整合、處理及分析,首先將所有屬于計(jì)量資料的數(shù)據(jù)均用(x±S表示);其次,對(duì)全部符合納入標(biāo)準(zhǔn)的73例臨床觀察項(xiàng)目,進(jìn)行單因素分析(計(jì)量資料的比較采用t檢驗(yàn),計(jì)數(shù)資料的比較采用卡方檢驗(yàn),以P0.05為差異具有統(tǒng)計(jì)學(xué)意義),最后比較兩組在ISR的發(fā)生率有無(wú)顯著性差異,結(jié)果顯示有顯著性差異(P0.05),具有統(tǒng)計(jì)學(xué)意義。中藥組與對(duì)照組相比較,其癥狀性腦梗及TIA的發(fā)生率無(wú)顯著性差異。(4)芎芍膠囊中藥組與對(duì)照組關(guān)于中醫(yī)辨證論治評(píng)分顯示:①治療前粗略觀察,氣虛證評(píng)分明顯低于血瘀證評(píng)分。②對(duì)兩組組內(nèi)治療前后,分別采用配對(duì)樣本t檢驗(yàn)發(fā)現(xiàn),“氣虛證”評(píng)分中,治療前后均值未見明顯變化,差異無(wú)統(tǒng)計(jì)學(xué)意義(中藥組P=0.292,對(duì)照組P=0.065,兩組P0.05),說明支架置入術(shù)及術(shù)后用藥,對(duì)氣虛證患者影響不明顯;“血瘀證”評(píng)分中,兩組治療前后均值有明顯降低,其差異具有統(tǒng)計(jì)學(xué)意義(P0.05),說明支架置入術(shù)和/或用藥,均可改善血瘀癥狀。③對(duì)兩組組間采用獨(dú)立樣本t檢驗(yàn)發(fā)現(xiàn),血瘀證術(shù)后中藥組與對(duì)照組均值具有差異,有統(tǒng)計(jì)學(xué)意義(P0.05),說明中藥組在術(shù)后改善狹窄率優(yōu)于對(duì)照組。結(jié)論(1)經(jīng)過6個(gè)月后的療效觀察,發(fā)現(xiàn)血管收縮、新生內(nèi)膜多度增生、血栓形成、血管重塑,最終可導(dǎo)致椎基底動(dòng)脈支架置入術(shù)后再狹窄,其機(jī)理符合中醫(yī)學(xué)“血瘀證”范疇。對(duì)中醫(yī)辨證證型屬于“血瘀證”的患者,芎芍膠囊不僅能降低椎動(dòng)脈支架置入術(shù)后局部血管再狹窄的發(fā)生起到預(yù)防作用,還能明顯改善血瘀證狀態(tài)。(2)此次中醫(yī)證候評(píng)分中,氣虛證評(píng)分總體不高,治療前后變化不大,考慮有以下兩個(gè)原因:①行椎基底動(dòng)脈支架置入術(shù)的患者,考慮其本身因血管狹窄而出現(xiàn)一系列癥狀,這與血管再狹窄的部分機(jī)理相似,符合中醫(yī)學(xué)“血瘀證”范疇,造成了在病例選擇上的偏向性。②考慮此次研究病例偏少。(3)對(duì)于癥狀性腦梗及TIA的發(fā)生無(wú)明顯差異。(4)但由于時(shí)間及條件的限制,本此課題研究所選病例數(shù)偏少,在初步證實(shí)芎芍膠囊能減少椎基底動(dòng)脈支架術(shù)后血管再狹窄的基礎(chǔ)上,應(yīng)進(jìn)一步擴(kuò)大樣本量進(jìn)行相關(guān)研究。
[Abstract]:Objective in recent years, with the development, popularization and application of interventional therapy, its characteristics of small trauma, less side effects and better overall therapeutic effect have been clinically recognized and widely used. There are complications such as thrombosis, cerebral hemorrhage, restenosis and overperfusion after stenting of vertebrobasilar artery, especially stent implantation. The incidence of post restenosis (ISR) is not only high, but also affects cerebral hemodynamics, which leads to the occurrence of ischemic cerebrovascular disease (ICVD), such as transient ischemic attack (TIA) and symptomatic cerebral infarction. Xiong Shao capsule, as the two main drug in Xuefu Zhuyu Decoction, has the effect of activating blood and removing stasis, after years of clinical research. It can obviously reduce the occurrence of restenosis after coronary artery interventional therapy. According to the principle of "heart and brain therapy", Xiong Shao capsule is applied to patients with ischemic cerebrovascular disease - vertebrobasilar artery stenting, and the effect on prevention of local restenosis is observed, and a new approach is explored for restenosis after the operation of vertebral basilar artery. Methods to prevent ischemic cerebrovascular disease. Method (1) retrieval, collection of related literature and reports, the retrieval tools used are Chinese academic journal full text database (CNKI), Wanfang database, Chinese biomedical literature database (Chinese Biomedical Literature Database, CBM), electronic retrieval MEDLINE database, EMBASE database Collect data and data, analyze the incidence of restenosis after stenting of vertebrobasilar artery, principle, related factors and related measures; the clinical study of restenosis after coronary stent implantation by traditional Chinese medicine drugs is extended to the prevention and study of restenosis after the brace of vertebrobasilar artery stenting. (2) formulate corresponding The clinical study scheme, method, process and specific implementation measures were used to design "Xiong Shao capsule clinical observation form" and apply the National Institutes of Health Stroke Scale (NIHSS) and the daily living capacity scale - the barson index (Brath index) as the neurological function score; and the cooperative hospital (Capital Medical University Declaration) (3) select the standard: age 18-80 years old, the vertebral basilar artery system (including the vertebral artery intracranial, the extracranial segment and basilar artery) successfully accepted balloon dilatation and / or stent implantation, and the routine oral administration of Aspirin Enteric-coated Tablets 100mgqd+ clopidogrel 75mgqd after the operation. 6 months, TCM syndrome differentiation type belongs to the patients with "blood stasis syndrome and / or qi deficiency syndrome", and 80 patients are expected to be selected. 80 cases of percutaneous vertebral artery stents are placed in the patients with successful ischemic cerebrovascular disease. By the method of random numbers, the routine treatment of Western Medicine plus placebo group (control group), western medicine routine plus Xiong Shao capsule (Chinese medicine group). 6 cases are observed. After month follow-up, 7 cases were not conformed to the standard of entry (auto fall off, irregular oral anticoagulant and antiplatelet drugs, irregular oral dispensing), and finally total of 73 patients were selected, 40 cases of Western medicine routine plus placebo group (control group) and 33 cases of Western medicine routine plus Xiong Shao capsule (Chinese medicine group). Through the TCD, the blood vessel ultrasound examination was carried out. Cranial color Doppler (TCCD), DSA and other examinations to understand the situation and degree of restenosis after two groups of stents. (4) collect data strictly according to the design requirements, carefully check the data, ensure the true and reliable data. The data are applied to the machine for two times, the statistical analysis is carried out, and the occurrence and process of restenosis after the vertebral artery stenting of the Chinese medicine group and the control group are compared and the process is compared. Degree, symptomatic cerebral infarction and transient ischemic attack, and the effect of high risk factors on post stent restenosis. Results (1) through literature search, sorting and analysis, the following characteristics are found: (1) anticoagulant and antiplatelet therapy in the perioperative period are the main measures to prevent ISR of vertebrobasilar artery. Anticoagulant and antiplatelet therapy are routinely applied. The drug was changed to aspirin for a long time after 6 months. As the time passed for more than 6 months, the cause of ISR was mainly caused by excessive hyperplasia of the intima of blood vessels. Prolonging the oral time of brili was not significant for preventing ISR. 2. Diabetes, the vascular distortion of the lesion, the postoperative remnant stenosis, and the stenosis of the long segment (10mmm) were vertebral ISR independent risk factors of basilar artery. Hypertension, hyperlipidemia, Hyperhomocysteine, and smoking are the high risk factors for ISR. (3) ISR is more likely to occur in patients with relatively younger age. There is no statistically significant difference in the incidence of restenosis between self expanding stents and balloon dilatation stents. Although self expanding stents are prone to restenosis in 6 months, the later stability is better than that of balloon dilatation stents. However, there are still studies showing that the diameter of the stent is better than that of balloon dilatation. The size of the stress affects the occurrence of ISR, such as a better flexible self expanding stent, which increases the risk of atherosclerotic plaques penetrating into the stent, because its larger radial stress can promote intimal hyperplasia to cause restenosis, and the balloon dilatation stent is the opposite, and its relatively small radial stress can reduce the occurrence of restenosis. From the point of view of traditional medicine of the motherland, no matter whether or not the stent implantation has complications, this treatment belongs to exogenous trauma. As a standard and damaging means, although it can solve the problem of "the standard", "this deficiency" still exists after the intervention treatment. It is this kind of exogenous trauma, plus branch. The process of stent implantation is the process of blood consumption and blood consumption, which leads to Qi deficiency to push blood, blood flow is not smooth, blood stasis is not smooth, and the blood stasis is accumulated in the pulse tube for a long time. It forms the restenosis after the operation. It is in line with the category of "blood stasis syndrome" in traditional Chinese medicine. The treatment should be used to activate blood and dissipate blood stasis. There are severe complications such as peptic ulcer or induced bleeding, which can also reduce the risk of ISR, shorten the time of hospitalization and improve the success rate of the operation. (SMC) apoptosis, thus inhibiting the occurrence and development of atherosclerosis (AS); intimal hyperplasia and pathological vascular remodeling synergy can cause the absence of the lumen in the process of atherosclerosis. Collagen plays a key role in the process of pathological vascular remodeling. Xiong Shao capsule can be used to regulate the content of collagen in the vascular wall during the process of atherosclerosis. The effect of improving pathological vascular remodeling and inhibiting intimal hyperplasia plays a role in preventing the stenosis of the lumen. Xiong Shao capsule can obviously enhance the expression of MMP-1mRNA in the injured part of blood vessel. It suggests that Xiong Shao capsule may increase the expression of MMP-1mRNA, increase the degradation of collagen and reduce the deposition of collagen in the vascular wall. The clinical study after the intervention showed that Xiong Shao capsule could obviously reduce the incidence of restenosis after coronary artery angiography after coronary intervention (45% reduction of restenosis), reduce the recurrence of angina and effectively improve the blood stasis of the patients. (2) from December 2012 to June 2016, in Xiyuan Hospital of Chinese Academy of Chinese medicine and the capital medicine The patients in Xuanwu Hospital of the University of science and universities were successfully treated with vertebral artery stenting, which were randomly divided into western medicine conventional therapy + placebo (control group) and Western medicine routine + Xiong Shao capsule (Chinese medicine group), of which 40 cases in the control group, 33 men, 7 women, 25 cases of hypertension, 16 diabetic history and 17 smokers, which were placed in the left vertebral artery stents 23. There were 20 stents on the right vertebral artery (40 cases with 43 vertebral artery stents, of which 3 were the left and right vertebral artery stents); the western medicine routine plus Xiong Shao capsule (Chinese medicine group) 33 cases, male 26 cases, 7 women, 27 patients with hypertension history, 14 cases of diabetes, 15 smokers, 17 left vertebral artery stents and right vertebral artery. There were 18 stents (33 patients with 35 vertebral artery stents, of which 2 were one of the left and right vertebral arteries). In general, the baseline was similar and comparable. (3) 73 cases were selected. After 6 months of follow-up, the restenosis rate of Xiong Shao capsule Chinese medicine group was 12.12% (4 cases /33 cases), and the control group's vertebral artery stenosis rate was 32. 5% (13 cases of /40 cases), the collected data were integrated, processed and analyzed through the SPSS20.0 statistical package. First, all the data belonging to the measured data were used (x + S). Secondly, the single factor analysis was carried out for all the 73 clinical observation items which were in conformity with the inclusion criteria. The comparison of the data was compared with t test and the comparison of counting data. With chi square test, P0.05 was statistically significant). At last, there was no significant difference in the incidence of ISR between the two groups. The results showed significant difference (P0.05). There was no significant difference in the incidence of symptomatic cerebral infarction and TIA between the Chinese medicine group and the control group. (4) Xiong Shao capsule Chinese medicine group and the control group. The score of TCM syndrome differentiation and treatment showed: (1) rough observation before treatment, the score of qi deficiency syndrome was significantly lower than that of blood stasis syndrome. (2) before and after treatment in the two groups, the paired sample t test showed that there was no significant change in the mean value of "Qi deficiency syndrome" before and after treatment (P=0.292, P=0.065 of the control group, and two groups of P). 0.05) the effect of stent implantation and postoperative medication on Qi deficiency syndrome was not obvious; in the "blood stasis syndrome" score, the mean value of the two groups before and after treatment was significantly reduced, and the difference was statistically significant (P0.05), indicating that the stent implantation and / or drug use could improve the blood stasis symptoms. (3) the blood stasis syndrome was found by independent sample t test among the two groups. The mean difference between the traditional Chinese medicine group and the control group was statistically significant (P0.05), indicating that the improvement of the stenosis rate in the Chinese medicine group was better than that of the control group. Conclusion (1) after the observation of the curative effect after 6 months, the vasoconstriction, neointimal hyperplasia, thrombosis and blood vessel restenosis can eventually lead to restenosis after the stenting of vertebral basilar artery. The mechanism conforms to the category of blood stasis syndrome of traditional Chinese medicine. Xiong Shao capsule can not only reduce the occurrence of local vascular restenosis after the stent implantation, but also obviously improve the state of blood stasis syndrome. (2) the score of qi deficiency syndrome is generally not high, and the treatment of qi deficiency syndrome is not high, and the treatment of qi deficiency syndrome is not high. There are two reasons for the following reasons: (1) a series of symptoms in the patients with vertebral basilar artery stent implantation, considering their own vascular stenosis, are similar to the mechanism of vascular restenosis, which conforms to the category of "blood stasis syndrome" in traditional Chinese medicine and causes the bias in the selection of cases. Less. (3) there is no significant difference in the occurrence of symptomatic cerebral infarction and TIA. (4) but due to the limitation of time and conditions, the number of cases selected in this study is less than that of the selected cases. On the basis of the preliminary confirmation that Xiong Shao capsule can reduce the restenosis after the stenting of vertebrobasilar artery, the sample should be further expanded to do the related research.

【學(xué)位授予單位】：中國(guó)中醫(yī)科學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R743

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