【摘要】：目的:溫陽通脈顆粒、常規(guī)西藥聯(lián)合治療腦缺血性疾病(脾腎陽虛型腦梗死)的臨床數(shù)據(jù)收集、觀察,分析和研究該方法的臨床療效,為溫陽通脈顆粒在辯證論治、病證結(jié)合以及中藥的多環(huán)節(jié)、多途徑、多靶點(diǎn)的治療優(yōu)勢(shì)上提供進(jìn)一步的依據(jù)。方法:選取干部神經(jīng)內(nèi)科收治的、符合臨床觀察要求的患者60例(病例來源于安徽中醫(yī)藥大學(xué)第一附屬醫(yī)院)為研究對(duì)象,采用隨機(jī)分組法,治療組(30例)和對(duì)照組(30例)。分別設(shè)立治療組(溫陽通脈顆粒+常規(guī)西藥組)、對(duì)照組(常規(guī)西藥組)進(jìn)行隨機(jī)對(duì)照觀察,兩組均以4周為一療程。兩組患者臨床治療過程中分別于治療前、2周、4周后檢測(cè)相應(yīng)的觀察指標(biāo)(血流變、凝血),同時(shí)觀察治療前后的腦彩超(TCD)變化、神經(jīng)功能缺損程度(CSS評(píng)分)、中醫(yī)臨床證候的變化,并應(yīng)用統(tǒng)計(jì)學(xué)對(duì)結(jié)果進(jìn)行分析。結(jié)果:(1)療效評(píng)估:溫陽通脈顆粒在治療組中醫(yī)證候積分改善的愈顯率為86.7%、總有效率96.7%,其兩者的結(jié)果均高于對(duì)照組的60.0%和73.3%(p0.01或p0.05);溫陽通脈組在體征、癥狀、中醫(yī)證候各積分均較單純西藥組有顯著的改善(p0.01或p0.05),尤其是在減少神經(jīng)功能缺損的評(píng)分與對(duì)照組比較差異顯著(p0.05);溫陽通脈顆粒治療組臨床的愈顯率和總有效率(66.7%、90.3%)均高于對(duì)照組(36.7%、80.0%),其中臨床愈顯率與對(duì)照組比較差異顯著(p0.05)。(2)指標(biāo)評(píng)估:(1)血流變指標(biāo)方面,溫陽通脈治療組能明顯降低各項(xiàng)指標(biāo)值,其中全血粘度、血漿粘度、紅細(xì)胞電泳、纖維蛋白原與對(duì)照組比較呈顯著下降(p0.01或p0.05)。(2)凝血指標(biāo)方面,治療組能明顯延長PT、APTT、TT,其中PT、APTT與對(duì)照組比較差異顯著(p0.01)(3)經(jīng)顱超聲血流圖檢查(TCD)方面,治療組血流速度參數(shù)(Vm)與對(duì)照組比較差異顯著(p0.05);脈動(dòng)參數(shù)(PI)除了BA與對(duì)照組比較差異顯著(p0.05),其余組內(nèi)、組間PI變化差異不顯著(p0.05)。(3)安全評(píng)估:治療期間觀察兩組患者服用藥物的毒副反應(yīng),并做好詳細(xì)的記錄,其結(jié)果均未出現(xiàn)明顯的不良反應(yīng)。而且兩組患者在三大常規(guī)、肝腎功能、電解質(zhì)及心電圖等各項(xiàng)安全性指標(biāo)與治療前相比均沒有統(tǒng)計(jì)學(xué)差異(p0.05),說明溫陽通脈顆粒配合西藥對(duì)患者各項(xiàng)安全指標(biāo)無不良影響,臨床應(yīng)用是安全的。結(jié)論:溫陽通脈顆粒聯(lián)合常規(guī)西藥在缺血性腦梗死患者的治療上臨床療效較為顯著,對(duì)血液流變學(xué)、凝血指標(biāo)較單純的西藥產(chǎn)生較積極的影響,尤其改善癥狀顯著。其作用機(jī)制可能是通過中藥多途徑、多環(huán)節(jié)、多靶點(diǎn)作用于腦缺血性中風(fēng)的復(fù)雜的病理環(huán)節(jié),從而改善微循環(huán)、降低機(jī)體的高凝狀態(tài),從而產(chǎn)生肯定的療效和獨(dú)特的優(yōu)勢(shì)。
[Abstract]:Objective: to collect clinical data, observe, analyze and study the clinical effect of Wenyang Tongmai granule and routine western medicine in treating cerebral ischemic disease (spleen and kidney yang deficiency cerebral infarction), and to provide dialectical treatment for Wenyang Tongmai granule. The combination of disease and syndromes and the advantages of multi-link, multi-channel and multi-target of traditional Chinese medicine provide further basis. Methods: sixty patients (from the first affiliated Hospital of Anhui University of traditional Chinese Medicine) who were admitted to the Department of Neurology were randomly divided into treatment group (n = 30) and control group (n = 30). The treatment group (Wenyang Tongmai granule routine western medicine group) and the control group (conventional western medicine group) were set up for randomized controlled observation. The two groups were treated with 4 weeks as a course of treatment. In the course of clinical treatment, the corresponding observation indexes (hemorheology, coagulation), changes of brain color Doppler (TCD), degree of nerve function defect (CSS) and clinical syndrome of TCM were detected before and after 2 weeks and 4 weeks of treatment respectively, and the changes of TCM clinical syndromes were also observed before and after treatment, and the changes of brain color Doppler ultrasound (TCD) before and after treatment were also observed. The results were analyzed by statistics. Results: (1) Therapeutic evaluation: the effective rate of Wenyang Tongmai granule in the treatment group was 86.7%, the total effective rate was 96.70.The results of both of them were higher than that of the control group (60.0% or 73.3%, p0.01 or p0.05), and the symptoms and signs of Wenyang Tongmai group were higher than that of the control group (p0.01 or p0.05). The scores of TCM syndromes were significantly improved compared with the control group (p0.01 or p0.05), especially the scores of reducing nerve function defect were significantly different from those of the control group (p0.05), the effective rate and the total effective rate of Wenyang Tongmai granule group (66.7%) were significantly higher than that of the control group (66.7%, 90.3%). All of them were higher than the control group (36.7%), and the clinical recovery rate was significantly higher than that of the control group (p0. 05). (2): (1) the hemorheology index; The blood viscosity, plasma viscosity, erythrocyte electrophoresis and fibrinogen were significantly decreased in the treatment group compared with the control group (p0.01 or p0.05). (2). In the treatment group, there was a significant difference between the PTT APTT and the control group (p0.01). (3) Transcranial ultrasound flow imaging (TCD). The blood flow velocity parameters (VM) of the treatment group were significantly different from those of the control group (p0.05), the pulse parameters (Pi) of the treatment group were significantly different from those of the control group (p0.05) except BA (p0.05). There was no significant difference in Pi between the two groups (p0. 05). (3). During the course of treatment, the toxicity and side effects of the two groups were observed, and detailed records were made. In addition, there was no statistical difference between the two groups in three major routine, liver and kidney function, electrolyte and electrocardiogram (p0.05), which indicated that Wenyang Tongmai granule combined with western medicine had no adverse effect on the safety indexes of the patients. Clinical application is safe. Conclusion: Wenyang Tongmai granule combined with routine western medicine is more effective in the treatment of patients with ischemic cerebral infarction, and has a more positive effect on hemorheology and coagulation index than simple western medicine, especially the improvement of symptoms. The mechanism may be that traditional Chinese medicine acts on the complex pathological links of cerebral ischemic stroke through multiple ways, links and targets, thus improving microcirculation and reducing the hypercoagulability of the body, thus producing positive curative effect and unique advantages.
【學(xué)位授予單位】：安徽中醫(yī)藥大學(xué)
【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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7 李燕，

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