本文選題：腦梗死 + 補(bǔ)陽(yáng)還五湯��； 參考：《廣西中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:觀察以不同劑量黃芪的補(bǔ)陽(yáng)還五湯治療腦梗死恢復(fù)期的臨床療效,為中醫(yī)藥治療腦梗死恢復(fù)期提供中醫(yī)理論基礎(chǔ)。方法:將廣西中醫(yī)藥大學(xué)附屬瑞康醫(yī)院神經(jīng)內(nèi)科符合納入標(biāo)準(zhǔn)的腦梗死恢復(fù)期氣虛血瘀住院或門(mén)診病人共96例,采用隨機(jī)數(shù)字表法入選的腦梗死恢復(fù)期患者分為對(duì)照組34例、治療A組33例和治療B組29例,觀察過(guò)程中有6例因失訪(fǎng)、出現(xiàn)并發(fā)癥及未按要求治療等原因剔除病例,最終病例對(duì)照組32例、治療A組30例和治療B組28例。對(duì)照組應(yīng)用腦梗死恢復(fù)期的二級(jí)預(yù)防常規(guī)治療(阿司匹林腸溶片100mg,每天一次,口服,抗血小板聚集,阿托伐他汀鈣20mg,每天睡前一次,口服,穩(wěn)定斑塊)。治療A組應(yīng)用腦梗死恢復(fù)期的二級(jí)預(yù)防常規(guī)治療+黃芪劑量為30g的補(bǔ)陽(yáng)還五湯(黃芪30g,當(dāng)歸12g,赤芍10g,地龍6g,川芎12g,桃仁10g,紅花10g,水煎分2次早晚服,每次200ml)。治療B組應(yīng)用腦梗死恢復(fù)期的二級(jí)預(yù)防常規(guī)治療+黃芪劑量為120g的補(bǔ)陽(yáng)還五湯。療程均為2月。結(jié)束治療后觀察三組的臨床療效,包括治療前后的神經(jīng)功能缺損評(píng)分、中醫(yī)證候積分的變化情況及腦血管經(jīng)顱多普勒(以下簡(jiǎn)稱(chēng)TCD)的大腦前、中、后動(dòng)脈收縮期峰值血流速度和平均血流速度。結(jié)果:1、神經(jīng)功能缺損評(píng)分(NDS):3組治療后,患者神經(jīng)功能缺損評(píng)分均可改善,差異有統(tǒng)計(jì)學(xué)意義(P0.05);治療B組評(píng)分低于治療A組,治療A組低于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P0.05),提示治療B組120g黃芪的補(bǔ)陽(yáng)還五湯的神經(jīng)功能缺損改善情況顯著優(yōu)于對(duì)照組及治療A組。2、中醫(yī)證候積分:3組治療前,患者中醫(yī)癥候積分差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);3組治療后,患者中醫(yī)癥候積分差異有統(tǒng)計(jì)學(xué)意義(P0.05),治療B組積分低于治療A組,治療A組低于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P0.05),提示治療后3組患者的中醫(yī)證候積分與治療前比較降低,且治療B組120黃芪的補(bǔ)陽(yáng)還五湯中醫(yī)證候改善方面顯著優(yōu)于對(duì)照組及治療A組。3、3組患者治療后,對(duì)照組TCD的ACA、MCA、PCA收縮期峰值血流速度及平均血流速度未見(jiàn)明顯改變,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);治療A組的ACA、PCA收縮期峰值血流速度及平均血流速度未見(jiàn)明顯改變,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);治療A組的MCA收縮期峰值血流速度及平均血流速度有所提高,差異有統(tǒng)計(jì)學(xué)意義(P0.05);治療B組ACA、MCA、PCA收縮期峰值血流速度及平均血流速度明顯加快,差異有統(tǒng)計(jì)學(xué)意義(P0.05),提示120g黃芪的補(bǔ)陽(yáng)還五湯能顯著加快腦血管流速,從而改善腦血液循環(huán)。結(jié)論:不同劑量黃芪的補(bǔ)陽(yáng)還五湯治療腦梗死恢復(fù)期均有療效,可不同程度改善腦梗死恢復(fù)期患者的臨床癥狀,促進(jìn)神經(jīng)功能恢復(fù),不同程度加快TCD的收縮期峰值及平均血流速度,改善腦血管循環(huán),但以120g黃芪的補(bǔ)陽(yáng)還五湯療效最佳,值得臨床推廣。
[Abstract]:Objective: to observe the clinical effect of Buyang Huanwu decoction (BYHD) with different doses of Astragalus membranaceus for the treatment of convalescence of cerebral infarction in order to provide the theoretical basis of TCM for the treatment of convalescence of cerebral infarction. Methods: Ninety-six inpatients with Qi deficiency and blood stasis in convalescence of cerebral infarction were divided into control group (control group, 34 cases) by random digital table, according to the inclusion criteria of Department of Neurology, Ruikang Hospital affiliated to Guangxi University of traditional Chinese Medicine. There were 33 cases in group A and 29 cases in group B. during the observation, 6 cases were excluded due to missing visit, complications and non-treatment. The final cases were 32 cases in the control group, 30 cases in the treatment group and 28 cases in the B group. The control group was treated with routine secondary prophylaxis therapy at convalescent stage of cerebral infarction (aspirin enteric-coated tablets 100mg daily, oral, anti-platelet aggregation, Atto vastatin calcium 20mg, once a day before bedtime, oral, stable plaque. Group A was treated with Huangqi 30g, Angelica sinensis 12g, Radix Paeoniae rubra 10g, Dilong 6g, Chuanxiong 12g, peach kernel 10g, safflower 10g, water decoction twice in the morning and evening, 200ml / time, treatment group A was treated with Astragalus membranaceus (30 g), Radix angelica sinensis (12g), Radix Paeoniae Rubra (10g), peach kernel (10g), safflower (10g). Group B was treated with Buyang Huanwu decoction with a dose of 120g of Astragalus membranaceus in the convalescent stage of cerebral infarction. The course of treatment was 2 months. After the treatment, the clinical effects of the three groups were observed, including the neurological impairment score before and after treatment, the changes of TCM syndrome score and the anterior and middle cerebral vascular transcranial Doppler (TCDs). Peak systolic velocity and mean blood flow velocity of posterior artery. Results after treatment, the neurological impairment scores of the patients were improved significantly (P 0.05), the scores of group B were lower than those of group A, and the scores of group A were lower than those of the control group, and the scores of group B were lower than those of group A, and the scores of group A were lower than those of group A (P < 0.05). The difference was statistically significant (P 0.05). It suggested that the improvement of nerve function defect of Buyang Huanwu decoction in group B was significantly better than that in control group and treatment group A. 2. There was no significant difference in the scores of TCM symptoms between the three groups. After treatment, the scores of TCM symptoms in group B were significantly lower than those in group A, and the scores in group A were lower than those in group A, and the scores in group A were lower than those in group A, and the scores in group A were lower than those in group A. The difference was statistically significant (P 0.05), indicating that the TCM syndromes score of the three groups decreased after treatment, and the improvement of the TCM syndromes of Buyang Huanwu decoction in group B (120 Astragalus) was significantly better than that in the control group and the treatment group A. 3 after treatment. There was no significant change in peak systolic velocity and mean blood flow velocity of TCD in control group (P 0.05), but no significant change in peak systolic velocity and mean flow velocity in group A. The peak systolic blood flow velocity and mean blood flow velocity of MCA in group A were increased, the difference was statistically significant (P 0.05), the peak systolic velocity and mean flow velocity of MCA in group B were significantly increased. The difference was statistically significant (P 0.05), suggesting that the 120g Huangqi Buyang Huanwu decoction could significantly accelerate the flow rate of cerebral vessels and thus improve the cerebral blood circulation. Conclusion: Buyang Huanwu decoction with different dosages of Astragalus membranaceus has curative effect on convalescence of cerebral infarction, which can improve the clinical symptoms and promote the recovery of nerve function in patients with cerebral infarction. The peak systolic phase and mean blood flow velocity of TCD were accelerated to improve cerebral vascular circulation, but 120g Astragalus membranaceus Buyang Huanwu decoction had the best curative effect and was worth popularizing in clinic.
【學(xué)位授予單位】：廣西中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R277.7

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