【摘要】：研究目的:觀(guān)察滌痰熄風(fēng)通絡(luò)湯對(duì)腦梗死急性期(中經(jīng)絡(luò)風(fēng)痰瘀阻證)患者的臨床療效及血脂的影響,并評(píng)價(jià)其安全性。研究方法:將60例符合納入標(biāo)準(zhǔn)的急性腦梗死(ACI)中經(jīng)絡(luò)風(fēng)痰瘀阻證患者隨機(jī)分為治療組30例、對(duì)照組30例。對(duì)照組給予ACI西醫(yī)常規(guī)治療;治療組在對(duì)照組基礎(chǔ)上加用滌痰熄風(fēng)通絡(luò)湯,日一劑,分早晚2次口服,療程14天。療程結(jié)束后,對(duì)兩組患者治療前后的三大常規(guī)、血生化、凝血功能、心電圖、中醫(yī)證候積分、中醫(yī)證候總療效、神經(jīng)功能缺損程度、BI評(píng)分、m RS量表評(píng)分進(jìn)行觀(guān)察比較,并進(jìn)行統(tǒng)計(jì)學(xué)分析。研究結(jié)果:(1)中醫(yī)證候總療效比較:治療14天后,治療組總有效率90.00%,對(duì)照組總有效率66.67%,兩組比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。(2)中醫(yī)證候總積分比較:治療14天后,治療組中醫(yī)證候總積分為(14.67±6.26)分,對(duì)照組為(18.87±7.37)分,兩組組內(nèi)治療前后中醫(yī)證候總積分比較有顯著差異(P0.01);兩組組間治療后比較差異有統(tǒng)計(jì)學(xué)意義(P0.05),治療組優(yōu)于對(duì)照組。(3)單項(xiàng)中醫(yī)證候積分比較:治療14天后,治療組的單項(xiàng)中醫(yī)證候積分除感覺(jué)減退外均較治療前明顯改善(P0.01),對(duì)照組的單項(xiàng)中醫(yī)證候積分在上肢不遂、口舌歪斜、語(yǔ)言蹇澀、頭暈?zāi)垦７矫婢^治療前明顯改善(P0.05);兩組組間治療后比較顯示治療組在上下肢不遂、頭暈?zāi)垦�、痰多方面改善明顯(P0.05),但在改善口舌歪斜、語(yǔ)言蹇澀、感覺(jué)減退方面兩組差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。(4)神經(jīng)功能缺損程度比較:治療14天后,治療組神經(jīng)功能缺損評(píng)分為(5.20±3.58)分,對(duì)照組為(7.53±4.69)分,兩組組內(nèi)治療前后神經(jīng)功能缺損評(píng)分比較有顯著差異(P0.01);兩組組間治療后比較差異有統(tǒng)計(jì)學(xué)意義(P0.05),治療組優(yōu)于對(duì)照組。(5)Barthel指數(shù)評(píng)分比較:發(fā)病3月,治療組Barthel指數(shù)評(píng)分為(85.17±16.27)分,對(duì)照組為(72.83±20.24)分,兩組組內(nèi)治療前后Barthel指數(shù)評(píng)分比較有顯著差異(P0.01);兩組組間治療后比較差異有統(tǒng)計(jì)學(xué)意義(P0.05),治療組優(yōu)于對(duì)照組。(6)改良Rankin量表評(píng)分比較:發(fā)病3月時(shí),兩組組內(nèi)治療前后改良Rankin量表評(píng)分比較有顯著差異(P0.01);兩組組間治療后比較差異有統(tǒng)計(jì)學(xué)意義(P0.05),治療組優(yōu)于對(duì)照組。(7)血脂比較:發(fā)病3月時(shí),兩組在調(diào)節(jié)膽固醇、甘油三酯、低密度脂蛋白膽固醇及高密度脂蛋白膽固醇水平方面均較治療前差異顯著(P0.01);兩組組間治療后比較顯示治療組在調(diào)節(jié)高密度脂蛋白膽固醇及低密度脂蛋白膽固醇方面較對(duì)照組更優(yōu)(P0.01)。(8)安全性評(píng)價(jià):治療前后觀(guān)察兩組患者血常規(guī)、二便常規(guī)、肝腎功能、血糖、凝血功能、心電圖等指標(biāo),均未見(jiàn)明顯異常。研究結(jié)論:(1)滌痰熄風(fēng)通絡(luò)湯聯(lián)合西醫(yī)常規(guī)治療急性腦梗死,在改善患者中醫(yī)證候總療效、中醫(yī)證候總積分、部分中醫(yī)證候積分方面明顯優(yōu)于對(duì)照組。(2)滌痰熄風(fēng)通絡(luò)湯聯(lián)合西醫(yī)常規(guī)治療急性腦梗死,可有效改善患者神經(jīng)功能缺損程度、提高日常生活活動(dòng)能力、降低致殘率,且明顯優(yōu)于對(duì)照組。(3)滌痰熄風(fēng)通絡(luò)湯可有效調(diào)節(jié)急性腦梗死患者血脂水平。(4)治療期間,兩組均未發(fā)生明顯不良反應(yīng),安全性佳。綜上,滌痰熄風(fēng)通絡(luò)湯是治療急性腦梗死的有效方劑,臨床療效確切,安全性佳,可有效改善患者預(yù)后及血脂水平,臨床值得進(jìn)一步研究。
[Abstract]:Objective: To observe the effect of Ditan Xifeng Tongluo Decoction on the clinical efficacy and blood lipids of patients with acute cerebral infarction (middle meridian wind phlegm stasis syndrome), and evaluate its safety.Methods: 60 patients with acute cerebral infarction (ACI) were randomly divided into treatment group (30 cases) and control group (30 cases). The treatment group was given Ditan Xifeng Tongluo Decoction twice a day for 14 days on the basis of the control group. After the treatment, three routines, blood biochemistry, coagulation function, electrocardiogram, TCM syndrome integral, total curative effect of TCM syndrome, degree of nerve function defect, BI score, and MRS scale were used for the two groups. Results: (1) After 14 days of treatment, the total effective rate of the treatment group was 90.00%, while that of the control group was 66.67%. There was significant difference between the two groups (P 0.05). (2) Comparing the total score of TCM syndromes: After 14 days of treatment, the total score of TCM syndromes in the treatment group was (14.67 +6.2). 6) The control group was (18.87 +7.37) points, there was a significant difference between the two groups before and after treatment (P 0.01); there was a significant difference between the two groups after treatment (P 0.05), the treatment group was better than the control group. (3) Comparison of single TCM syndrome score: 14 days after treatment, the treatment group had a single TCM syndrome score except hypoesthesia. Compared with pre-treatment, the scores of single TCM syndromes in the control group were significantly improved (P 0.01). Compared with pre-treatment, the scores of single TCM syndromes in the treatment group were significantly improved (P 0.05). After treatment, the two groups showed that the treatment group was significantly improved in upper and lower limb dysfunction, dizziness, dizziness, sputum and other aspects (P 0.05). There was no significant difference between the two groups (P 0.05). (4) Neurological deficit degree comparison: 14 days after treatment, the nerve function deficit score of the treatment group was (5.20 + 3.58) and that of the control group was (7.53 + 4.69). There was significant difference between the two groups before and after treatment (P 0.01). The difference was statistically significant (P 0.05), the treatment group was better than the control group. (5) Barthel index score comparison: 3 months after onset, the treatment group Barthel index score was (85.17 16.27) points, the control group was (72.83 20.24) points, two groups before and after treatment Barthel index score was significantly different between the two groups (P 0.01); (P 0.05), the treatment group is better than the control group. (6) Modified Rankin scale score comparison: at 3 months of onset, the two groups before and after treatment improved Rankin scale score was significantly different (P 0.01); the difference between the two groups after treatment was statistically significant (P 0.05), the treatment group is better than the control group. (7) Blood lipid comparison: at 3 months of onset, the two groups in the regulation of cholesterol. The levels of triglyceride, low density lipoprotein cholesterol and high density lipoprotein cholesterol were significantly different before and after treatment (P 0.01); the comparison between the two groups showed that the treatment group was better than the control group in regulating high density lipoprotein cholesterol and low density lipoprotein cholesterol (P 0.01). (8) Safety evaluation: observation before and after treatment There were no obvious abnormalities in the indexes of blood routine, routine defecation, liver and kidney function, blood glucose, blood coagulation function, electrocardiogram and so on. Ditan Xifeng Tongluo Decoction combined with routine western medicine in the treatment of acute cerebral infarction can effectively improve the degree of neurological impairment, improve the ability of daily living, reduce the disability rate, and is significantly better than the control group. (3) Ditan Xifeng Tongluo Decoction can effectively regulate the level of blood lipid in patients with acute cerebral infarction. (4) During the treatment, no significant adverse reactions occurred in both groups. To sum up, Ditan Xifeng Tongluo Decoction is an effective prescription for acute cerebral infarction, with definite clinical effect and good safety. It can effectively improve the prognosis and blood lipid level of patients, and is worthy of further study.
【學(xué)位授予單位】：湖北中醫(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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