【摘要】：背景：中風(fēng)病是危害我國城鄉(xiāng)人民健康的主要疾病之一,腦血管疾病已經(jīng)取代心血管疾病成為引起我國城市和農(nóng)村人口死亡的頭號(hào)殺手[1],,2010年中國大陸因中風(fēng)病及相關(guān)并發(fā)癥而死亡的人數(shù)高達(dá)170萬[2,且其發(fā)病有逐年增多、年輕化的趨勢。我國現(xiàn)存中風(fēng)病患者大約有700余萬人,其中近70%患者為缺血性卒中[3]。中風(fēng)病有著高致死率、高致殘率、高復(fù)發(fā)率的特點(diǎn),是目前治療的難點(diǎn)�，F(xiàn)代醫(yī)學(xué)以超早期溶栓、抗血小板聚集、抗凝、降纖、調(diào)脂穩(wěn)斑、神經(jīng)保護(hù)等作為主要治療方法[4],是目前防治中風(fēng)的主流方法,但仍存在著溶栓時(shí)間窗過短、出血轉(zhuǎn)化、再發(fā)等問題[5]。中醫(yī)中藥早在2千多年前就開始應(yīng)用于治療中風(fēng),現(xiàn)代中醫(yī)發(fā)展了中藥湯劑、中藥針劑、口服中成藥、針灸、推拿等多種治療方法,在中風(fēng)的治療中有獨(dú)特的作用和潛在的優(yōu)勢,但其作用和療效缺乏客觀評價(jià)和大樣本循證醫(yī)學(xué)證據(jù)。全國第五批名老中醫(yī)藥學(xué)術(shù)繼承工作指導(dǎo)老師、佛山市中醫(yī)院腦病科學(xué)術(shù)帶頭人譚峰教授在總結(jié)歷代醫(yī)家中風(fēng)學(xué)說和治驗(yàn)基礎(chǔ)上,結(jié)合自己多年臨床實(shí)踐,提出血瘀是中風(fēng)的關(guān)鍵因素,在全國率先提出運(yùn)用“三早”(早期活血化瘀、早期心理調(diào)護(hù)、早期康復(fù)綜合治療)治療缺血性中風(fēng),尤其是在早期運(yùn)用益氣活血通絡(luò)法治療氣虛血瘀型缺血性中風(fēng)病療效顯著,但未進(jìn)行定量評估療效的隨機(jī)對照研究,其機(jī)制尚未完全闡明。本研究從傳承譚峰教授早期運(yùn)用益氣活血通絡(luò)法治療氣虛血瘀型中風(fēng)的學(xué)術(shù)經(jīng)驗(yàn)出發(fā),選用具有益氣活血通絡(luò)之功的通陽活血顆粒治療氣虛血瘀型缺血性中風(fēng),研究通陽活血顆粒治療前后中風(fēng)患者中醫(yī)證候的變化,同時(shí)運(yùn)用三重磁刺激(TST)、美國國立衛(wèi)生研究院卒中量表(NIHSS)對其療效進(jìn)行定量評價(jià)。探討通陽活血顆粒治療氣虛血瘀型缺血性中風(fēng)的中醫(yī)機(jī)制,總結(jié)譚峰教授運(yùn)用益氣活血通絡(luò)法治療缺血性中風(fēng)的學(xué)術(shù)經(jīng)驗(yàn),為中醫(yī)藥防治缺血性中風(fēng)提供更多依據(jù)。目的：觀察通陽活血顆粒對氣虛血瘀型中風(fēng)患者中醫(yī)證侯的影響,傳承譚峰教授運(yùn)用益氣活血通絡(luò)法治療缺血性中風(fēng)的經(jīng)驗(yàn)。方法：①選擇2015年3月至2015年12月期間、發(fā)病6h-7天內(nèi)并被確診為缺血性中風(fēng)的佛山市中醫(yī)院腦病科住院患者共156例,選擇其中確診為氣虛血瘀型的缺血性中風(fēng)患者47例,隨機(jī)分為兩組,其中治療組(通陽活血顆粒+基礎(chǔ)治療)24例、對照組(基礎(chǔ)治療)23例；②采用《缺血性中風(fēng)證候要素診斷量表》,由專人評定兩組缺血性中風(fēng)患者治療前、治療后14天的中醫(yī)證侯學(xué)評分；③采用NIHSS評價(jià)兩組缺血性中風(fēng)患者治療前、治療后14天神經(jīng)功能學(xué)評分；④采用TST檢測兩組缺血性中風(fēng)患者治療前、治療后第14天偏癱側(cè)肢體TSTtest測試值。結(jié)果：①血瘀氣虛型缺血性中風(fēng)患者在本組缺血性中風(fēng)患者中占30.13%,是缺血性中風(fēng)最主要的證型之一。②本組氣虛血瘀型缺血性中風(fēng)患者的NIHSS與TSTtest測試值呈正相關(guān)(P0.05)；③本組氣虛血瘀型缺血性中風(fēng)患者治療組治療后與治療前的TSTest測試值差值高于對照組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)；④本組氣虛血瘀型缺血性中風(fēng)患者治療組治療前后的中醫(yī)證侯痰濕、血瘀、氣虛評分差值高于對照組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)；兩組患者治療前后的中醫(yī)證侯內(nèi)風(fēng)、內(nèi)火、陰虛評分差值比較無統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論：①血瘀氣虛證型是缺血性中風(fēng)早期主要證型之一；②TSTest測試值可定量分析皮質(zhì)脊髓束的損傷程度；反映缺血性中風(fēng)患者神經(jīng)功能中運(yùn)動(dòng)功能缺損程度；③通陽活血顆�？筛纳茪馓撗鲂腿毖灾酗L(fēng)患者的TSTtest測試值,從而改善肢體運(yùn)動(dòng)功能；④通陽活血顆粒顆粒可改善氣虛血瘀型缺血性中風(fēng)患者的氣虛、血瘀、痰濕證侯,與通陽活血顆粒益氣活血通絡(luò)之方義基本一致。
[Abstract]:Background: Stroke is one of the main diseases which are harmful to the health of our country and the urban and rural people. The cerebrovascular disease has replaced the cardiovascular disease as the number one killer[1] causing the death of the urban and rural population in our country. In 2010, the number of deaths due to stroke and related complications in the mainland of China reached 1.7 million[2], and its incidence increased year by year. The number of patients with stroke in our country is about 7 million, of which nearly 70% of the patients are ischemic stroke[3]. Apoplexy has the characteristics of high fatality rate, high disability rate and high recurrence rate, and is the difficult point of the current treatment. Modern medicine is the main treatment method for the treatment of apoplexy, such as ultra-early thrombolysis, anti-platelet aggregation, anti-coagulation, fiber-lowering, lipid-regulating, and neuroprotection. The traditional Chinese medicine has started to be applied to the treatment of apoplexy more than 2,000 years ago, and the modern Chinese medicine has developed a plurality of treatment methods such as the traditional Chinese medicine decoction, the traditional Chinese medicine injection, the oral Chinese patent medicine, the acupuncture, the massage and the like, and has a unique effect and a potential advantage in the treatment of the apoplexy, But its effect and curative effect lack objective evaluation and large-sample evidence of evidence-based medicine. in that fifth batch of the nation's fifth batch of traditional Chinese medicine academic inheritance work-guidance teacher, professor Tan Feng, the leader of the science of the science of encephalopathy in the middle hospital of Foshan, on the basis of summing up the stroke theory and the rule of medicine of the past dynasties, combined with his own multi-year clinical practice, put forward that blood stasis is the key factor of stroke, It is the first to put forward the application of 鈥渢hree-morning鈥，

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