温阳通脉汤对脑梗死恢复期(阳虚痰瘀阻络证)患者神经功能及脑血流动力学的影响

Effect of Wenyang Tongmai Tang on Neurological Function and Cerebral Hemodynamics in Patients with Convalescent Stage of Cerebral Infarction(Yang Deficiency Phlegm Stasis Obstruction Syndrome)

目的:观察温阳通脉汤对脑梗死恢复期(阳虚痰瘀阻络证)患者神经功能及脑血流动力学的影响。方法:将90例脑梗死恢复期(阳虚痰瘀阻络证)患者按照随机数表法分为两组,对照组45例采用常规西医治疗,治疗组45例在对照组基础上联合温阳通脉汤治疗。两组治疗2个月后,比较治疗前后中医证候积分(畏寒肢冷、倦怠懒言、便溏、目眩头晕、痰多)、神经功能缺损评分(NIHSS)、日常自理能力(改良Barthel指数评分)、改良Rankin量表(MRS)评分、神经相关因子[神经元特异性醇化酶(NSE)、胶质纤维酸性蛋白(GFAP)、脑源性神经营养因子(BDNF)]、脑血流动力学指标[脑动脉平均血流速度(Vm)、搏动指数(PI)、收缩期峰值速度值(Vs)],比较两组临床疗效和治疗安全性。结果:两组治疗后畏寒肢冷、倦怠懒言、便溏、目眩头晕、痰多积分,NIHSS评分,MRS评分,NSE、GFAP水平,PI指标水平均降低(P<0.05),且治疗组治疗后以上积分及实验室指标水平均低于对照组(P<0.05);两组治疗后Barthel指数评分,BDNF水平,Vm、Vs指标水平均升高(P<0.05),且治疗组治疗后以上评分及实验室指标水平均高于对照组(P<0.05);治疗组总有效率(91.1%,41/45)优于对照组(75.6%,34/45)(P<0.05);两组治疗期间均未发生明显药物不良反应。结论:温阳通脉汤治疗脑梗死恢复期(阳虚痰瘀阻络证)疗效确切,能够有效缓解临床症状,促进神经功能恢复,改善日常自理能力,与常规西医联合治疗能够产生协同作用,且治疗安全性高,其作用机制可能与改善脑血流动力学和调节神经相关因子有关。

Objective:To observe the effect of Wenyang Tongmai Tang on Neurological Function and Cerebral Hemodynamics in Patients with Cerebral Infarction Recovery Stage(Yang Deficiency Phlegm Stasis Obstruction Syndrome).Methods:90 patients with cerebral infarction in the recovery period(yang deficiency phlegm stasis obstruction syndrome)were randomly divided into two groups according to the number table method.The control group consisted of 45 cases treated with conventional Western medicine,while the observation group consisted of 45 cases treated with Wenyang Tongmai Tang on the basis of the control group.After two months of treatment,the two groups were compared in TCM syndrome scores(chilly limbs,tiredness,lazy speech,loose stools,dizziness,and phlegm),neurological deficit score(NIHSS),daily self-care ability(modified Barthel index score),modified Rankin Scale(MRS)score,the levels of nerve related factors[neuron specific alcoholase(NSE),glial fibrillary acidic protein(GFAP),brain derived neurotrophin(BDNF)],the levels of cerebral hemodynamic indicators[mean blood flow velocity(Vm),pulsatile index(PI),peak systolic velocity(Vs)]between two groups before and after treatment,to assess the clinical efficacy and treatment safety of the two groups.Statistical analysis of two groups of clinical efficacy and treatment safety.Results:After treatment,the scores of chills,fatigue,lazy speech,loose stools,dizziness,phlegm accumulation,NIHSS score,MRS score,NSE,GFAP levels,and PI index levels in both groups decreased(P<0.05),and the scores and laboratory indicators in the treatment group were lower than those in the control group(P<0.05);After treatment,the Barthel index score,BDNF level,Vm,Vs index levels increased in both groups(P<0.05),and the treatment group had higher scores and laboratory index levels than the control group(P<0.05);The total effective rate of the treatment group(91.1%,41/45)was better than that of the control group(75.6%,34/45)(P<0.05);No significant adverse drug reactions occurred during the treatment of both groups.Conclusion:Wen Yang Tong Mai Tang has a definite therapeutic effect on the recovery period of cerebral infarction(Yang deficiency phlegm stasis obstruction syndrome),which can effectively alleviate clinical symptoms,promote neurological function recovery,improve daily self-care ability of patients.Combined with conventional Western medicine,it can have a synergistic effect and high treatment safety.Its mechanism of action may be related to improving cerebral hemodynamics and regulating neural related factors.