综合治疗方案治疗缺血性中风急性期41例临床观察

Clinical observation on 41 cases of acute ischemic stroke treated with comprehensive therapeutic plan

目的研究评价以辨证论治为核心的中风病急性期综合治疗方案,并对建立中风病中医临床疗效评价体系进行探索。方法将41例缺血性患者随机分为治疗组20人和对照组21人。治疗组采用综合治疗方案,治疗模式为“内科基础治疗+辨证论治口服中药+静脉滴注中药制剂+针灸+常规护理+康复措施”,根据病程进展的不同时段,实施以上干预措施。对照组选择溶栓、降纤、抗凝、抗血小板、降低颅内压、改善脑血循环及营养代谢等治疗;两组均执行常规护理和康复方案。结果①两组都能明显改善神经功能缺损程度(P<0.05);各时点神经功能缺损程度两组之间差别无统计学意义。②治疗组能逐渐提高患者发病14 d至3月的日常生活能力(P<0.05),对照组虽然日常生活能力提高,但组内各时点比较,差异无统计学意义。③两组均能明显提高患者发病28 d至3月的生存质量(P<0.05)。④治疗组风证、火热证、痰证各时点分值呈持续下降趋势(P<0.05),气虚证、阴虚阳亢证分值发病28 d后逐渐下降(P<0.05);对照组风证各时点分值持续下降(P<0.05),火热证、痰证在发病28 d后逐渐改善(P<0.05)。治疗组与对照组比较,发病7d时火热证和发病14 d时痰证的改善明显(P<0.05)。⑤两组患者出现智能障碍的例数均随着病程进展而减少。⑥对照组复发2例;4例患者出现不良事件,2例为对照组患者,与治疗方案可能有关,2例为治疗组患者,与治疗方案无关。所有患者均未出现肝肾功能的异常。结论以辨证论治为特色的中风病急性期综合治疗方案能给患者最优的治疗,符合临床实际,值得临床推广;初步建立了具有中医特色的纵向与病程进展的不同时点、横向与各时点的临床特征相吻合的中风病临床疗效评价体系。

Objective To evaluate the comprehensive therapeutic plan with a core of syndrome differentiation and treatment for acute ischemic stroke （AIS） , and try to establish an evaluation system of Chinese medical curative effect on stroke. Methods To divide randomly 42 patients into the treatment group （n =20） and the control group （n =21 ）. The treatment group was given the comprehensive therapeutic plan with the basic treatment of internal medicine, herbal medicine orally after the syndrome differentiation, intravenous drip of herbal medical preparation, acupuncture, normal nurse and rehabilitation measures respectively at different time points in different disease development stages. The control group was given the treatment of thrombolysis, defibrinogen anticoagulation, antiplatelet, decrease of intracranial pressure （ICP）, improvement of cerebral circulation and nutritive metabolism. Results （ 1 ） The nervous afunction was relieved obviously in two groups （P 〈 0.05 ） and the difference between two groups at different time points was not statistically significant. （2） In the treatment group the patient ability of daily life was improved gradually from 14^th day to 3^nd month （P 〈0.05）. In the control group the difference at different time points was no statistically significant although the （3） The patient living quality was improved from 28th day to 3^rd patient ability of daily life was improved. month in two groups （ P 〈 0. 05 ）. （4） In the treatment group the scores of wind syndrome, fire-heat syndrome and phlegm syndrome at different time points had a trend of durative decrease （ P 〈 0. 05 ）. The scores of qi-insufficiency syndrome and syndrome of hyperactivity of yang due to yin-deficiency decreased gradually after 28 days （ P 〈 0.05 ） . In the control group the scores of wind syndrome decreased continuously at different time points （ P 〈 0.05 ）. The fire-heat syndrome and phlegm syndrome were relieved gradually （ P 〈 0. 05 ）. The fire-heat syndrome on 7^th day and phlegm syndrome on 14^th day were relieved obviously in the treatment group compared with the control group （ P 〈 0.05 ）. （5） The cases of mental deficiency in two groups deceased along with the disease development. （6） In the control group there were 2 recurrent cases. There were 4 cases had bad results,2 in the control group with a relation to the therapeutic plan and other 2 in the treatment group without relation to the therapeutic plan. All cases had no hepatosis or renal insufficiency. Conclusion The comprehensive therapeutic plan with the characteristics of syndrome differentiation and treatment has the best result to acute ischemic stroke. It is worth spreading in clinic. An evaluation system of the clinica1 curative effect on stroke with Chinese medical features was set up initially.