补阳还五汤配合康复训练对气虚血瘀证脑梗死患者运动功能及日常生活活动能力恢复的效果评估

Evaluation of the combination of Buyang huanwu decoction and rehabilitation training in the motor function and activity of daily living in patients with cerebral infarction of qixu xueyu syndrome

目的:观察采用中医益气活血之补阳还五汤结合康复训练的方法对气虚血瘀证脑梗死患者的运动功能及日常生活活动能力的影响。方法:选择2005-09/2006-07广东省中医院康复科住院患者68例。男38例,女30例;年龄44～91岁,平均(72±10)岁。脑梗死急性期者24例,恢复期者41例,后遗症期者3例。患者口服补阳还五汤。同时进行康复训练。①补阳还五汤:由黄芪60～120g,当归10g,川芎15g,赤芍15g,地龙10～15g,桃仁10g,红花5g,牛膝15g组成。加减法:气虚明显者加人参6～10g或党参15g;血瘀重者加三七3g;伴痰阻者加法夏10g,胆南星10g;伴肢体麻木、疼痛者加桂枝15g,鸡血藤30g;肢体拘急者加全蝎5～10g。水煎服,1剂/d,分2次服用,疗程30d。②康复治疗:进行定时更换体位、关节活动度及肌力训练、平衡训练、步态训练、上下楼梯训练及日常生活活动能力训练等。2次/d,60min/次,疗程30d。根据其治疗前、后Fugl-Meyer运动功能评分及Barthel指数量表评分,评估患者运动功能及日常生活活动能力的改善情况。结果:68例患者全部进入结果。①Fugl-Meyer运动功能评分及Bathel指数量表评分结果:患者治疗后Fugl-Meyer运动功能评分及Bathel指数量表评分均高于治疗前(60.27±26.97比43.52±25.79,67.13±23.67比45.0±20.60,t=9.97,9.02,P<0.01)。②治疗效果:68例患者完全恢复者6例(8.8%,6/68),显效23例(33.8%,23/68),有效26例(38.2%,26/68),稍好8例(11.8%,8/68),无效5例(7.4%,5/68)。无恶化及死亡病例,总有效率为80.9%。结论:康复训练配合补阳还五汤口服对气虚血瘀证脑梗死患者的运动功能及日常生活活动能力有积极的作用。

AIM： To investigate the effect of combination of Buyang huanwu decoction and rehabilitation training on the motor function and activity of daily living （ADL） of subjects with cerebral infarction of Qixu xueya syndrome. METHODS： Sixty-eight inpatients, including 38 men and 30 women aged from 44-91 years with the mean age of （72±10） years with cerebral infarction （24 eases in acute stage, 41 in convalescent period,3 in sequelae stage） of Qixu xueyu syndrome were enrolled between September 2005 and July 2006 in the Department of Rehabilitation, Guangdong Provincial Hospital of Traditional Chinese Medicine. All subjects were orally took modified Buyang huanwu decoction and gave rehabilitation training. ① Traditional Chinese medicine treatment with Buyang huanwu decoction： It was composed of astragali 60-120 g, angelica 10 g, szechwan lovge rhizome 15 g, paeoniae rubra 15 g, earth-worm 10-15 g, peach seed 10 g, safflower 5 g and twotooth achyranthes root 15 g. Plus-minus method： ginseng 6-10 g or tangshen 15 g was added for Qixu patients; notoginseng radix 3 g was added for blood stasis patients; pinelliae tuber 10 g and arisaema cam bile 10 g were added for stagnation of phlegm patients;ramulus cinnamomi 15 g and subereet spatholobus stem 30 g were added for patients with limbs anaesthesia and pain; scorpion 5-10 g was added for patients with limb spasm, taking decocted with water, 1 dose per day, taking medicine at twice for 30 days.②rehabilitative treatment： Body position transformation, range of motion training, muscle force training, balance training, gait training, up-down stair activity training, activities of daily living training were performed, twice a day, 60 minute per time, for 30 days. Fugl-Meyer motor assessment scale （FMA）and Barthel Index （BI） were applied before and after treatment to assess the improvement of motor function and activity of daily living in patients. RESULTS： A total of 68 patients were involved in the result analysis. ① Result of FMA and BI assessment： The FMA and BI scores were higher after treatment than that before treatment （60.27±26.97 vs 43.52±25.79, 67.13±23.67 vs 45.0±20.60,t =9.97,9.02,P 〈 0.01）. ② Therapeutic efficacy： The numbers of completely recovery, effective, valid, slightly improvement and invalid were 6 cases （8.8% ,6/68）, 23 cases （33.8% ,23/ 68）, 26 （38.2% ,26/68）, 8 （11.8% ,8/68）, 5 （7.4%,5/68） respectively, no worsen cases or death, The total effective rate was 80.9%. CONCLUSION： The Buyang huanwu decoction combined with rehabilitation training are effective to improve motor function and activity of daily living of patients with cerebral infarction of Qixu xueyu syndrome.