醒神通络方加针灸改善缺血性中风恢复期神经功能缺损的临床观察

Clinical Research of Xingshen Tongluo Needle Medicin Improve Ischemic Stroke on Recovery Phase Neurologic Impairment

目的:观察醒神通络方加针灸对缺血性中风恢复期患者神经功能缺损的疗效及对脑血流速度及血管内皮功能的影响。方法:将84例患者采用随机数字表法分为对照组和观察组各42例。两组均按照缺血性脑卒中二级预防方案常规治疗,包括抗血小板聚集、控制血糖、控制血压,调节血脂等。观察组在对照组治疗的基础上加用醒神通络方,1剂/d,常规水煎服,同时采用醒神通络针灸治疗,3次/周。两组疗程均为8周。进行治疗前后脑卒中患者神经功能缺损程度评分(CSS评分)及日常生活能力量表(ADL);采用经颅多普勒仪测定治疗前后脑梗死侧大脑前动脉(ACA)、大脑中动脉(MCA)、大脑后动脉(PCA)、基底动脉(BA)血流速度;检测治疗前后血清一氧化氮(NO)和内皮素1(ET-1)水平。结果:观察组疗效总有效率为83.33%,优于对照组的57.14%(P<0.05);治疗后观察组除意识因子外,其他CSS因子评分及CSS总分均低于对照组(P<0.01);治疗后观察组ADL评分高于对照组(P<0.01);治疗后观察组和对照组均有改善,而治疗后的观察组ACA和MCA血流速度均较治疗前明显改善,并好于对照组(P<0.01);两组治疗后PCA血流速度均较治疗前改善(P<0.01);治疗后两组NO水平均升高,观察组高于对照组(P<0.01);两组ET-1均下降,观察组低于对照组(P<0.01)。结论:醒神通络方加针灸提高缺血性中风恢复期患者ACA和MCA的血流速度,改善了血管内皮功能,改善脑血流灌注,促进了神经功能的恢复。

Objective： The purpose is to observe curative effect of Xingshen Tongluo needle medicin improve ischemic stroke at recovery phase on neurologic impairment and its influence on cerebral blood flow speed and vascular endothelial function. Method： Eighty-four cases patients were randomly divided into control group （42 cases） and observation group （42 cases） according to digital method.Both groups were received secondary prevention plan ischemic brain death conventional cure in secondary prevention plan, including anti-platelet aggregation, blood sugar control,blood pressure control,regulating blood lipids et.Observation group took Xingshen Tongluo decoction on the basis of therapy in control group,1 does/day,conventional water frying.At the same time adopt Xingshen Tongluo acupuncture,3 times/week.Treatment courses for the two groups continued 8 weeks.Before the treatment,give a mark of nervous functional defects degree with stroke patient and record activities of daily living （ADL）.Measuring arteria cerebri anterior（ACA） through transcranial doppler instrument＇s treatment,middle cerebral artery（MCA）,posterior cerebral artery（PCA）and basilar artery（BA） blood flow rate in cerebral infarction side.Detect the level of nitric oxide（NO） and endothelins1（ET-1）. Result： The total effective rate of disease curative effect in the observation group was 83.33% superior to 57.14% of the control group（P〈0.05）.After treatment,except consciousness factor,in the observation group,the score of the degree of neural function defect score standard（CSS） and the total score of CSS were lower than those in the control group（P〈0.01）.And the score of ADL was higher than that of the control group（P〈0.01）, after treatment, patients＇ illness in both group were improved.Besides blood velocity of ACA and MCA in observation group were better than those in the control group（P〈0.01）.For the two groups,compared with the time before treatment,blood velocity of PCA both improved（P〈0.01）.After treatment the level of NO in the two groups both increased, observation group which higher than that of the control group（P〈0.01）. And endothelins1 （ET-1） in the two groups both decreased,and for the observation group which lower than that of the control group（P〈0.01）. Conclusion： For ischemic type stroke patients, it can improve blood velocity of ACA and MCA Xingshen Tongluo needle medicine with drug was used in convalescence,and it improved function of vascular endothelium,cerebral blood perfusion,Promote the recovery of neural function.