自拟中风疼痛汤配合曲马多治疗中枢性卒中后疼痛

Zhongfeng-Tengtong decoction combined with pregabalin for central post-stroke pain

目的评价自拟中风疼痛汤配合曲马多治疗中枢性卒中后疼痛（central post-strokepain，CPSP）的临床疗效。方法将符合纳入标准的脑卒中患者121例，按随机数字表法分为联合治疗组61例，对照组60例。患者入组后均实施脑卒中常规二级预防，对照组在此基础上口服盐酸曲马多缓释片，联合治疗组在对照组基础上加服自拟中风疼痛汤，均治疗14d。采用疼痛数字评价量表（Numerical Rating Scale，NRS）评价患者的疼痛程度；Fugl-Meyer运动功能量表（Fugl．Meyer Assessment，FMA）评价患者的运动功能；脑卒中专用的生活质量量表（Stroke Specific Quality of Life Scale，SS-QOL）评价患者的生活质量；观察记录2组患者治疗前后血液流变学指标的变化。结果治疗后，联合治疗组NRS评分[（2．5±0．4）分比（4．6±0．7）分，t=20．303）低于对照组（P〈0．01）；FMA评分[（57．1±18．1）分比（44．2±12．5）分，t=4．702]、SS．QOL评分[（193．4±25．6）分比（165．4±22．8）分，t=6．536]均高于对照组（P〈0．01）；联合治疗组全血黏度[（4．22±0．13）mPa·S比（4．56±0．41）mPa·S，t=14．452]、血浆黏度[（1．72±0.31）mPa·S比（2．33±0．23）mPa·S，t=14．258]、纤维蛋白原[（3．72±0．49）g／L比（4．98±0．41）g，L，户17．783]、血栓形成系数[（0．76±0．30）比（1．11±0．20），f=8．178]均低于对照组（P〈0．01）。结论中风疼痛汤联用曲马多可有效缓解CPSP患者疼痛症状，改善患者肢体运动功能，提高生活质量。

Objective To observe the clinical effect of Zhongfeng-Tengtong decoction combined with tramadol in the treatment of central post-stroke pain （CPSP）. Methods A total of 121 patients with stroke were recruited in our hospital. The patients were randomly divided into 2 groups by the ramdom number table method, 61 patients in the treatment group and 60 in the control group. All patients received conventional treatment of stroke secondary prevention, and the control group received oral tramadol hydrochloride sustained release tablets, while the treatment group received Zhongfeng-Tengtong decoction based on the intervention of control group. Both groups were treated for 14 days. The outcomes included Numerical Rating Scale （NRS）, Fugl-Meyer Assessment （FMA）, Stroke Specific Quality of Life Scale （SS-QOL）, and the changes of hemorheology indexes of the 2 groups before and after treatment. Results After treatment, the NRS scores of treatment group were significantly lower than the control group （2.5 ± 0.4 vs. 4.6 ± 0.7; t=20.303, P〈0.01）. and FMA and SS-QOL scores of treatment group were significantly higher than the control group （FMA 57.1 ±18.1 vs. 44.2 ± 12.5; t=4.702, P〈0.01）, （SS-QOL 193.4 ± 25.6 vs. 165.4 ± 22.8; t=6.536, P〈0.01）. The whole blood viscosity, plasma viscosity, fibrinogen and thrombosis coefficient of treatment group were significantely lower than the control group （whole blood viscosity 4.22 ± 0.13 mPa.s vs. 4.56 ± 0.41 mPaos, t=14.452, P〈0.01; plasma viscosity 1.72± 0.31 mPaos vs. 2.33 ± 0.23 mPaos, t=14.258, P〈0.01; fibrinogen 3.72 ± 0.49 g/L vs.4.98 ± 0.41 g/L, t=17.783, P〈0.01; thrombosis coefficient 0.76 ± 0.30 vs. 1.11 ± 0.20, t=5.178, P〈0.01）. Conclusions Zhongfeng-Tengtong decoction combined with tramadol could alleviate the pain symptom in patients with CPSP, improve the movement function of limbs and improve the quality of life.