复方菖蒲益智汤治疗中风后轻度认知功能障碍痰浊瘀阻证的疗效分析

Efficacy Analysis of Fufang Changpu Yizhi Decoction in Treatment of Mild Cognitive Impairment with Phlegm Turbidity and Stasis Syndrome After Stroke

目的:探讨复方菖蒲益智汤治疗中风后轻度认知功能障碍(MIC)痰浊瘀阻证的疗效及对氧化损伤、血脂、脑血流情况的影响。方法:将符合条件的192例患者根据入院先后随机按数字表法分为对照组和观察组各96例。对照组口服尼莫地平片,30 mg/次,1次/d;观察组采用复方菖蒲益智汤内服,1剂/d。两组疗程均为12周。进行认知功能评定采用简易精神状态(MMSE)和蒙特利尔认知评估量表(Mo CA)评定,进行痰浊瘀阻,毒损脑络证评分,检测超氧化物歧化酶(SOD),丙二醛(MDA),同型半胱氨酸(Hcy),血液流变学指标和血脂水平。治疗前后各进行1次检测。测量大脑前动脉(ACA)和大脑中动脉(MCA)平均血流速度,治疗前后各检测1次。结果:观察组认知能力临床疗效总有效率为79.17%,高于对照组的56.25%(P<0.05);治疗后观察组Mo CA和MMSE评分均高于对照组,痰浊瘀阻,毒损脑络证低于对照组(P<0.01);治疗后观察组总胆固醇(TC),甘油三脂(TG)和低密度脂蛋白胆固醇(LDL-C)水平均低于对照组(P<0.05),观察组高密度脂蛋白胆固醇(HDL-C)水平高于对照组(P<0.05);治疗后观察组血液流变学指标全血黏度(高切、低切)、血浆黏度、纤维蛋白原和血小板聚集均低于对照组(P<0.05,P<0.01);治疗后观察组Hcy和MDA水平均低于对照组,SOD水平高于对照组(P<0.05,P<0.01);治疗后观察组ACA和MCA平均血流速度快于对照组(P<0.01)。结论:复方菖蒲益智汤治疗中风后MIC能提高患者的认识功能,改善临床症状,其疗效优于尼莫地平片,并能调节脂代谢,改善血管内皮功能和血液微循环,促进脑血流动力。

Objective： To discuss the clinical efficacy of Fufang Changpu Yizhi decoction for mild cognitive impairment（ MCI） with phlegm turbidity and stasis syndrome after stroke and investigate its effects on oxidative damage,blood lipid and cerebral blood flow. Method： One hundred and ninety-two eligible patients were randomly divided into control group（ 96 cases） and observation group（ 96 cases） by random number table.Patients in the control group received nimodipine tablets by orally taking,30 mg / time,1 time / day,patients in the observation group took Fufang Changpu Yizhi decoction orally,1 dose / day. The treatment course was 12 weeks for both groups. Before and after treatment,cognitive function was evaluated by mini mental state examination（ MMSE） and montreal cognitive assessment（ Mo CA） scales. Scores of phlegm turbidity and stasis,as well as damage of brain collateral by toxin were graded; levels of superoxide dismutase（ SOD）,malondialdehyde（ MDA）,homocysteine（ Hcy）,hemorheology indexes and blood lipid levels were detected. The mean blood flow rates of anterior cerebral artery（ ACA） and middle cerebral artery（ MCA） were measured once respectively before and after treatment. Result： The total effective rate of cognitive function was 79. 17% in observation group,higher than 56. 25% in control group（ P 0. 05）. After treatment,scores of Mo CA and MMSE in observation group were higher than those in control group,and scores of phlegm turbidity and stasis and damage of brain collateral were lower than those in control group（ P〈0. 01）. The levels of total cholesterol（ TC）,triglyceride（ TG） and low density lipoprotein cholesterin（ LDL-C） in the observation group were lower than those in control group after treatment（ P〈0. 05）,while the level of high density lipoprotein cholesterin（ HDL-C） was lower than that in control group（ P〈0. 05）. Hemorheological indexes of whole blood viscosity（ high shear and low shear）,plasma viscosity,fibrinogen and platelet aggregation rate in the observation group were lower than those in control group after treatment（ P〈0. 05,P〈0. 01）. Levels of Hcy and MDA in the observation group were lower than those in control group after treatment,while the level of SOD was higher than that in control group（ P〈0. 05,P〈0. 01）.Mean blood flow rates of ACA and MCA in treatment were higher than those in control group after treatment（ P〈0. 01）. Conclusion： Fufang Changpu Yizhi decoction has better effect than nimodipine tablets in improving the cognitive function of patients after stroke and ameliorating clinical symptoms,in addition,it can improve functions of vascular endothelium and blood circulation,regulate lipid metabolism,and promote cerebral hemodynamics.