通圣方联合中药泥灸治疗气虚血瘀证缺血性脑卒中恢复期肌痉挛临床观察

Tongsheng Decoction Combined with Traditional Chinese Medicine Moxibustion Mud in Treating Myospasm of Ischemic Stroke Recovery Period with Qi Deficiency and Blood Stasis Syndrome

目的:探讨通圣方内服联合中药泥灸治疗气虚血瘀型缺血性脑卒中恢复期肌痉挛的疗效以及对血清甘氨酸(Gly)和γ-胺基丁酸(GABA)水平的影响。方法:选择缺血性脑卒中恢复期(气虚血瘀证)患者89例,参照数字表法随机分成对照组和观察组。依据《中国脑卒中康复治疗指南》两组患者行常规对症干预。对照组44例给予综合性康复治疗;观察组45例内服通圣方,1剂/d,2次/d;中药药蜡膏饼外敷于相应穴位,用红外线理疗机加热模拟灸法,l h/次,1次/d。两组患者治疗疗程均为6周。比较两组临床痉挛指数(CSI),改良Ashworth评分,巴塞尔(Barthel,BI)指数分,步行能力及中医(TCM)症状评分;统计分析两组临床疗效;观察两组不良事件反应情况;检测两组血清Gly和GABA水平。结果:观察组临床总有效率为93.33%,明显高于对照组的75%,(P<0.05);治疗后观察组患者的CSI,Ashworth,步行能力及中医症状评分均明显低于对照组,BI评分显著高于对照组(P<0.01);观察组患者不良事件发生率为6.67%,明显少于对照组的25%(P<0.01);治疗后,观察组血清Gly和GABA水平均明显高于对照组,比较差异有统计学意义(P<0.01)。结论:通圣方内服联合中药泥灸治疗缺血性脑卒中恢复期(气虚血瘀证)肌痉挛疗效确切,上调血清Gly和GABA水平可能在其中发挥重要作用。

Objective： To investigate the clinical efficacy of Tongshen decoction combined with traditional Chinese medicine（TCM） moxibustion mud in treating myospasm of ischemic stroke recovery period with Qi deficiency and blood stasis syndrome, and its influence on serum levels of glycine （Gly） and gamma amino acid butyric acid （GABA）. Method： Eighty-nine eligible cases were selected and randomly divided into control group and observation group according to random number table. Conventional interventions were made to the two groups according to ＇Chinese Stroke Rehabilitation Treatment Guidelines＇. The control group （44 cases） was treated with comprehensive rehabilitation therapy. The treatment group （45 cases） was given Tongshen decoction by oral （1 dose/day, bid）, traditional Chinese medicine cerate on the corresponding acupuncture points and warming with infrared physiotherapy machine （1 h/time, qd）. All patients were treated for 6 weeks. Clinic Spasticity Index （CSI）, modified Ashworth score, Barthel index （BI） score, walking ability and TCM symptom scores were compared between the two groups. Clinical efficacies were analyzed between the two groups. Their adverse events were observed. Serum levels of Gly and GABA were detected in the two groups. Result： Total effective rate of observation group was 93.33%, which was higher than 75%of control group （P〈0.05）. CSI, Ashworth, walking ability and TCM symptom scores in observation group were obviously lower, but with a higher BI score （P〈0.01）. Adverse events of observation group was 6.67%, which was evidently lower than 25%of control one （P〈0.01）. After treatment, serum levels of Gly and GABA in observation group were obviously higher than control group, with statistical significance （P〈0.01）. Conclusion： Tongshen decoction combined with TCM moxibustion mud has an exact effect in treating myospasm of ischemic stroke recovery period with Qi deficiency and blood stasis syndrome, which may be related to up-regulation of serum levels of Gly and GABA.