脑卒中简化中医辨证分型诊疗策略研究与临床应用

The clinical application and strategic research in simplified syndrome differentiation of traditional Chinese medicine in acute cerebral infarction

目的探讨急性缺血性脑卒中（acutecerebralinfarction，ACI）中医简化分型诊疗策略的临床应用效果及可行性。方法根据高利教授中医简化分型理论和标准，随机选取77例ACI住院患者进行中医简化分型诊疗，其中热证型46例、非热证型31例，选取同期ACI住院患者49例未中医简化分型对照观察。根据中国急性缺血性脑卒中诊治指南（2014）对热证组、非热证组和未分型ACI患者分别实施治疗，热证组另加自拟清热抗炎方清热解毒泻火，观察入院及治疗2周患者NIHSS、Barthelindex、舌苔、睡眠障碍、四末温度、并发症、大便干秘、出院费用等指标，评价ACI简化分型诊疗策略的临床应用效果。结果3组患者治疗2周前后NIHSS评分比较；差异均有统计学意义（t=3．435，2．601，5．723；P〈0．05），Barthelindex比较，差异均有统计学意义（t=3．57，3．15。3．28；P〈0．01）。治疗2周后3组组间NIHSS、Barthelindex均未见统计学差异（P〉0．05）。热证型组治疗2周后舌苔、苔色、苔质、四末温度、大便干秘正常率明显提高，并发症发生率降低，治疗前后比较差异有统计学意义（P〈0．05）。热证组患者出院费用明显低于未分型组（t=2．615，P〈0．05）。结论脑卒中简化分型诊疗策略临床应用对脑卒中综合诊疗效果显著，热证组、非热证组和未分型组综合治疗都能明显促进脑卒中功能恢复。热证组患者生活舒适度提高，并发症发生率和住院费用降低。本研究是脑卒中传统诊疗策略创新，对推动脑卒中创新诊疗具有重要意义。

Objective To explore the clinical effect and feasibility of simplified syndrome differentiation of traditional Chinese medicine （TCM） in diagnosis and treatment of acute cerebral infarction （ACI）. Methods A total of 77 ACI inpatients were randomly enrolled for simplified syndrome differentiation of TCM in diagnosis and treatment based on the theory and standard by Professor Gao Li, including heat syndrome group （n=46）, non-heat syndrome type group （n=31）. The control group was selected in inpatients with ACI without simplified syndrome differentiation of TCM at the same time. According to the Guidelines of Diagnosis and Treatment of Acute Ischemic Stroke in China （2014）, the patients with ACI were treated individually in the heat syndrome group, non-heat syndrome group and the control group. In the heat syndrome group, we added a self-regulating Chinese herbal medicine in cleating away heat and anti-inflammation. To compare the changes of the scores of the National Institute of Health stroke scale （NIHSS）, Barthel index, tongue coating, sleep disorders, temperatures at the terminals of 4 limbs, complications, constipation, hospital costs, and other indicators between before and after treatment in 2 weeks for evaluating the clinical effects of simplified syndrome differentiation of TCM in diagnosisand treatment of ACI. Results There were significant difference among the three groups in the score of NIHSS in before and aider treatment in 2 weeks （t=3.435, 2.601, 5.723, P〈0.05）. The comparison in Barthel index showed significant difference （t=3.57, 3.15, 3.28, P〈0.01）. After 2 weeks treatment, the difference was not significant in the score of NIHSS and Barthel index among the three groups （P〉0.05）. In the heat syndrome group, the normal rates were improved in tongue coating, the color of tongue coating, the texture of tongue coating, sleep disorders, temperatures at the terminals of 4 limbs, constipation and complication rate was decreased （P〈0.05）. The hospital cost in the heat syndrome group was significantly lower than that of the control group （t=2.615,P〈0.05）. Conclusion The clinical application of simplified syndrome differentiation of TCM has improved evidently in diagnosis and treatment of ACI with a satisfactory rehabilitation. The living convenience of patients has been promoted and the complications and hospitalization costs has been decreased in the heat syndrome group. This study is a innovation in diagnosis and treatment of TCM to promote therapeutic efficiency in ACI.