通窍活血汤加减口服联合药枕治疗脑梗死临床观察

Clinical Observation on Treatment of Cerebral Infarction with Tongqiao Huoxue Decoction Combined with Medicine Pillow

目的:观察通窍活血汤联合药枕治疗脑梗死的临床疗效。方法:将120例脑梗死患者采用随机数字表法分为对照组和治疗组,每组60例。对照组采用常规对症治疗:给予吸氧、心电监护监测生命体征,维持水、电解质平衡,监测、调控血糖、血压,颅内高压患者给予适量脱水降颅压药物治疗:甘露醇或甘油果糖减轻脑水肿;给予抗血小板聚集药:阿司匹林肠溶片或氯吡格雷片;调血脂药物应用:阿托伐他汀钙片;给予清除自由基治疗:依达拉奉注射液;给予营养神经治疗:神经节苷脂注射液。治疗组在对照组治疗基础上口服通窍活血汤加减治疗,方药组成:麝香(冲服)0.15 g,桃仁12 g,红花12 g,赤芍12 g,川芎12 g,干姜12 g,大枣9 g,黄芪15 g,水煎服,每次200 mL,每日2次,连续治疗14 d;联合通窍活血汤加减药枕(麝香5 g,桃仁50 g,红花50 g,赤芍50 g,川芎50 g,干姜30 g,大枣20 g,黄芪50 g,将中药按上述比例加工成粗颗粒状,充分搅匀后填枕,每个药枕质量为500 g,做枕芯填充于枕内,药枕一面朝上,与头部接触,每周换1次药枕),治疗21 d为1个疗程。观察两组患者临床疗效、相关生化指标变化、血流动力学改变、神经功能缺损情况、不良反应情况等。结果:治疗组治疗有效率为91.67%,优于对照组的78.33%,差异有统计学意义(P<0.05);治疗组治疗后纤维蛋白原降低、凝血酶原时间升高,与对照组比较,差异有统计学意义(P<0.05);治疗组治疗后全血黏度、血浆黏度、红细胞压积改善明显,与对照组比较,差异有统计学意义(P<0.05);治疗组治疗后神经功能缺损评、Barthel指数评分与对照组比较,差异有统计学意义(P<0.05)。结论:通窍活血汤加减口服联合药枕治疗脑梗死临床疗效显著,可降低纤维蛋白原,延长凝血酶原时间,降低血液黏度,减少神经功能损伤。

Objective： To investigate the clinical effect of Tongqiao Huoxue decoction combined with medicine pillow in the treatment of cerebral infarction. Methods： 120 patients with cerebral infarction were randomly divided into the control group and the treatment group. The control group received routine symptomatic treatment： oxygen inhalation,monitoring vital signs by ECG monitoring,maintenance of water and electrolyte balance,monitoring and control of blood sugar and blood pressure. Patients with intracranial hypertension were treated with appropriate amount of dehydration and lowering intracranial pressure drugs： mannitol or glycerol fructose to reduce brain edema; antiplatelet： aspirin enteric-coated tablets or clopidogrel tablets; regulating blood lipids drug application： atorvastatin tablets; free radical scavenging therapy： edaravone injection; nutritional neurotherapy： ganglioside injection. The treatment group was treated with Tongqiao Huoxue decoction orally administration on the basis of the control group.Composition： Shexiang（ Musk） 0. 15 g,Taoren（ Peach Seed） 12 g,Honghua（ Carthamus Tinctorius） 12 g,Chishao（ Radix Paeoniae Rubra） 12 g,Chuanxiong（ Ligusticum Wallichii） 12 g,Ganjiang（ Dried Ginger） 12 g,Dazao（ Jujube） 9 g,Huangqi（ Astragalus）15 g,water decoction,200 mL once,twice a day for 14 days continuous treatment. Combined with Tongqiao Huoxue decoction for reducing medicine pillow,its composition： Shexiang（ Musk） 5 g,Taoren（ Peach Seed） 50 g,Honghua（ Carthamus Tinctorius）50 g,Chishao（ Radix Paeoniae Rubra） 50 g,Chuanxiong（ Ligusticum Wallichii） 50 g,Ganjiang（ Dried Ginger） 30 g,Dazao（ Jujube） 20 g,Huangqi（ Astragalus） 50 g. The Chinese medicine was processed into coarse granular shape according to the above proportion,and the pillow was filled with a mass of 500 g for each pillow. The pillow was filled with and inside the pillow. The pillow was placed on one side and contacted with the head. The medicine pillow was changed once a week and treated for 21 days as a course of treatment. The clinical efficacy,changes of biochemical indexes,hemodynamics,neurological deficit and adverse reactions were observed in the two groups. Results： the effective rate of treatment group was 91. 67%,which was better than that of the control group 78. 83%（ P 〈0. 05）. After treatment,the fibrinogen decreased and the prothrombin time increased in the treatment group compared with the control group（ P 〈0. 05）. After treatment,the whole blood viscosity,plasma viscosity and hematocrit in the treatment group were significantly improved compared with the control group,the difference was statistically significant（ P〈 0. 05）. The scores of neurologic impairment and Barthel index in the treatment group were significantly different from those in the control group（ P〈 0. 05）. Conclusion： Tongqiao Huoxue decoction orally administration combined with medicine pillow can reduce fibrinogen,increase prothrombin time,decrease blood viscosity and reduce nerve function injury.