补肾活血方结合西医常规疗法治疗老年慢性脑供血不足

Clinical study on treatment of Bushen-Huoxue decoction for the patients with senile chronic cerebral circulation insufficiency

目的 评价补肾活血方结合西医常规疗法治疗老年慢性脑供血不足（chronic cerebralcirculation insufficiency,CCCI）的疗效。方法将符合入选标准的70例CCCI患者按随机数字表法分为2组，每组35例。2组均给予降压、降糖、调脂等常规疗法治疗，在此基础上对照组口服盐酸氟桂利嗪胶囊，观察组加服补‘肾活血方。2组均治疗30 d。采用眩晕残障程度评定量表（Dizziness Handicap Inventory,DHI）评价患者的眩晕程度，采用蒙特利尔认知评估量表（Montreal Cognitive Assessment，MoCA）评价患者的认知能力，采用超声经颅多普勒血流分析仪检测基底动脉（basilarartery，BA）、双侧椎动脉（bilateralvertebral artery,VA）及双侧大脑中动脉（middle cerebral artery,MCA）的平均血流速度（mean flow velocity,Vm），采用化学比色法检测血浆酸性磷脂酸（acidity phosphatidic acid，AP）含量，评价临床疗效。结果观察组总有效率为94．3％（33／35）、对照组为82．9％（29／35），2组比较差异有统计学意义（χ^2=9．728，P=0．011）。治疗后，观察组中医症状评分[（6．2±3．3）分比（9．8±3．7）分，t=8．920]、DHI评分[（4．4±2．5）分比（9-3±3．6）分，f=12．081]低于对照组（P〈0．01），MoCA评分[（25．7±2．6）分比（23．2±2．8）分，t=6．638]高于对照组（P〈0．05）；观察组左侧vA[（37．2±8．5）cm／s比（34．9±7．6）cm／s，f=9．103]、左侧MCA[（63-3±9．8）cm／s比（60．1±8．4）cm／s，f=7．839]、右侧MCA[（62．8±10．5）cm／s比（60．9±9．5）cm／s，t=6．583]的Vm高于对照组（P〈0．01）；观察组血浆AP[（3．74±1．08）μmol／L比（5．8l±1．35）μtmol／L，t=9．627]低于对照组（P〈0．01）。结论补肾活血方结合西医常规疗法可改善CCCI患者的临床症状、眩晕程度及认知水平，改善脑部血供，提高临床疗效。

Objective To observe the effect of Bushen-Huoxue decoction combined with conventional therapy on the clinical symptoms, vertigo degree and cognitive function of elderly patients with chronic cerebral cerebral circulation insufficiency （CCCI） and to explore its mechanism. Methods A total of 70 patients were randomly divided into observation group and control group according to random number table method. The two groups were given antihypertensive, hypoglycemic, lipid and other western medicine treatment. On this basic treatment, the control group added orally flunarizine hydrochloride capsules, 5 mg/day before sleeping, while the observation group with Bushen-Huoxue decoction per day. All the treatment last 30 days. dizziness handicap inventory （DHI） and montreal cognitive assessment （MoCA） were used for the symptoms evaluation, and the mean flow velocity of the following arteries basilar artery （BA）, bilateral vertebral artery （VA） and middle cerebral artery （MCA） were assessed by the Ultrasound transcranial doppler blood flow analyzer. The acidity phosphatidic acid, AP were detected by chemical colorimetric method. And the clinical effect rates were compared after treatment. Results The total effective rate of observation group was 94.3% （33/35）, higher than 82.9% （29/35） in the control group, and the difference in group 2 was statistically significant （χ^2=9.728, P〈0.05）. After treatment, the TCM symptom scores （6.2±3.3 vs. 9.8±3.7, t=8.920）, DHI score （4.4± 2.5 vs. 9.3± 3.6, t=12.081） and MoCA score （25.7 ± 2.6 vs. 23.2 ±2.8, t=6.638） improvement of the observation group were significantly better than those of control group （P〈0.05）. The Vms of LVA （37.2 ± 8.5 crn/s vs. 34.9± 7.6 cm/s, t=9.103）, LMCA （63.3 ± 9.8 cm/s vs. 60.1 ± 8.4 cm/s, t=7.839）, RMCA （62.8 ± 10.5 cm/s vs. 60.9 ± 9.5 cm/s, t=6.583） and plasma AP （3.74 ± 1.08 μmol/L vs. 5.81μ1.35 μmol/L, t=9.627） improvement of the observation group were significantly better than those of control group （P〈0.05）. Conclusions The Bushen-Huoxue decoction can improve the clinical symptoms and vertigo of the elderly and improve the cognitive level of the patients. The mechanism may be related to the improvement of the cerebral blood flow velocity, the decrease of olasma AP, and the state of ischemia and hylaoxia.