自拟复脉方辅助西医治疗急性脑梗死的效果及作用机制探讨

Efficacy and mechanism of self-made Fumai Decoction in the adjuvant treatment of patients with acute cerebral infarction

目的探讨自拟复脉方辅助西医治疗急性脑梗死的效果及作用机制。方法选择我院2017年1月至2019年4月收治的急性脑梗死患者共146例,以随机抽签法分为对照组(73例)和观察组(73例)。对照组给予西医规范对症干预,观察组在此基础上加用自拟复脉方治疗。比较两组近期疗效、治疗前后主要症候评分、NIHSS评分、ADL评分、凝血功能指标水平、血液流变学指标水平、过氧化氢酶及相关生长因子水平。结果观察组近期有效率高于对照组(94.52%vs.76.71%,P<0.05)。治疗后,观察组主要症候评分、NIHSS评分、ADL评分、凝血功能指标水平及血液流变学指标水平均改善,观察组偏瘫、口舌歪斜、言语蹇涩/不语、气短乏力症候评分低于对照组[(1.05±0.22)分vs.(1.63±0.38)分,(0.92±0.19)分vs.(1.47±0.35)分,(0.95±0.19)分vs.(1.41±0.36)分,(1.11±0.18)分vs.(1.57±0.30)分,P<0.05];观察组NIHSS评分低于对照组[(8.26±1.49)分vs.(12.49±2.31)分,P<0.05],ADL评分高于对照组[(76.36±10.71)分vs.(63.50±7.45)分,P<0.05];观察组血小板聚集率、vWF、FIB低于对照组[53.82%±7.06%vs.64.64%±8.80%,105.47%±20.83%vs.124.26%±25.69%,(2.09±0.27) g/L vs.(2.62±0.45) g/L,P<0.05],PT、APTT、TT高于对照组[(14.75±1.97) s vs.(12.59±1.61) s,(43.52±8.26) s vs.(37.65±7.49) s,(18.84±2.09) s vs.(16.10±1.32),P<0.05];观察组全血黏度/10 s、全血黏度/100 s、PV、EDR低于对照组[(9.80±0.99) mPa·s vs.(11.54±1.42) mPa·s,(5.31±0.40) mPa·s vs.(6.98±0.63) mPa·s,(1.67±0.38) mPa·s vs.(2.10±0.52) mPa·s,(18.93±2.15) mm·h vs.(23.37±3.31) mm·h]。治疗后,观察组过氧化氢酶和相关生长因子水平均改善,观察组过氧化氢酶、VEGF、bFGF高于对照组[(21.93±5.83) pg/ml vs.(18.79±4.20) pg/ml,(327.51±70.36) pg/ml vs.(285.03±61.84) pg/ml,(35.46±4.22) pg/ml vs.(27.68±3.36) pg/ml]。结论自拟复脉方辅助西医治疗急性脑梗死能够显著减轻临床症状,保护神经损伤,促进生活质量恢复,并有助于改善血液流变学和血液黏稠度指标,可能与该方案对过氧化氢酶、VEGF、bFGF水平调节作用密切相关。

Objective To investigate the clinical efficacy and mechanism of self-made Fumai Decoction in the adjuvant treatment of patients with acute cerebral infarction.Methods Totally 146 patients with acute cerebral infarction were chosen,who were treated in our hospital from January 2017 to April 2019,and they were randomly divided into 2 groups.Control group(n=73)was given standardized intervention program of western medicine,and observation group(n=73)received self-made Fumai Decoction on the basis of treatment for control group.The recent clinical efficacy,main syndrome scores,NIHSS score,ADL score,the levels of coagulation function index,hemorheological index,catalase and related growth factor before and after treatment of the two groups were compared.Results The recent clinical effective rate of observation group was higher than that of control group(94.52%vs.76.71%,P<0.05).After treatment,the main syndromes score,NIHSS score,ADL score and the levels of coagulation function and hemorheological indexes of observation group were improved(P<0.05),and the syndrome scores of hemiplegia,tongue skewed,silent speech and shortness of breath in observation group were lower than those in control group[(1.05±0.22)vs.(1.63±0.38),(0.92±0.19)vs.(1.47±0.35),(0.95±0.19)vs.(1.41±0.36),(1.11±0.18)vs.(1.57±0.30),P<0.05];the NIHSS score of observation group was lower than that of control group[(8.26±1.49)vs.(12.49±2.31),P<0.05],while the ADL score was higher[(76.36±10.71)vs.(63.50±7.45),P<0.05];the platelet aggregation rate,vWF and FIB in observation group were lower than those of control group[(53.82%±7.06%)vs.(64.64%±8.80%),(105.47%±20.83%)vs.(124.26%±25.69%),(2.09±0.27)g/L vs.(2.62±0.45)g/L,P<0.05],while the levels of PT,APTT and TT were higher[(14.75±1.97)s vs.(12.59±1.61)s,(43.52±8.26)s vs.(37.65±7.49)s,(18.84±2.09)s vs.(16.10±1.32),P<0.05];the whole blood viscosity/10 s,whole blood viscosity/100 s,PV and EDR in observation group were lower than those in control group[(9.80±0.99)mPa·s vs.(11.54±1.42)mPa·s,(5.31±0.40)mPa·s vs.(6.98±0.63)mPa·s,(1.67±0.38)mPa·s vs.(2.10±0.52)mPa·s,(18.93±2.15)mm·h vs.(23.37±3.31)mm·h].After treatment,the levels of catalase and related growth factor in observation group were improved(P<0.05),and the levels of catalase,VEGF and bFGF in observation group were higher than those in control group[(21.93±5.83)pg/ml vs.(18.79±4.20)pg/ml,(327.51±70.36)pg/ml vs.(285.03±61.84)pg/ml,(35.46±4.22)pg/ml vs.(27.68±3.36)pg/ml,P<0.05].Conclusion Self-made Fumai Decoction in the adjuvant treatment of patients with acute cerebral infarction can significantly alleviate clinical symptoms,protect nerve injury,promote the recovery of quality of life and improve the index of hemorheology and blood viscosity,which may be closely related to its regulation effects on catalase,vascular endothelial growth factor and bFGF expression.