血栓通脉汤联合针刺治疗脑卒中的临床研究

Clinical research of Xueshuan Tongmai Decoction combined with acupuncture in the treatment of cerebral apoplexy

目的探讨血栓通脉汤联合针刺治疗脑卒中的临床效果。方法选择2017年1月—2019年1月山东省医学科学院附属医院收治的脑卒中患者120例,依照随机数字表法将其分为常规组、针刺组及联合组,各40例。常规组采用西药常规疗法,针刺组在常规组的基础上给予针刺治疗,联合组在针刺组的基础上给予血栓通脉汤治疗,三组均连续治疗3个月。治疗后进行临床疗效评价。比较三组治疗前后的中医症状评分、美国国立卫生研究院卒中量表(NIHSS)、格拉斯哥昏迷量表(GCS)评分及血清一氧化氮(NO)、内皮素(ET-1)水平。记录并比较三组治疗过程中不良反应发生情况。结果联合组的临床总有效率高于常规组和针刺组,差异有统计学意义(P<0.05)。三组治疗后中医症状各项评分(肢体麻木、自汗、气短乏力、舌质暗)均低于治疗前(P<0.05);针刺组和联合组治疗后中医症状各项评分均低于常规组(P<0.05);联合组治疗后中医症状各项评分低于针刺组(P<0.05)。三组治疗后NIHSS评分均低于治疗前,GCS评分均高于治疗前(P<0.05);针刺组和联合组治疗后NIHSS评分均低于常规组,GCS评分均高于常规组(P<0.05);联合组治疗后NIHSS评分低于针刺组,GCS评分高于针刺组(P<0.05)。三组治疗后血清NO水平均高于治疗前,血清ET-1水平均低于治疗前(P<0.05);针刺组和联合组治疗后血清NO水平均高于常规组,血清ET-1水平均低于常规组(P<0.05);联合组治疗后血清NO水平高于针刺组,血清ET-1水平低于针刺组(P<0.05)。三组治疗期间均无严重的不良反应发生。结论血栓通脉汤联合针刺治疗脑卒中临床效果显著,能够明显改善患者的神经功能和血管内皮功能损伤,且安全性较好。

Objective To explore clinical efficacy of Xueshuan Tongmai Decoction combined with acupuncture in the treatment of cerebral apoplexy.Methods One hundred and twenty patients with cerebral apoplexy admitted to Affiliated Hospital of Shandong Academy of Medical Sciences from January 2017 to January 2019 were selected.According to the random number table method,the patients were divided into routine group,acupuncture group and combined group,with 40 cases in each group.Routine group was treated with routine Western medicine.Acupuncture group was treated with acupuncture on the basis of routine group.Combined group was treated with Xueshuan Tongmai Decoction on the basis of acupuncture group.All three groups were treated for 3 months.Clinical efficacy was evaluated after treatment.The score of Chinese medicine symptoms,National Institute of Health stroke scale(NIHSS),Glasgow coma scale(GCS),serum nitric oxide(NO)and endothelin(ET-1)levels were compared before and after treatment.The incidence of adverse reactions during the treatment was recorded and compared among three groups.Results Total clinical effective rate of combined group was higher than that of routine group and acupuncture group(P<0.05).After treatment,the scores of Chinese medicine symptoms(numbness of limb,spontaneous sweating,panting and weakness,dark tongue quality)in three groups were lower than those before treatment(P<0.05);after treatment,the scores of Chinese medicine symptoms in acupuncture group and combination group were lower than those in routine group(P<0.05);after treatment,the scores of Chinese medicine symptoms in combination group were lower than those in acupuncture group(P<0.05).NIHSS scores of three groups after treatment were lower than those before treatment,GCS scores of three groups after treatment were higher than those before treatment(P<0.05);NIHSS scores of acupuncture group and combination group after treatment were lower than those of routine group,GCS scores of acupuncture group and combination group after treatment were higher than thoseof routine group (P < 0.05);NIHSS score of combined group after treatment was lower than that of acupuncture group, GCS score of combined group after treatment was higher than that of acupuncture group (P < 0.05). After treatment, serum NO levels in three groups were higher than those before treatment, and serum ET-1 levels in three groups were lower than those before treatment (P < 0.05);serum NO levels in acupuncture group and combination group after treatment were higher than those in routine group, and serum ET-1 levels in acupuncture group and combination group after treatment were lower than those in routine group (P < 0.05);after treatment, serum NO level in combined group was higher than that in acupuncture group, and serum ET-1 level in combined group was lower than that in acupuncture group (P < 0.05). There were no serious adverse reactions during the treatment of three groups. Conclusion Xueshuan Tongmai Decoction combined with acupuncture has a significant clinical effect in treating cerebral apoplexy, which can significantly improve neurological function and vascular endothelial function damage of patients, and it has good safety.