通脑丸治疗老年后循环缺血性眩晕痰瘀阻窍型的疗效及作用机制

Therapeutic Effect and Mechanism of Tongnao Pills in Treating Senile Posterior Circulation Ischemic Vertigo with Phlegm and Blood Stasis Type

目的:观察通脑丸治疗老年后循环缺血性眩晕(痰瘀阻窍型)患者的疗效,探讨其作用机制。方法:将甘肃省中医院收治的80例老年痰瘀阻窍型后循环缺血性眩晕患者作为研究对象,按入院编号随机分两组,单号对照组、双号观察组,每组40例;两组患者均给予基础治疗,对照组在基础治疗基础上给予长春西汀静脉滴注,观察组在对照组基础上加服通脑丸,比较两组患者的临床疗效,中医证候评分,欧洲眩晕评分量表(EEV)评分,眩晕障碍量表的筛查表(DHI-S)评分,椎基底动脉平均血流速度(Vm)和搏动指数(PI),血流动力学改变[平均动脉压(MAP),中心静脉压(CVP),右房压(RAP),左房压(LAP),心排出量(CO),心脏每搏量(SV)],血液黏度及血脂水平变化、症状消失时间、安全性评价。结果:观察组患者的治疗总有效率95.00%(38/40)明显高于对照组的75.00%(30/40)(χ2=4.804,P<0.05);治疗后两组患者证候均明显改善(P<0.05),观察组患者的头晕目眩、恶心呕吐、耳鸣耳聋、倦怠乏力、头蒙不清证候评分均低于对照组(P<0.05);两组患者的EEV和DHI-S评分均明显下降(P<0.05),观察组EEV和DHI-S评分较对照组均明显减少(P<0.05);两组患者的两侧双侧椎动脉(VA)和BA的Vm均明显升高,PI明显降低(P<0.05),观察组患者的两侧VA和基底动脉(BA)的平均血流速度(Vm),搏动指数(PI)均优于对照组(P<0.05);两组患者的MAP,CVP,RAP,LAP均明显较治疗前降低,CO,SV较治疗前增加(P<0.05),观察组患者SV明显高于对照组(P<0.05);两组患者的全血高切黏度、全血低切黏度、血浆黏度、及甘油三酯(TG),总胆固醇(TC),低密度脂蛋白胆固醇(LDL-C)水平均明显下降,高密度脂蛋白(HDL-C)明显升高(P<0.05),观察组患者的血液黏度及血脂水平均明显优于对照组(P<0.05);观察组患者头晕目眩、恶心呕吐、耳鸣耳聋、倦怠乏力、头蒙不清的消失时间均少于对照组(P<0.05);两组患者均未发生严重不良反应。结论:痰瘀阻窍型老年后循环缺血性眩晕患者应用通脑丸进行治疗,可明显缓解患者眩晕症状,改善血液流变学,提升椎基底动脉血流速度,改善脑供血异常情况,提高患者生活质量,不良反应少,安全性好,具有良好的治疗效果,值得临床推广应用。

Objective:To explore the curative effect and mechanism of Tongnao pill in the treatment of senile posterior circulation ischemic vertigo with phlegm and blood stasis type.Method:The 80 elderly patients with posterior circulation ischemic vertigo(phlegm and blood stasis type)admitted to Gansu Provincial Hospital of Traditional Chinese Medicine were selected as the research subjects and were randomly divided into two groups according to the hospital admission number.Those with odd numbers were classified into control group and those with even numbers were classified into observation group,with 40 cases in each group.All of the patients in both groups were given basic treatment,and the patients in control group additionally received intravenous infusion of vinpocetine on the basis of basic treatment,while the patients in observation group additionally received Tongnao pill on the basis of the treatment in control group.The clinical efficacy,traditional Chinese medicine(TCM)syndrome score,European Evaluation of Vertigo(EEV)score,dizziness handicap inventory-screening(DHI-S)score,vertebral basilar artery average blood flow velocity(Vm)and pulsatility index(PI),hemodynamic changes[mean arterial pressure(MAP),central venous pressure(CVP),right atrial pressure(RAP),left atrial pressure(LAP),cardiac output(CO),cardiac stroke volume(SV)],changes in blood viscosity and blood lipid levels,symptom disappearance time,and safety of the two groups were compared.Result:The total effective rate in the observation group was 95.00%(38/40),significantly higher than 75.00%(30/40)in the control group(χ~2=4.804,P<0.05).After treatment,the symptoms were significantly improved in both groups(P<0.05),and the scores of dizziness,nausea and vomiting,tinnitus and deafness,tiredness and fatigue in the observation group were lower than those in the control group(P<0.05),the EEV and DHI-S scores were decreased significantly in both groups(P<0.05),and such scores in the observation group were significantly lower than those in the control group(P<0.05),the Vm of bilateral vertebral artery(VA)and basilar artery(BA)on both sides were significantly increased in both groups,while the PI was significantly reduced(P<0.05),and these two indicators in the observation group were better than those in the control group(P<0.05),the MAP,CVP,RAP and LAP were significantly reduced in both groups after treatment,while the CO and SV were increased after treatment(P<0.05),and the SV of the observation group was significantly higher than that of the control group(P<0.05).The high blood viscosity,low blood viscosity,plasma viscosity and TG,TC,LDL-C levels were decreased significantly while HDL-C increased significantly in both groups(P<0.05),and the blood viscosity and blood lipid levels in the observation group were significantly better than those in the control group(P<0.05).The time to disappearance of dizziness,nausea,vomiting,tinnitus and deafness,malaise,fatigue,and confused mind in observation group was less than that in the control group(P<0.05),no serious adverse events occurred in both groups.Conclusion:Tongnao pills for the treatment of senile posterior circulation ischemic vertigo(phlegm and blood stasis type)can significantly alleviate the symptoms of vertigo,improve hemorrheology,increase the blood flow velocity of the vertebrobasilar artery,improve the abnormal blood supply to the brain,and improve the quality of life for patients,with fewer adverse reactions,high safety,and good therapeutic effect.Therefore,it is worth to be applied in clinical use.