开窍汤联合疏血通注射液改善急性脑梗死患者神经功能的临床效果及机制探讨

Clinical effect and mechanism of kaiqiao decoction combined with shuxuetong injection on improving nerve function in patients with acute cerebral infarction

目的观察开窍汤联合疏血通注射液改善急性脑梗死患者神经功能的临床效果及其可能的作用机制。方法选择2018年6月-2019年6月本院收治的80例急性脑梗死患者,按照随机数字表分为对照组和观察组,每组各40例;2组患者均给予常规治疗,对照组在常规治疗基础上给予疏血通注射液,观察组患者在对照组基础上加用开窍汤治疗,2周为1个疗程,连续用药2个疗程;通过观察治疗前后神经功能缺损程度变化以评价临床治疗效果,并评价运动功能、日常生活能力,检测大脑动脉血流速度及血清中细胞凋亡、神经损伤相关指标水平变化。结果与对照组的有效率75.00%(30/40)比较,观察组的有效率92.50%(37/40)显著升高(χ^2=4.501,P<0.05);观察组治疗2、4周后的NIHSS评分均显著低于对照组(P<0.05);观察组治疗4周后的FMA评分、MBI评分显著高于对照组,即运动功能、日常生活能力提高更明显(P<0.05);观察组患者治疗4周后的MCA,PCA,ACA,BA血灌速度显著高于对照组(P<0.05);观察组治疗4周后的Caspase-3,H-FABP水平显著低于对照组,IGF-1,CGRP水平则显著高于对照组(P<0.05)。结论开窍汤联合疏血通注射液更利于改善急性脑梗死患者的神经功能,提高运动功能、日常生活能力,其机制可能与增加脑血流灌注、抑制细胞凋亡、神经损伤以发挥脑保护作用有关。

Objective To observe the clinical effect and possible mechanism of kaiqiao decoction combined with shuxuetong injection on improving nerve function in patients with acute cerebral infarction.Methods Eighty patients with acute cerebral infarction admitted to our hospital from June 2018 to June 2019 were selected and divided into control group and observation group according to the random number table,with 40 patients in each group.Patients in both groups were treated with conventional western medicine.Patients in the control group were given shuxuetong injection on the basis of conventional intervention.Patients in the observation group were treated with kaiqiaotang on the basis of the control group.The clinical therapeutic effect was evaluated by observing the changes in the degree of neurological impairment before and after treatment,the changes in motor function and daily living ability were evaluated,and the changes in blood flow velocity of cerebral artery,the relative parameters of cell apoptosis and nerve injury in serum were detected.Results Compared with the control group,the effective rate of the observation group was 75.00%(30/40),the effective rate of the observation group was 92.50%(37/40)(χ^2=4.501,P<0.05).The NIHSS scores of the observation group were significantly lower than those of the control group after 2 weeks of treatment and 4 weeks of treatment(P<0.05).After 4 weeks of treatment,the FMA score and MBI score of the observation group were significantly higher than those of the control group(P<0.05).After 4 weeks of treatment,the blood flow velocities of MCA,PCA,ACA and BA of the observation group after treatment were significantly higher than those of the control group(P<0.05).After 4 weeks of treatment,the serum levels of Caspase-3 and H-FABP in the observation group were significantly lower than those in the control group,while the serum levels of IGF-1 and CGRP in the observation group were significantly higher than those in the control group(P<0.05).Conclusion Kaiqiao decoction combined with shuxuetong injection was more conducive to improving the neurological function of patients with acute cerebral infarction,improving the motor function and the ability of daily living,and its mechanism might be related to increasing cerebral blood perfusion,inhibiting the apoptosis of nerve cells and damage to play the role of brain protection.