芪参还五胶囊配合穴位贴敷治疗脑梗死恢复期患者痰瘀互结证的疗效分析

The effect of Qishen Huanwu Capsule combined with acupoint application on the turbid phlegm and blood stasis in cerebral infarction during the recovery period

目的探讨芪参还五胶囊配合穴位贴敷治疗脑梗死恢复期患者痰瘀互结证的临床疗效及对脑血流动力学、血脂和氧化应激的影响。方法选取2018年4月—2019年12月河北省沧州中西医结合医院收治的脑梗死恢复期患者80例,采用分层区组随机化分组法分为观察组和对照组,每组40例。两组均给予常规西医康复治疗,对照组在常规西医治疗基础上给予穴位贴敷治疗,观察组在对照组治疗基础上加用芪参还五胶囊口服,均治疗6周后观察疗效,比较两组患者治疗前后的中医证候积分、美国国立卫生研究院卒中量表(NIHSS)评分、Fugl-Meyer运动功能量表(FMA)评分和脑卒中专用生活质量量表(SS-QOL)评分;测定并比较两组患者治疗前后大脑中动脉的血流动力学参数、血脂指标和氧化应激相关指标。结果观察组治疗后的显效率为75.00%,高于对照组的52.50%(P<0.05)。观察组治疗前后中医证候积分、NIHSS、FAM和SS-QOL评分的差值大于对照组(P<0.05)。观察组治疗前后脑血流动力学参数(平均血流速度、最大峰值流速、血管阻力指数和搏动指数)、血脂指标(总胆固醇、甘油三脂、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇)和氧化应激指标(血清超氧化物歧化酶、丙二醛、谷胱甘肽过氧化物酶、脂质过氧化物酶)的差值大于对照组(P<0.05)。结论芪参还五胶囊配合穴位贴敷治疗脑梗死恢复期患者痰瘀互结证能够增强疗效,减轻患者神经功能损伤,改善患者运动功能和生活质量,其机制可能与调节脑血流动力学、调控血脂、改善氧化还原失衡状态有关。

Objective To investigate the clinical effect of Qishen Huanwu Capsule combined with acupoint application on the turbid phlegm and blood stasis in cerebral infarction during the recovery period and its influence on cerebral hemodynamics,blood lipid and oxidative stress.Methods A total of 80 patients with cerebral infarction during the recovery period admitted to our hospital from April 2018 to December 2019 were included in the study,and were divided into observation group and control group by stratified randomization,with 40 patients in each group.The two groups were both given conventional western medicine as rehabilitation treatment.In addition,the control group was also given acupoint application therapy,while the observation group was further given oral administration of Qishen Huanwu capsule on the basis of control group.The curative effect was observed after 6 weeks of treatment.Traditional Chinese medicine(TCM)syndrome,National Institutes of Health Stroke Scale(NIHSS),Fugl-Meyer Assessment(FMA)and Stroke Specific Quality of Life(SS-QOL)scale scores were compared between the two groups before and after treatment.The hemodynamic parameters of the middle cerebral artery,blood lipid levels and oxidative stress indexes were detected and compared between the two groups before and after treatment.Results After treatment,the effective rate of the observation group was 75.00%,which was significantly higher than that of the control group(52.50%,P<0.05).The differences of TCM syndrome,NIHSS,FAM and SSQOL scores before and after treatment were greater in the observation group than those in the control group(P<0.05).Besides,the differences of hemodynamic parameters[mean velocity(Vm),peak systolic velocity(Vs),resistance index(RI),and pulsatility index(PI)],blood lipid indexes[total cholesterol(TC),triglyceride(TG),highdensity lipoprotein cholesterol(HDL-C),and low-density lipoprotein cholesterol(LDL-C)]and oxidative stress indexes[superoxide dismutase(SOD),malondialdehyde(MDA),glutathione peroxidase(GSH-Px)and lipid peroxidase(LPO)]before and after treatment were higher in the observation group compared with the control group(P<0.05).Conclusions Qishen Huanwu Capsule combined with acupoint application can enhance the curative effect for turbid phlegm and blood stasis in cerebral infarction during the recovery period,reduce the neurological damage of patients,and improve the patients’motor function and quality of life,the mechanism of which may be related to the regulation of cerebral hemodynamics,blood lipids,and oxidant-antioxidant imbalance.