化痰熄风法对痰湿体质缺血性脑卒中患者临床疗效的影响

Clinical Efficacy of Therapy of Resolving Phlegm and Extinguishing Wind on Ischemic Stroke Patients with Phlegm-damp Constitution

【目的】探讨化痰熄风法对痰湿体质缺血性脑卒中患者临床疗效的影响。【方法】将74例痰湿体质缺血性脑卒中患者随机分为试验组和对照组,每组各37例。对照组急性期按照《中国急性缺血性脑卒中诊治指南2018》给予常规药物治疗,恢复期按照《中国缺血性脑卒中和短暂性脑缺血发作二级预防指南2014》给予药物二级预防治疗,试验组在对照组的基础上给予化痰熄风法(天麻健脑饮颗粒)治疗,疗程为4周。观察2组患者治疗前、治疗7 d后和治疗4周后中医证候积分、痰湿体质分值、美国国立卫生院神经功能缺损评分(NIHSS)和改良Barthel指数(MBI)评分的变化情况,并评价2组患者的临床疗效。【结果】(1)研究过程中,对照组脱落1例,试验组脱落3例,最终对照组36例、试验组34例患者完成全部疗程。(2)治疗4周后,试验组的总有效率为94.12%(32/34),对照组为75.00%(27/36),组间比较,试验组的疗效明显优于对照组,差异有统计学意义(P<0.05)。(3)治疗7 d和4周后,2组患者的中医证候积分、NIHSS评分和痰湿体质分值均较治疗前降低(P<0.05),MBI评分均较治疗前提高(P<0.05),且试验组在不同时段对中医证候积分、NIHSS评分和痰湿体质分值的降低作用以及对MBI评分的提高作用均优于对照组,差异均有统计学意义(P<0.05)。【结论】在常规药物治疗基础上结合化痰熄风法治疗痰湿体质缺血性脑卒中患者疗效确切,能有效降低患者的中医证候积分和神经功能缺损评分,改善患者的痰湿体质,提示中医体质学说在疾病的治疗方面具有指导意义,通过体质干预可对疾病的转归产生深远影响。

Objective To observe the clinical efficacy of therapy of resolving phlegm and extinguishing wind on ischemic stroke patients with phlegm-damp constitution. Methods Seventy-four patients of ischemic stroke with phlegm-damp constitution were randomly divided into the trial group and the control group, 37 cases in each group. The control group was treated with routine medicine in acute phase following “Chinese Guidelines for the Diagnosis and Treatment of Acute Ischemic Stroke 2018”, and then was given medicine for the secondary prevention in recovery phase following “Chinese Guidelines for Secondary Prevention of Ischemic Stroke and Transient Ischemic Attack 2014”. The trial group was treated with Tianma Jiannao Yin Granules for resolving phlegm and extinguishing wind on the basis of treatment for the control group,and the course of treatment for the two groups lasted 4 weeks. Before treatment, 7 days and 4 weeks after treatment, the changes of traditional Chinese medicine(TCM)syndrome scores,phlegm-damp constitution scores,National Institute of Health Stroke Scale(NIHSS)scores for neurological impairment and modified Barthel Index(MBI)scores in the two groups were observed. After treatment,the clinical efficacy of the two groups was evaluated. Results(1)During the trial,one case fell off from the control group and 3 cases fell off from the trial group. At the end of the trial,36 patients in the control group and 34 patients in the trial group completed the whole course of treatment.(2)After 4 weeks of treatment,the total effective rate of the trial group was 94.12%(32/34),and that of the control group was 75.00%(27/36). The intergroup comparison showed that the curative effect of the trial group was significantly superior to that of the control group,the difference being statistically significant(P < 0.05).(3)After 7 days and 4 weeks of treatment,the TCM syndrome scores,NIHSS scores and phlegm-damp constitution scores of the two groups were decreased compared with those before treatment(P < 0.05),and MBI scores were increased compared with those before treatment(P < 0.05). The trial group had stronger effect on reducing TCM syndrome scores,NIHSS scores and phlegm-damp constitution scores and on increasing the MBI scores in different periods than the control group,the difference being statistically significant(P < 0.05). Conclusion Based on conventional medicine treatment,the combined use of therapy of resolving phlegm and extinguishing wind exerts a certain effect on patients of ischemic stroke with phlegm-damp constitution. The therapy can effectively reduce the TCM syndrome scores and neurological impairment scores,and improve the phlegm-damp constitution of the patients,which indicates that the theory of TCM constitution has guiding significance in the treatment of diseases, and the intervention of constitution can have a profound impact on the prognosis of the disease.