化痰通络汤加减联合点穴按摩辅助治疗急性缺血性脑卒中

Clinical study on modified Huatan Tongluo Decoction combined with acupoint massage for the patients with acute ischemic stroke

目的评价化痰通络汤加减联合点穴按摩治疗急性缺血性脑卒中(acute ischemic stroke,AIS)的疗效。方法将符合入选标准的2020年1月-2021年1月本院83例AIS患者采用随机数字表法分为对照组41例和观察组42例。对照组给予西医常规疗法治疗,观察组在对照组基础上采用化痰通络汤加减联合点穴按摩治疗。2组均治疗2周。分别于治疗前后进行中医症状评分,采用美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评估神经功能缺损程度,改良Barthel指数(Modified Barthel Index,MBI)评估患者日常生活能力;采用ELISA法检测血清缺血修饰蛋白(ischemia modified albumin,IMA)、MMP-9、生长分化因子-15(growth differentiation factor-15,GDF-15)水平,评价临床疗效。结果观察组总有效率为92.9%(39/42)、对照组为75.6%(31/41),2组比较差异有统计学意义(χ^(2)=4.67,P=0.031)。观察组治疗后神志不清、意识恍惚、麻木无力、口舌歪斜、半身不遂评分低于对照组(t值分别为2.18、3.11、2.80、2.07、2.24,P值均<0.05),NIHSS评分低于对照组(t=2.58,P=0.012),MBI评分高于对照组(t=2.59,P=0.011)。观察组治疗后血清IMA[(67.05±8.34)mg/L比(71.48±8.52)mg/L,t=2.39]、MMP-9[(100.72±12.49)ng/L比(107.66±13.05)ng/L,t=2.48]、GDF-15[(438.16±43.20)ng/L比(461.93±44.19)ng/L,t=2.48]水平低于对照组(P<0.05)。结论化痰通络汤加减联合点穴按摩可缓解AIS患者的临床症状和脑损伤程度,改善其神经功能和生活能力,提高临床疗效。

Objective To evaluate the efficacy of modified Huatan Tongluo Decoction combined with acupoint massage in the treatment of acute ischemic stroke(AIS).Methods A total of 83 patients with AIS,who met the inclusion criteria in the hospital between January 2020 and January 2021,were randomly divided into the control group(n=41)and the observation group(n=42).The control group received conventional western medicine treatment,and the observation group adopted modified Huatan Tongluo Decoction combined with acupoint massage therapy on the basis of the control group.Both groups were treated for 2 weeks.The TCM symptoms were scored before and after treatment.The National Institutes of Health Stroke Scale(NIHSS)was used to evaluate the degree of neurological deficit and Modified Barthel Index(MBI)was used for the evaluation of daily living ability of patients.The Serum levels of Ischemia Modified Albumin(IMA),matrix metalloproteinase-9(MMP-9)and growth differentiation factor-15(GDF-15)were detected by ELISA,and the clinical efficacy was evaluated.Results The total effective rate was 92.9%(39/42)in observation group and that in the control group was 75.6%(31/41)(χ^(2)=4.67,P=0.031).After treatment,the scores of unconsciousness,consciousness trance,numbness and weakness,deviation of the eye and mouth and hemiplegia in observation group were significantly lower than those in the control group(t=2.18,3.11,2.80,2.07,2.24,all Ps<0.05),and the NIHSS score was significantly lower than that of the control group(t=2.58,P=0.012)while the MBI score was significantly higher than that of control group(t=2.59,P=0.011).After treatment,the levels of serum IMA[(67.05±8.34)mg/L vs.(71.48±8.52)mg/L,t=2.39],MMP-9[(100.72±12.49)ng/L vs.(107.66±13.05)ng/L,t=2.48]and GDF-15[(438.16±43.20)ng/L vs.(461.93±44.19)ng/L,t=2.48]in observation group were significantly lower than those in the control group(P<0.05).Conclusion The modified Huatan Tongluo Decoction combined with acupoint massage can relieve the clinical symptoms and brain damage degree,improve the neurological function and living ability,and enhance the clinical efficacy of patients with AIS.