天麻钩藤饮联合丁苯酞序贯疗法治疗急性缺血性脑卒中(风阳上扰)的临床观察

Clinical Observation of Tianma Gouteng Decoction(天麻钩藤饮)Combined with Butylphthalide Sequential Therapy in the Treatment of Acute Ischemic Stroke Patients with Wind-Yang Disturbance Syndrome

目的探讨天麻钩藤饮联合丁苯酞序贯疗法治疗急性缺血性脑卒中(AIS)(风阳上扰)的临床疗效。方法随机将75例AIS(风阳上扰)患者分成对照组37例,观察组38例。对照组在常规治疗基础上加用丁苯酞序贯疗法,观察组在对照组基础上加用天麻钩藤饮。分别于治疗前、治疗后、治疗后3个月观察两组美国国立卫生院卒中量表(NIHSS)、改良Rankin评分(mRS)、改良Barthel指数(MBI)、Fugl-Meyer量表(FMA)、中医证候评分、大脑中动脉平均血流速度(Vm)及搏动指数(PI),评价两组疗效及治疗前、治疗后3个月血管内皮生长因子(VEGF)、血管生成素-1(Ang-1)、碱性成纤维细胞生长因子(bFGF)表达水平。结果治疗后、治疗后3个月观察组NIHSS、mRS、中医证候评分及PI均低于对照组(P<0.05),MBI、FMA评分及Vm均高于对照组(P<0.05),观察组临床疗效优于对照组(P<0.05),VEGF、Ang-1、bFGF观察组较对照组显著升高(P<0.01)。结论天麻钩藤饮联合丁苯酞序贯疗法能更好地促进AIS(风阳上扰)患者VEGF、Ang-1、bFGF分泌,提高脑血流动力,改善神经功能缺损症状,促进神经功能恢复,改善日常生活能力,促进运动能力恢复,为中西医结合治疗AIS提供了临床依据。

Objective To investigate the clinical efficacy of Tianma Gouteng Decoction(天麻钩藤饮)combined with butylphthalide sequential therapy in the treatment of acute ischemic stroke(AIS)with wind-yang disturbance syndrome,and its effect on cerebral blood flow and angiogenesis.Methods Randomly divide 80 patients with AIS with wind-yang disturbance syndrome into a control group and an observation group.Finally,37 cases in the control group and 38 cases in the observation group completed the test.The control group was treated with butylphthalide sequential therapy on the basis of conventional treatment,and the observation group was treated with Tianma Gouteng Decoction on the basis of the treatment of the control group.The National Institutes of Health Stroke Scale(NIHSS),Modified Rankin Score(mRS),Modified Barthel Index(MBI),Fugl-Meyer Scale(FMA)were observed before treatment,14 days after treatment,and 3 months after treatment.Traditional Chinese medicine syndrome score,middle cerebral artery average blood flow velocity(Vm)and pulsatility index(PI);and further evaluate the efficacy of the two groups and vascular endothelial growth factor(VEGF)and angiogenin treatment-1(Ang-1),basic fibroblast growth factor(bFGF)expression levels.Results Comparing the observation group with the control group,the NIHSS,mRS,traditional Chinese medicine syndrome scores and PI of the observation group 14 days after treatment and 3 months after treatment were lower than those of the control group(P<0.05),and MBI,FMA scores and Vm were all higher In the control group(P<0.05),further studies showed that the observation group had better efficacy than the control group(P<0.05),and VEGF,Ang-1,bFGF in the observation group were significantly higher than those in the control group(P<0.01).Conclusion Tianma Gouteng Decoction combined with butylphthalide sequential therapy can better promote the secretion of angiogenesis-related indicators VEGF,Ang-1,bFGF in patients with AIS wind-yang disturbance syndrome,improve cerebral blood flow,and improve neurological deficits symptoms,promote the recovery of nerve function,improve the ability of daily living,and promote the recovery of exercise ability,providing a clinical basis for the treatment of AIS with integrated Chinese and western medicine.