平肝熄风汤结合氟桂利嗪治疗眩晕临床疗效观察

Observation of Clinical Effect on Pinggan Xifeng Decoction(平肝熄风汤)Combined with Flunarizine in Treatment of Vertigo

目的探究平肝熄风汤结合氟桂利嗪治疗眩晕(肝阳上亢型)临床疗效及安全性。方法研究纳入103例眩晕(肝阳上亢型)患者(2018年5月—2020年3月收治),并以随机数字表法将纳入患者分成两组,予以对照组51例患者氟桂利嗪治疗,予以观察组52例患者氟桂利嗪+平肝熄风汤治疗,比较两组患者治疗效果、治疗前后患者中医证候(主症、次症、舌脉象)积分变化、视觉眩晕模拟量表(visual vertigo analogue scale,VVAS)评分变化及前庭症状指数(vestibular symptom index,VSI)变化、头晕残障量表(dizziness handicap inventory,DHI)评分变化、治疗前后两组患者血糖以及血脂水平变化、椎-基底动脉血流动力学指标变化、治疗前后血清同型半胱氨酸(homocysteine,Hcy)以及尿微量白蛋白(urine microalbumin,UmALB)水平变化、治疗不良反应情况与1年复发率。结果观察组与对照组总有效率分别为96.15%(50/52)、84.31%(43/51),观察组有效率更高(P<0.05);治疗前,两组中医证候(主症、次症、舌脉象)积分、VVAS评分及VSI评分、DHI评分、血糖以及血脂水平、椎动脉平均血流速度(mean flow velocity of vertebral artery,MV)及血管搏动指数(thepulsatility index,PI)、基底动脉MV及PI水平、Hcy及UmALB水平等指标比较,P>0.05,治疗后各组患者中医证候(主症、次症、舌脉象)积分、VVAS评分及VSI评分、DHI评分、血糖以及血脂水平、椎动脉MV及PI、基底动脉MV及PI水平、Hcy及UmALB水平等指标均改善,观察组治疗后中医证候(主症、次症、舌脉象)积分、VVAS评分及VSI评分、DHI评分、血糖以及血脂水平、椎动脉MV及PI、基底动脉MV及PI水平、Hcy及UmALB水平等指标均优于对照组(P<0.05);对照组与观察组不良反应率分别为9.80%(5/51)、0.00%(0/52),观察组更低(P<0.05);对照组患者1年复发率(7.84%,4/51)高于观察组患者(0.00%,0/52)(P<0.05)。结论平肝熄风汤结合氟桂利嗪治疗眩晕(肝阳上亢型)临床疗效显著,患者症状改善,恢复较好,且患者不良反应少,1年复发率低,安全可靠,值得应用。

Objective To explore the clinical efficacy and safety of Pinggan Xifeng Decoction(平肝熄风汤)combined with flunarizine in the treatment of vertigo(hyperactivity of liver Yang type).Methods In this study,103 patients with vertigo(hyperactivity of liver Yang type)admitted from May 2018 to March 2020 were divided into two groups by random number table method.Fifty-one patients in the control group were treated with flunarizine,and 52 patients in the observation group were treated with flunarizine+Pinggan Xifeng Decoction.The treatment effect of patients in each group,the changes of TCM syndromes(main symptoms,secondary symptoms,tongue and pulse),the changes of visual vertigo analog scale(VVAS)score,vestibular symptom index(VSI)score and Dizziness Handicap Inventory(DHI)score,the changes of blood glucose and blood lipid levels of patients in both groups before and after treatment,the changes of vertebral basilar artery hemodynamics,serum homocysteine(Hcy)and urinary microalbumin(UmALB)before and after treatment,adverse reactions and 1-year recurrence rate of patients were compared.Results The total effective rate of the observation group and control group was 96.15%(50/52)and 84.31%(43/51),respectively,and the effective rate of the observation group was higher(P<0.05).Before treatment,the scores of TCM syndromes(primary symptom,secondary symptom,tongue and pulse),VVAS score,VSI score,DHI score,levels of blood glucose and blood lipid,mean blood flow velocity(mV)and vascular pulse index(PI)of vertebral artery,the levels of MV and PI of basilar artery,the levels of Hcy and Umalb and other indexes in two groups were not significant(P>0.05).After treatment,the scores of TCM syndromes(primary symptom,secondary symptom,tongue and pulse),VVAS score,VSI score,DHI score,levels of blood glucose and blood lipid,mean blood flow velocity(mV)and vascular pulse index(PI)of vertebral artery,the levels of MV and PI of basilar artery,the levels of Hcy and Umalb and other indexes were improved in each group.After treatment,the scores of TCM syndromes(primary symptom,secondary symptom,tongue and pulse),VVAS score,VSI score,DHI score,levels of blood glucose and blood lipid,mean blood flow velocity(mV)and vascular pulse index(PI)of vertebral artery,the levels of MV and PI of basilar artery,the levels of Hcy and Umalb in the observation group were all better than those in the control group(P<0.05).The adverse reaction rates of the control group and observation group were 9.80%(5/51)and 0.00%(0/52),respectively,and that of the observation group was lower(P<0.05).The 1-year recurrence rate in the control group(7.84%,4/51)was higher than that in the observation group(0.00%,0/52)(P<0.05).Conclusion Pinggan Xifeng Decoction combined with flunarizine in the treatment of vertigo(hyperactivity of liver Yang type)has significant clinical efficacy,with improved symptoms and good recovery,less adverse reactions and low 1-year recurrence rate,which is safe and reliable and worthy of application.