芪仙通络方熏蒸辅助治疗对脑梗死后偏瘫气虚血瘀证患者神经功能及康复效果的影响

Clinical study of Qixian Tongluo Prescription fumigation on nerve function and rehabilitation effect in patients with hemiplegia after cerebral infarction with qi-deficiency blood stasis syndrome

目的探讨芪仙通络方熏蒸辅助治疗对脑梗死后偏瘫气虚血瘀证患者神经功能及康复效果的影响。方法随机对照试验设计。选取2020年10月-2021年12月本院68例脑梗死后偏瘫气虚血瘀证患者作为观察对象,采用随机单双编号法分为2组,每组34例。对照组予以西医常规疗法治疗,观察组在对照组基础上辅助芪仙通络方熏蒸。2组均持续治疗8周。分别于治疗前后进行中医证候评分,采用美国国立卫生研究院卒中量表(NIHSS)评估神经功能缺损程度,Fugl-Meyer运动功能量表(FMA)评估肢体运动障碍程度;采用ELISA法检测中枢神经特异性蛋白β(S100β)、神经元特异性烯醇化酶(NSE)、内皮素(ET)、一氧化氮(NO)、CRP、SOD水平,评价临床疗效。结果观察组总有效率为94.12%(32/34)、对照组为76.47%(26/34),2组比较差异有统计学意义(χ^(2)=4.22,P=0.040)。观察组治疗后半身不遂、气短乏力、心悸、手足肿胀积分低于对照组(t值分别为3.44、2.37、2.72、3.89,P<0.05或P<0.01);NIHSS评分低于对照组(t=6.56,P<0.01);FMA上肢、下肢评分高于对照组(t值分别为2.17、2.78,P<0.05)。治疗后,观察组血清S-100β[(0.69±0.27)μg/L比(0.85±0.36)μg/L,t=2.07]、NSE[(8.36±3.69)μg/L比(11.34±4.93)μg/L,t=2.82]、ET[(53.16±12.12)ng/L比(61.25±11.31)ng/L,t=2.85]水平低于对照组(P<0.05或P<0.01),NO[(82.26±14.53)μmol/L比(70.16±12.27)μmol/L,t=3.71]水平高于对照组(P<0.01);血清CRP水平低于对照组(t=2.74,P<0.01),SOD活力高于对照组(t=2.49,P<0.05)。结论芪仙通络方熏蒸辅助治疗可有效促进脑梗死后偏瘫患者神经功能及血管内皮功能的恢复,改善患者肢体功能障碍,提高临床疗效。

Objective To explore the effect of Qixian Tongluo Prescription fumigation on nerve function and rehabilitation effect in patients with hemiplegia after cerebral infarction of qi-deficiency blood stasis syndrome.Methods Randomized controlled trial.Sixty-eight patients with hemiplegia after cerebral infarction of qi-deficiency blood stasis syndrome in the hospital were enrolled between October 2020 and December 2021.According to random odd-even numbering method,participants were divided into the control group(routine western medicine)and the observation group(Qixian Tongluo Prescription fumigation on basis of control group),34 in each group.All were continuously treated for 8 weeks.TCM syndromes were scored before and after treatment.The severity of neurological impairment was evaluated by National Institutes of Health Stroke Scale(NIHSS).The severity of limb movement disorder was evaluated by Fugl-Meyer Assessment(FMA).The levels of central nervous specific protein(S-100β),neuron-specific enolase(NSE),endothelin(ET),nitric oxide(NO),C-reactive protein(CRP)and superoxide dismutase(SOD)were detected by ELISA.The clinical response rate was assessed.Results There were significant differences in total response rate between the observation group and the control group[94.12%(32/34)vs.76.47%(26/34);χ^(2)=4.22,P=0.040].After treatment,scores of hemiplegia,shortness of breath,palpitation and limbs swelling in observation group were significantly lower than those in the control group(t=3.44,2.37,2.72,3.89,P<0.05 or P<0.01),NIHSS score was significantly lower than that of the control group(t=6.56,P<0.01),and FMA scores of upper and lower limbs were significantly higher than those in the control group(t=2.17,2.78,P<0.05).After treatment,levels of serum S-100β[(0.69±0.27)μg/L vs.(0.85±0.36)μg/L,t=2.07],NSE[(8.36±3.69)μg/L vs.(11.34±4.93)μg/L,t=2.82]and ET[(53.16±12.12)ng/L vs.(61.25±11.31)ng/L,t=2.85]in observation group were significantly lower than those in the control group(P<0.05 or P<0.01),while NO[(82.26±14.53)μmol/L vs.(70.16±12.27)μmol/L,t=3.71]was significantly higher than that of the observation group(P<0.01).The level of serum CRP in observation group was significantly lower than that of the control group(t=2.74,P<0.01),and SOD activity was significantly higher than that of the control group(t=2.49,P<0.05).Conclusion Qixian Tongluo Prescription fumigation can promote the recovery of nerve function and vascular endothelial function in patients with hemiplegia after cerebral infarction,improve limb disorders and clinical effect.