真实世界益气活血法治疗脑梗死气虚血瘀证疗效的多因素分析

Multivariate Analysis of Therapeutic Effect of Supplementing Qi and Promoting Blood Circulation Method in Real World on Qi Deficiency and Blood Stasis Syndrome of Cerebral Infarction

目的 观察真实世界益气活血法治疗脑梗死气虚血瘀证的疗效及影响因素。方法 本研究纳入2019年1月至2023年2月于北京中医药大学东直门医院通州院区脑病科就诊的226例脑梗死气虚血瘀证患者,给予中药益气活血法(补阳还五汤或小续命汤加减)治疗2周后观察美国国立卫生研究院卒中量表(National Institute of Health stroke scale, NIHSS)评分、改良Rankin评分(Modified Rankin scale,MRS)和日常生活活动能力表评分(Barthel Index of Activities of Daily Living, BI)并进行疗效的多因素分析。结果 中药益气活血法可改善脑梗死气虚血瘀证患者的NIHSS评分、MRS评分和BI评分,而影响NIHSS评分、MRS评分和BI评分的主要因素为年龄、合并疾病数量、基线MRS评分和BI评分。合并高血压影响NIHSS评分疗效,合并高血压、冠状动脉粥样硬化性心脏病、高脂血症和糖尿病等对MRS评分疗效无影响。结论 患者年龄、合并疾病数量、基线MRS评分、基线BI评分是影响中药益气活血法治疗脑梗死气虚血瘀证疗效的因素。

Objective To observe the therapeutic effect and influencing factors of Qi-tonifying and Blood-activating therapy in the acute phase of Qi deficiency and Blood stasis syndrome in stroke patients in the real world.Methods This study included 226 stroke patients with acute phase Qi deficiency and Blood stasis syndrome admitted to the Neurology Department of the Tongzhou Branch of Dongzhimen Hospital,Beijing University of Chinese Medicine from January 2019 to February 2023.They were treated with Supplementing Qi and Promoting Blood Circulation(Buyang Huanwu decoction or Xiaoxuming decoction combined with modifications)for 2 weeks.The NIHSS score,modified Rankin scale,and Barthel index were observed and subjected to Multivariate analysis.Results Qi-tonifying and Blood-activating therapy with Chinese herbal medicine could reduce the NIHSS score,modified Rankin scale,and increase Barthel index in stroke patients with acute phase Qi deficiency and Blood stasis syndrome.The main factors affecting the NIHSS score,modified Rankin scale,and Barthel index were age,number of comorbidities,baseline modified Rankin scale,and baseline Barthel index.Hypertension affected the therapeutic effect of NIHSS score,while hypertension,coronary heart disease,hyperlipidemia,and diabetes did not affect the therapeutic effect of the modified Rankin scale.Conclusion Age,number of comorbidities,baseline modified Rankin scale,and baseline Barthel index are factors that affect the therapeutic effect of Qi-tonifying and Blood-activating therapy in the acute phase of Qi deficiency and Blood stasis syndrome in stroke patients.