通脑活络针刺法联合化瘀通脉消痹汤治疗脑梗死急性期临床研究

Clinical Study on Tongnao Huoluo Acupuncture Method Combined with Huayu Tongmai Xiaobi Decoction for Cerebral Infarction in Acute Stage

目的:观察通脑活络针刺法联合化瘀通脉消痹汤治疗脑梗死急性期风痰瘀阻证的临床疗效。方法:选取62例脑梗死急性期风痰瘀阻证患者,按照随机数字表法分为观察组和对照组各31例。2组均给予常规西药治疗,在此基础上对照组给予化瘀通脉消痹汤治疗,观察组给予通脑活络针刺法联合化瘀通脉消痹汤治疗。2组均治疗3周。比较2组临床疗效,血液流变学指标,血脂指标,脑血管储备功能,大脑中动脉血流速度及血清脑源性神经营养因子(BDNF)、细胞间黏附因子-1 (ICAM-1)、胰岛素样生长因子-1 (IGF-1)、血管内皮生长因子(VEGF)水平。结果:治疗后,观察组总有效率96.77%,高于对照组80.65%(P<0.05)。2组红细胞压积(HCT)、血小板黏附率(PAR)、纤维蛋白原(FIB)水平均较治疗前降低(P<0.05),观察组HCT、PAR、FIB水平均低于对照组(P<0.05)。2组血清甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)水平均较治疗前降低(P<0.05),观察组血清TG、TC、LDL-C水平均低于对照组(P<0.05);2组血清高密度脂蛋白胆固醇(HDL-C)水平均较治疗前升高(P<0.05),观察组血清HDL-C水平高于对照组(P<0.05)。2组脑血管储备功能及大脑中动脉收缩期峰值血流速度(Vs)、舒张末期血流速度(Vd)、平均血流速度(Vm)均较治疗前升高(P<0.05),观察组脑血管储备功能及大脑中动脉Vs、Vd、Vm均高于对照组(P<0.05)。2组血清BDNF、IGF-1、VEGF水平均较治疗前升高(P<0.05),观察组血清BDNF、IGF-1、VEGF水平均高于对照组(P<0.05);2组血清ICAM-1水平均较治疗前降低(P<0.05),观察组血清ICAM-1水平低于对照组(P<0.05)。结论:通脑活络针刺法联合化瘀通脉消痹汤治疗脑梗死急性期风痰瘀阻证,可改善血液流变学,调节血脂,增强脑血管储备功能,促进神经功能恢复。

Objective:To observe the clinical effect of Tongnao Huoluo Acupuncture Method combined with Huayu Tongmai Xiaobi Decoction for cerebral infarction in acute stage with wind-phlegm stasis syndrome.Methods:A total of 62 cases of patients with cerebral infarction in acute stage with windphlegm stasis syndrome were selected and divided into the observation group and the control group according to the random number table method,with 31 cases in each group.Both groups were treated with routine western medicine;the control group was additionally treated with Huayu Tongmai Xiaobi Decoction,and the observation group was additionally treated with Tongnao Huoluo Acupuncture Method combined with Huayu Tongmai Xiaobi Decoction.Both groups were treated for 3 weeks.The clinical effects,hemorheology indexes,blood lipid indexes,cerebrovascular reserve function,blood flow velocity of middle cerebral artery,and levels of brain-derived neurotrophic factor(BDNF),intercellular adhesion molecule-1(ICAM-1),insulin-like growth factor-1(IGF-1)and vascular endothelial growth factor(VEGF)in serum were compared between the two groups.Results:After treatment,the total effective rate was 96.77%in the observation group,higher than that of 80.65%in the control group(P<0.05).Hematocrit(HCT),platelet adhesion rate(PAR),and fibrinogen(FIB)levels in the two groups were decreased when compared with those before treatment(P<0.05),and HCT,PAR,and FIB levels in the observation group were lower than those in the control group(P<0.05).The levels of triglyceride(TG),total cholesterol(TC),and low-density lipoprotein cholesterol(LDL-C)in serum in the two groups were decreased when compared with those before treatment(P<0.05),and the levels of TG,TC,and LDL-C in serum in the observation group were lower than those in the control group(P<0.05).The levels of highdensity lipoprotein cholesterol(HDL-C)in serum in the two groups were increased when compared with those before treatment(P<0.05),and the level of HDL-C in serum in the observation group was higher than that in the control group(P<0.05).The cerebrovascular reserve function and peak systolic blood flow velocity(Vs),end-diastolic blood flow velocity(Vd)and mean blood flow velocity(Vm)of middle cerebral artery in the two groups were increased when compared with those before treatment(P<0.05),and the cerebrovascular reserve function and Vs,Vd and Vm of middle cerebral artery in the observation group were higher than those in the control group(P<0.05).The levels of BDNF,IGF-1,and VEGF in serum in the two groups were increased when compared with those before treatment(P<0.05),and the levels of BDNF,IGF-1,and VEGF in serum in the observation group were higher than those in the control group(P<0.05).The levels of ICAM-1 in serum in the two groups were decreased when compared with those before treatment(P<0.05),and level of ICAM-1 in serum in the observation group was lower than that in the control group(P<0.05).Conclusion:Tongnao Huoluo Acupuncture Method combined with Huayu Tongmai Xiaobi Decoction for cerebral infarction in acute stage with wind-phlegm stasis syndrome can improve hemorheology,regulate blood lipids,enhance cerebrovascular reserve function,and promote the recovery of neurological function.