化痰熄风通络汤联合依达拉奉右莰醇治疗急性脑梗死的临床疗效分析

Clinical analysis of Huatan Xifeng Tongluo Decoction combined with edaravone and dexborneol in the treatment of acute cerebral infarction

目的探讨化痰熄风通络汤联合依达拉奉右莰醇治疗急性脑梗死(ACI)的疗效。方法205例急性脑梗死患者,按照随机数字表法分为试验组(103例,因自然失访脱落2例,最终101例)及对照组(102例,因自然失访脱落3例,最终99例)。对照组给予依达拉奉右莰醇注射液治疗,试验组在对照组的治疗基础上同时给予化痰熄风通络汤治疗。比较两组神经功能[美国国立卫生研究院卒中量表(NIHSS)评分、改良Rankin量表(mRS)评分]、自理能力[Barthel指数(BI)]、临床疗效、血液流变学指标(全血低切粘度、全血高切粘度、血浆粘度)、肝肾功能[谷丙转氨酶(GPT)、谷草转氨酶(GOT)、血肌酐(Scr)、胱抑素C(Cys C)、β_(2)微球蛋白(β_(2)-MG)、视黄醇结合蛋白(RBP)]、神经元特异性烯醇化酶(NSE)及药物的安全性。结果两组治疗后NIHSS评分、mRS评分均降低,BI评分均升高;且试验组治疗后NIHSS评分(4.02±0.68)分、mRS评分(0.98±0.17)分低于对照组的(4.81±0.87)、(1.19±0.21)分,BI评分(72.69±5.32)分高于对照组的(68.12±5.17)分,差异有统计学意义(P<0.05)。治疗后,试验组总有效率为91.09%(92/101),高于对照组的80.81%(80/99),差异有统计学意义(P<0.05)。两组治疗后的血浆粘度、全血高切粘度、全血低切粘度均降低,且试验组治疗后血浆粘度(1.49±0.27)mPa·s、全血高切粘度(4.01±0.75)mPa·s、全血低切粘度(7.15±1.12)mPa·s均低于对照组的(1.72±0.31)、(4.43±0.85)、(8.06±1.23)mPa·s,差异有统计学意义(P<0.05)。两组治疗前后的GPT、GOT、Scr、Cys C、β_(2)-MG、RBP对比,差异均无统计学意义(P>0.05)。两组治疗后NSE均降低,且试验组治疗后NSE(8.14±2.16)ng/ml低于对照组的(12.23±3.23)ng/ml,差异有统计学意义(P<0.05)。试验组和对照组药物不良反应发生率分别为5.94%(6/101)和5.05%(5/99),比较差异无统计学意义(P>0.05)。结论化痰熄风通络汤联合依达拉奉右莰醇治疗急性脑梗死,可促进患者神经功能缺损症状恢复,提高生活自理能力,改善血液流变学,且安全性良好。

Objective To explore the efficacy of Huatan Xifeng Tongluo Decoction combined with edaravone and dexborneol in the treatment of acute cerebral infarction(ACI).Methods 205 patients with acute cerebral infarction were divided into an experimental group(103 cases,2 drop-out cases due to loss of followup,and finally 101 cases remained)and a control group(102 cases,3 drop-out cases due to loss of follow-up,and finally 99 cases remained)according to random number table method.The control group was treated with edaravone and dexborneol for injection,and the experimental group was treated with Huatan Xifeng Tongluo Decoction on the basis of the control group.Both groups were compared in terms of neurological function[National Institutes of Health Stroke Scale(NIHSS)score and Modified Rankin Scale(mRS)score],self-care ability[Barthel index(BI)],clinical efficacy,hemorheology index(whole blood low shear viscosity,whole blood high shear viscosity,plasma viscosity),liver and kidney function[glutamic pyruvate transaminase(GPT),glutamic oxaloacetic transaminase(GOT),serum creatinine(Scr),cystatin C(Cys C),β_(2) microglobulin(β_(2)-MG),retinol binding protein(RBP)],neuron specific enolase,and drug safety.Results After treatment,NIHSS score and mRS score decreased,and BI score increased in both groups;the experimental group had NIHSS score of(4.02±0.68)points and mRS score of(0.98±0.17)points,which were lower than(4.81±0.87)and(1.19±0.21)points in the control group;the experimental group had higher BI score of (72.69±5.32) points than (68.12±5.17) points in the control group;the difference was statistically significant (P<0.05). After treatment, the total effective rate of the experimental group was 91.09% (92/101), which was higher than 80.81% (80/99) of the control group, and the difference was statistically significant (P<0.05). After treatment, the plasma viscosity, whole blood high shear viscosity and whole blood low shear viscosity decreased in both groups;in the experimental group, the plasma viscosity was (1.49±0.27) mPa·s, the whole blood high shear viscosity was (4.01±0.75) mPa·s and the whole blood low shear viscosity was (7.15±1.12) mPa·s, which were lower than (1.72±0.31), (4.43±0.85) and (8.06±1.23) mPa·s in the control group;the difference was statistically significant (P<0.05). There were no significant differences in GPT, GOT, Scr, Cys C, β_(2)-MG and RBP between the two groups before and after treatment (P>0.05). After treatment, NSE in both groups decreased, and the experimental group had lower NSE of (8.14±2.16) ng/ml than (12.23±3.23) ng/ml in the control group. The difference was statistically significant (P<0.05). The incidence of adverse drug reactions in the experimental group and the control group were 5.94% (6/101) and 5.05% (5/99), and the difference was not statistically significant in comparison (P>0.05). Conclusion Huatan Xifeng Tongluo Decoction combined with edaravone and dexborneol in the treatment of acute cerebral infarction can promote the recovery of neurological deficit, enhance self-care ability, improve hemorheology with good safety.