针康法联合健脑醒聪汤治疗缺血性脑卒中后认知障碍患者的疗效观察

Efficacy of Zhenkang Therapy Combined with Jiannao Xingcong Decoction in Treatment of Patients with Cognitive Impairment after Ischemic Stroke

目的探讨健脑醒聪汤联合针康法治疗缺血性脑卒中后认知障碍患者的临床疗效。方法前瞻性选取2021年1月—2022年12月期间广东省中西医结合医院收治的135例缺血性脑卒中后认知障碍患者作为研究对象,采用随机数字表法分为对照A组、对照B组和治疗组,每组各45例。对照A组给予奥拉西坦,对照B组给予奥拉西坦+针康法,治疗组给予奥拉西坦+针康法+健脑醒聪汤。均持续治疗4周。观察比较3组患者临床疗效,治疗前后中医证候积分、美国国立卫生研究院卒中(National institute of health stroke scale,NIHSS)评分、Barthel指数(Barthel index,BI)、神经递质[脑源性神经营养因子(Brain-derived neurotrophic factor,BDNF)、胶质纤维酸性蛋白(Glial fibrillary acidic protein,GFAP)]水平。结果治疗后治疗组中医疗效总有效率88.89%(40/45)明显高于对照A组47.73%(21/44)、对照B组70.45%(31/44),差异有统计学意义(P<0.05)。治疗后治疗组西医疗效总有效率91.11%(41/45)高于对照A组52.27%(23/44)、对照B组72.73%(32/44),差异有统计学意义(P<0.05)。治疗4周后3组患者中医证候头痛如刺、智能减退、神情默默、寡言少语评分均较治疗前降低,差异有统计学意义(P<0.05);且治疗组中医证候头痛如刺、智能减退、神情默默、寡言少语评分均明显低于对照A、B组,差异有统计学意义(P<0.05)。治疗4周后3组患者BI评分均较治疗前升高,NIHSS评分均较治疗前降低,差异有统计学意义(P<0.05);且治疗组BI评分明显高于对照A、B组,NIHSS评分明显低于对照A、B组,差异有统计学意义(P<0.05)。治疗4周后3组患血清BDNF水平均较治疗前升高,GFAP水平均较治疗前降低,差异有统计学意义(P<0.05);且治疗组血清BDNF水平明显高于对照A、B组,GFAP水平明显低于对照A、B组,差异有统计学意义(P<0.05)。治疗期间,3组患者血常规、尿常规、心电图、肝肾功能、便常规、血压等安全性指标均无异常改变。结论针康法联合健脑醒聪汤能有效改善缺血性脑卒中后认知障碍患者神经功能,缓解临床症状,提高日常生活能力,增强疗效,机制可能与调节BDNF、GFAP水平有关。

Objective To investigate the clinical efficacy of Jiannao Xingcong Decoction combined with Zhenkang therapy(acupuncture+rehabilitation)in treating cognitive impairment in patients after ischemic stroke.Methods This prospective study included 135 patients with cognitive impairment after ischemic stroke,treated at Guangdong Provincial Hospital of Integrated Traditional Chinese and Western Medicine from January 2021 to December 2022.Patients were randomly divided into three groups:control group A(oxiracetam),control group B(oxiracetam+Zhenkang therapy),and the treatment group(oxiracetam+Zhenkang therapy+Jiannao Xingcong Decoction),with 45 cases in each group.All treatments lasted for four weeks.Clinical efficacy,traditional Chinese medicine(TCM)symptom scores,National Institute of Health Stroke Scale(NIHSS)scores,Barthel Index(BI)scores,and levels of neurotransmitters[brain-derived neurotrophic factor(BDNF)and glial fibrillary acidic protein(GFAP)]of the three groups were compared before and after treatment.Results After treatment,the total clinical efficacy in the treatment group was 88.89%(40/45),significantly higher than 47.73%(21/44)in the control group A and 70.45%(31/44)in the control group B(P<0.05).The total efficacy of Western medicine in the treatment group was 91.11%(41/45),significantly higher than 52.27%(23/44)in the control group A and 72.73%(32/44)in the control group B(P<0.05).After four weeks,TCM symptom scores for headache like stabbing,intelligence reduction,silent demeanor,and reticence were significantly lower in all groups compared to those before treatment(P<0.05),with the treatment group showing significantly lower scores than control groups A and B(P<0.05).BI scores increased and NIHSS scores decreased significantly in all groups after treatment(P<0.05),with the treatment group showing significantly higher BI scores and lower NIHSS scores than control groups A and B(P<0.05).Serum BDNF levels increased and GFAP levels decreased significantly in all groups after treatment(P<0.05),with the treatment group showing significantly higher BDNF and lower GFAP levels than control groups A and B(P<0.05).During the treatment,there were no abnormal changes in safety indicators such as routine blood tests,urine tests,electrocardiograms,liver and kidney function tests,stool tests,and blood pressure in the three groups.Conclusion The combination of Zhenkang therapy and Jiannao Xingcong Decoction effectively improves neurological function,alleviates clinical symptoms,and enhances daily living abilities in patients with cognitive impairment after ischemic stroke.The underlying mechanism may be related to the regulation of BDNF and GFAP levels.