通窍化瘀汤辅助治疗缺血性脑卒中的疗效及对神经功能的影响

Clinical efficacy of Tongqiao Huayu decoction in the adjuvant treatment of ischemic stroke and its influence on neurological function

目的 观察通窍化瘀汤辅助治疗缺血性脑卒中的疗效及对神经功能的影响。方法 选取2021年1—12月泉州市中医院收治的缺血性脑卒中患者60例,按照随机数字表法分为中西联合组30例和丁苯酞组30例。在常规治疗基础上,丁苯酞组予丁苯酞软胶囊治疗,中西联合组在丁苯酞组基础上联合通窍化瘀汤治疗,2组均连续治疗30 d。比较2组临床疗效,治疗前后血清学指标[神经元特异性烯醇化酶(NSE)、血管内皮生长因子(VEGF)、同型半胱氨酸(Hcy)、超敏C反应蛋白(hs-CRP)]、血液流变学指标[纤维蛋白原(Fib)、血浆黏度(PV)、血小板聚集率]、美国国立卫生院卒中量表(NIHSS)评分、日常生活活动能力(ADL)评分及不良反应。结果 中西联合组总有效率为93.33%,高于丁苯酞组的70.00%(χ^(2)=5.455,P=0.020)。治疗30 d后,2组血清NSE、Hcy、hs-CRP水平较治疗前降低,血清VEGF水平较治疗前升高,且中西联合组降低或升高的幅度大于丁苯酞组(P<0.05或P<0.01);2组Fib、PV、血小板聚集率较治疗前降低,且中西联合组低于丁苯酞组(P<0.01);2组NIHSS评分较治疗前降低,ADL评分较治疗前升高,且中西联合组降低或升高的幅度大于丁苯酞组(P<0.01);中西联合组与丁苯酞组不良反应总发生率比较差异无统计学意义(3.33%vs.13.33%,χ^(2)=0.873,P=0.350)。结论 通窍化瘀汤在缺血性脑卒中的辅助治疗中具有显著临床效果,可明显改善血管内皮功能和血流动力学,改善患者神经功能和日常活动能力,且安全性较高。

Objective To observe the clinical efficacy of Tongqiao Huayu decoction in the adjuvant treatment of ischemic stroke and its influence on neurological function.Methods Sixty patients with ischemic stroke admitted to Quanzhou Hospital of Traditional Chinese Medicine from January to December 2021 were selected and randomly divided into the combined traditional Chinese and Western medicine group(n=30) and the butylphthalide group(n=30).On the basis of conventional treatment,the butylphthalide group was treated with butylphthalide soft capsules,and the combined traditional Chinese and Western medicine group was treated with Tongqiao Huayu decoction on the basis of butylphthalide group.Both groups were treated for 30 days.The clinical efficacy,serological indexes(NSE,VEGF,Hcy,hs-CRP),hemorheological indexes(Fib,PV,platelet aggregation rate),National Institutes of Health Stroke Scale(NIHSS) score,Activities of Daily Living(ADL) score before and after treatment,and adverse reactions were compared between the two groups.Results The total effective rate of the combined traditional Chinese and Western medicine group was 93.33%,which was higher than 70.00% of the butylphthalide group(χ^(2)=5.455,P=0.020).After 30 days of treatment,the levels of serum NSE,Hcy and hs-CRP were lower than those before treatment,and the levels of serum VEGF were higher than those before treatment,and the decrease or increase amplitude in the combined Chinese and Western medicine group was greater than that in the butylphthalide group(P<0.05 or P<0.01).The Fib,PV,platelet aggregation rate of two groups were lower than those before treatment,and the combined traditional Chinese and Western medicine group was lower than the butylphthalide group(P<0.01).NIHSS scores in the two groups were lower than those before treatment,the ADL scores were higher than those before treatment,and the decrease or increase amplitude in the combined Chinese and Western medicine group was greater than that in the butylphthalide group(P<0.01).There was no significant difference in the total incidence of adverse reactions between the combined traditional Chinese and Western medicine group and butylphthalide group(3.33% vs.13.33%,χ^(2)=0.873,P=0.350).Conclusion Tongqiao Huayu decoction has significant clinical effect in the adjuvant treatment of ischemic stroke,which can significantly improve vascular endothelial function and hemodynamics,improve neurological function and daily activity ability of patients,and has high safety.