化痰醒脑方联合重复经颅磁刺激治疗脑梗死

Huatan Xingnao Formula Combined with Repeated Transcranial Magnetic Stimulation in Treatment of Cerebral Infarction

目的:观察化痰醒脑方联合重复经颅磁刺激对脑梗死患者运动诱发电位(motor evoked potential,MEP)潜伏期、中枢运动传导时间(central motor conduction time,CMCT)、脑血流动力学的影响。方法:158例脑梗死患者随机分为对照组和观察组各79例。对照组给予重复经颅磁刺激,观察组在对照组治疗基础上给予化痰醒脑方。观察两组患者治疗前后MEP潜伏期、CMCT、大脑血流峰值流速(peak systolic velocity,Vs)、脑血管储备(cerebrovascular reserve,CVR)、血管阻力指数(resistance index,RI)、血管搏动指数(pulsatility index,PI)、美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分、中医证候积分、超氧化物歧化酶(super oxide dimutese,SOD)水平、丙二醛(methane dicarboxylic aldehyde,MDA)水平,两组患者临床疗效、不良反应。结果:观察组治疗后MEP潜伏期为(20.17±1.64)ms、CMCT为(9.23±0.82)ms,对照组治疗后MEP潜伏期为(21.86±1.85)ms、CMCT为(10.33±0.84)ms,观察组治疗后MEP潜伏期和CMCT均低于同期对照组,差异均有统计学意义(P<0.05)。观察组治疗后Vs为(58.22±5.24)cm·s^(-1)、CVR为(38.82±3.09)%,对照组治疗后Vs为(48.19±3.40)cm·s^(-1)、CVR为(33.98±4.11)%,观察组治疗后Vs、CVR均高于同期对照组,差异有统计学意义(P<0.05)。观察组治疗后RI为(0.55±0.09)、PI为(0.73±0.09),对照组治疗后RI为(0.64±0.12)、PI为(0.90±0.10),观察组治疗后RI、PI低于同期对照组,差异有统计学意义(P<0.05)。观察组治疗后SOD为(118.83±6.83)U·mL^(-1)、MDA为(3.13±0.89)μmol·L^(-1),对照组治疗后SOD为(107.87±9.02)U·mL^(-1)、MDA为(4.98±0.92)μmol·L^(-1),观察组治疗后SOD水平高于同期对照组,MDA水平低于同期对照组,差异有统计学意义(P<0.05)。观察组治疗后NIHSS评分为(4.33±1.35)分、中医证候积分为(5.78±1.57)分,对照组治疗后NIHSS评分为(7.89±1.83)分、中医证候积分为(14.03±2.71)分,观察组治疗后NIHSS评分、中医证候积分均低于同期对照组,差异有统计学意义(P<0.05)。观察组有效率为97.47%,对照组有效率为84.81%,观察组高于对照组,差异有统计学意义(P<0.05)。观察组不良反应发生率为6.33%,对照组不良反应发生率为8.86%,两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:化痰醒脑方联合重复经颅磁刺激治疗脑梗死临床疗效显著,能够改善患者脑血流动力学、氧化应激反应,促进神经功能的恢复,且无明显不良反应。

Objective:To observe the effect of Huatan Xingnao Formula combined with repetitive transcranial magnetic stimulation on evoked motor evoked potential(MEP)latency and central motor conduction time(CMCT)and cerebral hemodynamics in patients with cerebral infarction.and cerebral hemodynamics.Methods:158 patients with cerebral infarction were randomly divided into control group and observation group,with 79 cases in each group.The control group was given repeated transcranial magnetic stimulation,and the observation group was given Huatan Xingnao Formula on basis of the control group.MEP latency,CMCT,peak systolic velocity(Vs),cerebrovascular reserve(CVR),and vascular resistance index(RI),pulsatility index(PI),National Institute of Health stroke scale(NIHSS)score,TCM syndrome score,the level of super oxide dimutese(SOD)and methane dicarboxylic aldehyde(MDA),clinical efficacy and adverse reactions of the two groups were observed before and after treatment.Results:The latency of MEP and CMCT after treatment was(20.17±1.64)ms and(9.23±0.82)ms in the observation group,and(21.86±1.85)ms and(10.33±0.84)ms in the control group.The latency of MEP and CMCT in the observation group were lower than those in the control group.The differences were statistically significant(P<0.05).The Vs(58.22±5.24)cm·s^(-1) and CVR(38.82±3.09)%in the observation group after treatment,Vs(48.19±3.40)cm·s^(-1) and CVR(33.98±4.11)%in the control group after treatment,and Vs and CVR in the observation group after treatment were higher than those in the control group.The difference was statistically significant(P<0.05).After treatment,RI(0.55±0.09)and PI(0.73±0.09)in the observation group,and RI(0.64±0.12)and PI(0.90±0.10)in the control group were lower than those in the control group,and the difference was statistically significant(P<0.05).SOD(118.83±6.83)U·mL^(-1) and MDA(3.13±0.89)μmol·L^(-1) in the observation group,SOD(107.87±9.02)U·mL^(-1) and MDA(4.98±0.92)μmol·L^(-1) in the control group,and MDA(3.13±0.89)μmol·L^(-1) in the control group.After treatment,SOD level in observation group was higher than that in control group,MDA level was lower than that in control group,and the difference was statistically significant(P<0.05).NIHSS score(4.33±1.35)and TCM syndrome score(5.78±1.57)in the observation group after treatment;NIHSS score(7.89±1.83)and TCM syndrome score(14.03±2.71)in the control group after treatment;NIHSS score and TCM syndrome score in the observation group after treatment were lower than those in the control group.The difference was statistically significant(P<0.05).The effective rate was 97.47%in the observation group and 84.81%in the control group,and the difference was statistically significant(P<0.05).The incidence of adverse reactions was 6.33%in the observation group and 8.86%in the control group.There was no significant difference between the two groups(P>0.05).Conclusion:Huatan Xingnao Formula combined with repeated transcranial magnetic stimulation has significant clinical efficacy in treatment of cerebral infarction,which can improve cerebral hemodynamics and oxidative stress response,promote the recovery of nerve function,with no obvious adverse reactions.