通窍活血汤对缺血性脑卒中昏迷患者促醒作用的临床研究

Clinical Study on the Awakening Effect of Tongqiao Huoxue Decoction in Patients with Ischemic Stroke Coma

目的:分析通窍活血汤对缺血性脑卒中昏迷患者的促醒作用,探讨其安全性与有效性。方法:选择2023年1月至2024年4月南方医科大学南方医院白云分院接诊的60例缺血性脑卒中昏迷患者,以随机数字表法将其分为对照组与观察组,各30例。对照组患者行常规西医治疗,观察组患者在对照组基础上加以通窍活血汤鼻饲治疗。比较两组患者疗效、格拉斯哥昏迷量表(GCS)、美国国立卫生研究院卒中量表(NIHSS)、苏醒情况、肌力分级、血象指标及安全性指标。结果:观察组患者治疗总有效率为80.00%,高于对照组的53.33%,差异具有统计学意义(P<0.05);观察组患者的苏醒率为76.67%,高于对照组的50.00%,差异具有统计学意义(P<0.05);观察组患者促醒时间较对照组短,差异具有统计学意义(P<0.05);治疗后观察组患者GCS评分高于对照组,NIHSS评分低于对照组,差异具有统计学意义(P<0.05);治疗后观察组患者血清同型半胱氨基酸(Hcy)、N末端脑钠肽前体(NT–proBNP)水平低于对照组,差异具有统计学意义(P<0.05);治疗后观察组患者下肢肌力4~5级占比为76.67%,高于对照组的50.00%,差异具有统计学意义(P<0.05);两组患者不良反应情况比较,差异无统计学意义(P>0.05)。结论:通窍活血汤联合常规西医治疗可有效提高缺血性脑卒中昏迷患者促醒效果,缩短促醒时间,改善患者神经功能、生理状况,并具有较高的安全性,其机制可能与降低Hcy、NT–proBNP水平有关。

Objective To analyze the awakening effect of Tongqiao Huoxue Decoction on patients with ischemic stroke coma and to explore its safety and efficacy.Methods A total of 60 patients with ischemic stroke coma who were admitted to Baiyun Branch of Southern Hospital,Southern Medical University from January 2023 to April 2024 were selected and randomly divided into a control group and an observation group,with 30 cases in each group.Patients in the control group received conventional Western medical treatment,while patients in the observation group were additionally treated with Tongqiao Huoxue Decoction via nasal feeding on the basis of the control group.The efficacy,Glasgow coma scale(GCS),National Institutes of Health stroke scale(NIHSS),awakening status,muscle strength classification,blood indices,and safety indicators were compared between the two groups.Results The total effective rate of treatment in the observation group was 80.00%,which was higher than 53.33%in the control group,and the difference was statistically significant(P<0.05).The awakening rate in the observation group was 76.67%,which was higher than 50.00%in the control group,and the difference was statistically significant(P<0.05).The time to awakening in the observation group was shorter than that in the control group,and the difference was statistically significant(P<0.05).After treatment,the GCS score of the observation group was higher that those of the control group,and the NIHSS score was lower than that of the control group,with statistically significant differences(P<0.05).After treatment,the levels of serum homocysteine(Hcy)and N-terminal pro-brain natriuretic peptide(NT-proBNP)in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).The proportion of patients with lower limb muscle strength of grade 4 to 5 in the observation group was 76.67%,which was higher than 50.00%in the control group,and the difference was statistically significant(P<0.05).There was no statistically significant difference in adverse reactions between the two groups(P>0.05).Conclusion Tongqiao Huoxue Decoction combined with conventional Western medical treatment can effectively improve the awakening effect in patients with ischemic stroke coma, shorten the time to awakening, improve the neurological function and physiological condition of patients, and has high safety. Its mechanism may be related to the reduction of Hcy and NT-proBNP levels.