目的:探讨急性脑梗死(又称缺血性脑卒中)早期给予涤痰化瘀汤治疗对患者并发抑郁、神经功能康复的影响.方法:选取在安徽中医药大学附属滁州中西医结合医院脑病科住院治疗的痰瘀互结型急性脑梗死患者100例,随机分为中药组和常规治疗组,各50例,两组均给予常规基础治疗,中药组加用涤痰化瘀汤,入院72h开始服用,疗程为6个月.分别检测两组治疗前、治疗3个月、治疗6个月中性粒细胞与淋巴细胞比值(Neutrophil to Lymphocyte Ratio,NLR)、血尿酸(Uric Acid,UA)、脑血流动力学指标[大脑后动脉平均血流速度(Vm)、搏动指数(Pulsatility Index,PI)和阻力指数(Resistance Index,RI)]变化情况,并观察两组治疗前后美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale,NIHSS)评分、改良 Barthel 指数(Modified Barthel Index,MBI)评分、汉密尔顿抑郁量表(Hamilton Depression Scale,HAMD)评分、中医证候积分(痰证积分、血瘀证积分)变化情况,同时随访两组6个月脑梗死复发情况.结果:治疗前两组NIHSS评分、MBI评分、中医证候积分无差异(P＞0.05),治疗3个月,两组NIHSS评分均较治疗前降低(P＜0.05),MBI评分均较治疗前升高(P＜0.05),但中药组优于常规治疗组(P＜0.05),常规治疗组中医证候积分较治疗前无明显变化(P＞0.05),但中药组中医证候积分较治疗前下降(P＜0.05),且两组差异有统计学意义(P＜0.05).治疗6个月后两组NIHSS评分较治疗3个月时明显下降(P＜0.05),MBI评分明显上升(P＜0.05),差异有统计学意义(P＜0.01),常规治疗组中医证候积分较3个月时无明显变化(P＞0.05),但中药组较3个月时明显下降(P＜0.05),且差异有统计学意义(P＜0.05).治疗3个月后常规治疗组HAMD评分、NLR、UA显著高于中药组;治疗6个月后,两组HAMD评分、NLR、UA均降低,且中药组低于常规治疗组(P＜0.05).治疗3个月后,常规治疗组的Vm低于中药组,PI、RI高于中药组(P＜0.05),治疗6个月后两组Vm、PI、RI均较治疗前改善,中药组优于常规治疗组(P＜0.05).中药组治疗3个月后出现10例并发抑郁,6个月后为6例,常规治疗组治疗3个月后有20例并发抑郁,治疗6个月后为15例,差异有统计学意义(P＜0.05).治疗6个月后,中药组3例脑梗死复发,常规治疗组为10例.两组不良反应发生率比较,差异无统计学意义(P＞0.05).结论:涤痰化瘀汤早期治疗急性缺血性脑梗死能明显改善患者神经功能缺损,提高日常生活能力,改善中医证候、脑血流动力,降低NLR、UA水平,减少卒中后抑郁发生率,同时降低脑梗死复发率,临床应用无明显不良反应,安全性好.
Effects of early intervention of the Ditan Huayu decoction on depression and neurological rehabilitation in ischemic cerebral infarction of the phlegm and blood stasis type patients
Objective:To explore the effect of the Ditan Huayu decoction(涤痰 化瘀汤)on the complicated depression and neurological rehabilitation in the early stage of acute cerebral infarction.Methods:A total of 100 patients with acute cerebral infarction of phlegm-blood stasis syndrome were selected and randomly divided into the traditional Chinese medicine group and routine treatment group,with 50 cases in each group.Both groups were given routine basic treatment.The traditional Chinese medicine group was treated with the Ditan Huayu decoction more,which was taken at 72 hours after admission for 6 months.The changes in NLR,UA,cerebral hemodynamics(Vm,PI,RI)before treatment,after 3 months of treatment and after 6 months of treatment were detected.The changes of NIHSS score,MBI score,HAMD score and TCM syndrome score(phlegm syndrome score and blood stasis syndrome score)before and after treatment were observed.Meanwhile,the recurrence rate of cerebral infarction in both groups was followed up for 6 months.Results:There was no difference in NIHSS,MBI and TCM symptom scores between the two groups before treatment(P＞0.05).After treatment for 3 months,NIHSS score was decreased(P＜0.05),and MBI score was increased(P＜0.05),but the traditional Chinese medicine group was superior to the routine treatment group(P＜0.05).TCM syndrome scores in the routine treatment group had no obvious change(P＞0.05),but TCM syndrome scores in the traditional Chinese medicine group were decreased(P＜0.05),the difference was statistically significant(P＜0.05).After treatment for 6 months,NIHSS scores were decreased significantly(P＜0.05),and the MBI score was increased significantly(P＜0.05)in the two groups(P＜0.01).The scores of TCM syndromes in the routine treatment group did not change significantly(P＞0.05),but the scores in the traditional Chinese medicine group were decreased significantly(P＜0.05).The difference between the two groups was statistically significant(P＜0.05).After treatment for 3 months,HAMD score,NLR and UA in the routine group were significantly higher than those in the traditional Chinese medicine group.After 6 months,the scores of HAMD,NLR and UA in both groups were decreased,and those in the traditional Chinese medicine group were lower than those in the routine treatment group(P＜0.05).After treatment for 3 months,Vm,PI and RI in the routine treatment group were lower than those in the traditional Chinese medicine group(P＜0.05).After 6 months of treatment,Vm,PI and RI were improved compared with those before treatment,and the traditional Chinese medicine group was superior to the routine treatment group(P＜0.05).Depression occurred in 10 cases after 3 months and 6 case after 6 months in the traditional Chinese medicine group,and 20 cases after 3 months and 15 cases after 6 months in the routine treatment group,with significant differences(P＜0.05).After treatment for 6 months,there were 3 cases of recurred cerebral infarction in the traditional Chinese medicine group and 10 cases in the routine treatment group.There was no significant difference in the incidence of adverse reactions between two groups(P＞0.05).Conclusion:Early treatment of acute cerebral infarction with the Ditan Huayu decoction can obviously ameliorate the neurological deficits,improve the ability of daily living,TCM syndrome score and cerebral hemodynamics,and reduce the levels of NLR and UA,the incidence of post-stroke depression and the recurrence rate of cerebral infarction.The clinical application has no obvious adverse reactions,and the safety is good.
万方数据
维普
