桃红四物汤辅助治疗气虚血瘀型症状性颈动脉狭窄支架置入术后支架内再狭窄的临床疗效观察
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摘要
目的:研究桃红四物汤对气虚血瘀型症状性颈动脉狭窄脑血管支架(CAS)术后支架内再狭窄和临床疗效的疗效。方法:90例,随机分成观察组48人和对照组42人。对照组CAS围手术期及CAS术后3月予以双联抗血小板、降脂治疗;观察组围手术期及术后3月在对照组治疗的基础上予以桃红四物汤口服,门诊和电话随访日常生活功能情况、副作用等情况,比较桃红四物汤对CAS术后支架再狭窄、NIHSS评分、日常生活功能改善等情况。结果:观察组与对照组性别、年龄等基线及卒中相关危险因素无统计学差异;观察组,中度狭窄17例,重度狭窄31例,随访再狭窄5例,临床总有效32例;对照组,其中度狭窄14例,重度狭窄28例,再狭窄率11例,临床有效24例;2组劲动脉狭窄程度例数(p=0.836)、狭窄率(40.6±12.7)%,与观察组狭窄率(32.9±10.3)%比较(P=0.504),均无统计差异,随访再狭窄率比较有差异(P=0.006),有效比例无统计学差异(P=0.06),临床有效分布有统计学差异(P=0.013),再狭窄例数比较无统计学差异(P=0.67>0.05)。结论:对于颈动脉狭窄CAS术后,辅予以桃红四物汤治疗,总体上不能改变患者支架再狭窄和临床有效的比例,但可改善症状性脑血管狭窄CAS术后炎症反应和延缓再狭窄程度、促进神经功能缺损的恢复。
Objective:vascular To investigate the with effect of Taohong Siwu decoction on in-stent restenosis and clinical outcome after were cerebral carotid divided stenosis(CAS)symptomatic carotid artery stenosis.Methods:The first diagnosis of symptomatic stenosis,into and the dialectical group classification of TCM patients with Qi deficiency and blood stasis.control and 90 patients observation 48 and control were group 42 by random number table method.In the group,the anti-platelet and lipid-lowering treatments the performed during the the perioperative period of CAS 3 months Taohong after CAS.In the observation group,perioperative period and postoperative Daily 3 months were treated with Siwu decoction treatment on an oral basis,outpatient and telephone NIHSS follow-up.life function,daily side effects,function.etc.,compared with were the of post-CAS stent restenosis,baseline score and risk improvement of living Results:and There no significant differences in the 17 stroke-related factors between the had were observation group the control group.followup In the observation group,32 patients had moderate stenosis,31 patients severe stenosis,5 patients had restenosis,and cases patients had clinical total effective disease.There 14 cases of stenosis,28 cases of severe stenosis,and 11 of restenosis,and and 24 cases of clinical stenosis.the The number of cases of arterial stenosis(P=0.886)stenosis rate(40.6+12.7)%,the stenosis rate of observation group(32.9+10.3)%comparison(P=0.504),different(P=0.006),the effective ratio was not statistically there was no statistical difference,the rate of restenosis was significant(P=0.06),and the clinical effective distribution was statistically different(P=0.06),Clinical effective distribution(P=0.013).There was no statistical difference in the number of restenosis cases of statistically was significant(P=0.67>0.05).Conclusion:For patients with carotid stenosis after CAS,supplemented with Taohong Siwu decoction,the overall and rate delay of stent restenosis and clinical after effective can not be changed.But it can and improve promote the the inflammatory reaction neurological the degree of restenosis symptomatic cerebrovascular stenosis recovery of deficits.
Objective:vascular To investigate the with effect of Taohong Siwu decoction on in-stent restenosis and clinical outcome after were cerebral carotid divided stenosis(CAS)symptomatic carotid artery stenosis.Methods:The first diagnosis of symptomatic stenosis,into and the dialectical group classification of TCM patients with Qi deficiency and blood stasis.control and 90 patients observation 48 and control were group 42 by random number table method.In the group,the anti-platelet and lipid-lowering treatments the performed during the the perioperative period of CAS 3 months Taohong after CAS.In the observation group,perioperative period and postoperative Daily 3 months were treated with Siwu decoction treatment on an oral basis,outpatient and telephone NIHSS follow-up.life function,daily side effects,function.etc.,compared with were the of post-CAS stent restenosis,baseline score and risk improvement of living Results:and There no significant differences in the 17 stroke-related factors between the had were observation group the control group.followup In the observation group,32 patients had moderate stenosis,31 patients severe stenosis,5 patients had restenosis,and cases patients had clinical total effective disease.There 14 cases of stenosis,28 cases of severe stenosis,and 11 of restenosis,and and 24 cases of clinical stenosis.the The number of cases of arterial stenosis(P=0.886)stenosis rate(40.6+12.7)%,the stenosis rate of observation group(32.9+10.3)%comparison(P=0.504),different(P=0.006),the effective ratio was not statistically there was no statistical difference,the rate of restenosis was significant(P=0.06),and the clinical effective distribution was statistically different(P=0.06),Clinical effective distribution(P=0.013).There was no statistical difference in the number of restenosis cases of statistically was significant(P=0.67>0.05).Conclusion:For patients with carotid stenosis after CAS,supplemented with Taohong Siwu decoction,the overall and rate delay of stent restenosis and clinical after effective can not be changed.But it can and improve promote the the inflammatory reaction neurological the degree of restenosis symptomatic cerebrovascular stenosis recovery of deficits.
引文
[1]中国医学会神经病学分会神经血管介入协作组,急性缺血性脑卒中介入诊疗指南撰写组.中国急性缺血性脑卒中早期血管内介入诊疗指南[J].中华神经科杂志,2015,48(5):1-6.
[2]刘艳贞.颈动脉狭窄程度、糖尿病史与进展性缺血性卒中的关联性分析[J].黑龙江医药科学,2018,(1):174-175.
[3]杨加青,魏丽红,郑献召.症状性颈动脉狭窄支架成形术对患者生活质量的影响[J].中国实用神经疾病杂志,2018,(5):531-534.
[4]杨加青,魏丽红,郑献召.症状性颈动脉狭窄支架成形术对患者生活质量的影响[J].中国实用神经疾病杂志,2018,(5):531-534.
[5]李倩,徐达,陈邓,等.颅内动脉狭窄支架植入术后支架内再狭窄危险因素Meta分析[J].中国现代神经疾病杂志,2018,(3):183-191.
[6]刘奇,郭飞,赵宇,等.颈动脉支架成形术治疗颅外段颈动脉夹层的疗效观察[J].卒中与神经疾病,2016,(4):228-231.
[7]贾敬选,赵美英.中医药在脑血管支架置入后防治并发症中的作用[J].中国医药指南,2014,(30):273-273,274.
[8]张新春,毕小丽,黄燕.颈动脉狭窄支架植入围手术期中医药干预治疗思路[J].江苏中医药,2011,(3):3-4.
[9]何坤梅,何乾超,刁丽梅.中医药对颈动脉支架植入术后再狭窄的防治[J].中医临床研究,2017,(32):140-142.
[10]林浩,朱庆斌,倪小佳,等.中国神经血管手术防治卒中相关指南的系统评价[J].中国脑血管病杂志,2018,(4):169-176.
[11]贾建平,陈生弟.神经病学[M].北京:人名卫生出版社,2013:175-186.
[12]渠泽平,吴丽娥.大面积脑梗死诊治研究进展[J].中国实用神经疾病杂志,2018,(1):114-116.
[13]全国第四次脑血管病学术会议.脑卒中患者临床神经功能缺损程度评分标准.中国实用内科学杂志,1997,17(15):313-315.
[14]徐立燕,王雁.高分辨率磁共振成像对颅内大动脉粥样硬化的评估价值[J].中华神经医学杂志,2017,(12):1242-1246.
[15]李韶雅,李敬伟,徐运.症状性颅内动脉粥样硬化斑块的致病机制研究进展[J].中国卒中杂志,2017,(6):554-558.
[16]罗明华,关怀敏,解金红,等.冠心病药物涂层支架置入后再内皮化研究[J].实用医学杂志,2016,(5):724-727.1718
[17]郭奕彤,谭志刚.血管内支架材料特点与缺血性脑卒中的治疗效果[J].中国组织工程研究,2013,(12):2257-2264.
[18]陈海云,何超明.血清ox-LDL、Lp-PLA2水平与缺血性脑卒中患者动脉粥样硬化及神经功能缺损的相关性研究[J].卒中与神经疾病,2017,(6):504-507.
[19]孙雨萌,左海奇,田野.巨噬细胞在血管炎症及动脉粥样硬化中的作用[J].中国循证心血管医学杂志,2017,(12):1541-1543.
[20]刘力学.抗氧化应激治疗对缺血性卒中患者颈动脉粥样硬化斑块作用[J].中国卒中杂志,2016,(3):235-237.DOI:10.3969/j.issn.1673-5765.2016.03.014.
[21]章靓,陈旺,庞文生,等.血栓形成机制及血小板膜糖蛋白Ⅱb/Ⅲa受体拮抗剂的研究进展[J].国际药学研究杂志,2009,(4):268-271.
[22]宋杰,李全利,万国江,等.内皮细胞在涂层心血管植入物表面的生长:模似仿生性构建具有生物活性的细胞外基质[J].中国组织工程研究与临床康复,2009,(43):8425-8431.
[23]GianPF,DouglasL,StefanieD.CriticalreevaluationofendothelialprogenitorcellphenotypesfortherapeuticanddiagnosticusemCirculationResearch,2012,10(4):624-637.
[24]李倩,徐达,陈邓,等.颅内动脉狭窄支架植入术后支架内再狭窄危险因素Meta分析[J].中国现代神经疾病杂志,2018,(3):183-191.
[25]李英,朱榆红.普罗布考、阿托伐他汀钙与阿司匹林合用对动脉粥样硬化的疗效[J].临床医学,2010,(5):12-14.
[26]李建秀,于红俊,孙文亮.桃红四物汤对老年气阴两虚兼血瘀型糖尿病足患者血清CRP水平及IL-6水平影响研究[J].陕西中医,2018,(2):196-198.
[29]刘竹青,尹登科,韩岚,等.桃红四物汤含药血清对过氧化氢损伤的人脐静脉内皮细胞的保护作用[J].中国中药杂志,2013,(3):402-406.
[27]张远海.桃红四物汤对脑缺血再灌注损伤大鼠脑内血管新生及PI3K/AKT信号转导通路的影响[J].蚌埠医学院学报,2017,(1):36-40,56.
[28]吴欢茹,韩岚,彭代银,等.脑缺血再灌注大鼠海马区神经营养因子的表达及桃红四物汤的干预[J].安徽中医药大学学报,2017,(5):56-61.
[29]王瑱,符德玉,桂明泰,等.桃红四物汤治疗心血瘀阻型稳定性冠心病的临床疗效[J].河北中医,2017,(4):506-510.
[30]尹登科,杨晔,尹娟娟,等.桃红四物汤对蛋白酶激活受体激活诱导血小板释放VEGF和Endostatin的影响[J].中成药,2012,(9):1631-1635.
[31]李建秀,于红俊,孙文亮.桃红四物汤对老年气阴两虚兼血瘀型糖尿病足患者血清CRP水平及IL-6水平影响研究[J].陕西中医,2018,(2):196-198.
[32]刘竹青,尹登科,韩岚,等.桃红四物汤含药血清对过氧化氢损伤的人脐静脉内皮细胞的保护作用[J].中国中药杂志,2013,(3):402-406.
[33]张远海.桃红四物汤对脑缺血再灌注损伤大鼠脑内血管新生及PI3K/AKT信号转导通路的影响[J].蚌埠医学院学报,2017,(1):36-40,56.
[34]朱玉.颅外段颈动脉粥样硬化重度狭窄病变的药物与血管内介入治疗的比较[D].山东大学,2012.
[35]李倩,徐达,陈邓,等.颅内动脉狭窄支架植入术后支架内再狭窄危险因素Meta分析[J].中国现代神经疾病杂志,2018,(3):183-191.
[2]刘艳贞.颈动脉狭窄程度、糖尿病史与进展性缺血性卒中的关联性分析[J].黑龙江医药科学,2018,(1):174-175.
[3]杨加青,魏丽红,郑献召.症状性颈动脉狭窄支架成形术对患者生活质量的影响[J].中国实用神经疾病杂志,2018,(5):531-534.
[4]杨加青,魏丽红,郑献召.症状性颈动脉狭窄支架成形术对患者生活质量的影响[J].中国实用神经疾病杂志,2018,(5):531-534.
[5]李倩,徐达,陈邓,等.颅内动脉狭窄支架植入术后支架内再狭窄危险因素Meta分析[J].中国现代神经疾病杂志,2018,(3):183-191.
[6]刘奇,郭飞,赵宇,等.颈动脉支架成形术治疗颅外段颈动脉夹层的疗效观察[J].卒中与神经疾病,2016,(4):228-231.
[7]贾敬选,赵美英.中医药在脑血管支架置入后防治并发症中的作用[J].中国医药指南,2014,(30):273-273,274.
[8]张新春,毕小丽,黄燕.颈动脉狭窄支架植入围手术期中医药干预治疗思路[J].江苏中医药,2011,(3):3-4.
[9]何坤梅,何乾超,刁丽梅.中医药对颈动脉支架植入术后再狭窄的防治[J].中医临床研究,2017,(32):140-142.
[10]林浩,朱庆斌,倪小佳,等.中国神经血管手术防治卒中相关指南的系统评价[J].中国脑血管病杂志,2018,(4):169-176.
[11]贾建平,陈生弟.神经病学[M].北京:人名卫生出版社,2013:175-186.
[12]渠泽平,吴丽娥.大面积脑梗死诊治研究进展[J].中国实用神经疾病杂志,2018,(1):114-116.
[13]全国第四次脑血管病学术会议.脑卒中患者临床神经功能缺损程度评分标准.中国实用内科学杂志,1997,17(15):313-315.
[14]徐立燕,王雁.高分辨率磁共振成像对颅内大动脉粥样硬化的评估价值[J].中华神经医学杂志,2017,(12):1242-1246.
[15]李韶雅,李敬伟,徐运.症状性颅内动脉粥样硬化斑块的致病机制研究进展[J].中国卒中杂志,2017,(6):554-558.
[16]罗明华,关怀敏,解金红,等.冠心病药物涂层支架置入后再内皮化研究[J].实用医学杂志,2016,(5):724-727.1718
[17]郭奕彤,谭志刚.血管内支架材料特点与缺血性脑卒中的治疗效果[J].中国组织工程研究,2013,(12):2257-2264.
[18]陈海云,何超明.血清ox-LDL、Lp-PLA2水平与缺血性脑卒中患者动脉粥样硬化及神经功能缺损的相关性研究[J].卒中与神经疾病,2017,(6):504-507.
[19]孙雨萌,左海奇,田野.巨噬细胞在血管炎症及动脉粥样硬化中的作用[J].中国循证心血管医学杂志,2017,(12):1541-1543.
[20]刘力学.抗氧化应激治疗对缺血性卒中患者颈动脉粥样硬化斑块作用[J].中国卒中杂志,2016,(3):235-237.DOI:10.3969/j.issn.1673-5765.2016.03.014.
[21]章靓,陈旺,庞文生,等.血栓形成机制及血小板膜糖蛋白Ⅱb/Ⅲa受体拮抗剂的研究进展[J].国际药学研究杂志,2009,(4):268-271.
[22]宋杰,李全利,万国江,等.内皮细胞在涂层心血管植入物表面的生长:模似仿生性构建具有生物活性的细胞外基质[J].中国组织工程研究与临床康复,2009,(43):8425-8431.
[23]GianPF,DouglasL,StefanieD.CriticalreevaluationofendothelialprogenitorcellphenotypesfortherapeuticanddiagnosticusemCirculationResearch,2012,10(4):624-637.
[24]李倩,徐达,陈邓,等.颅内动脉狭窄支架植入术后支架内再狭窄危险因素Meta分析[J].中国现代神经疾病杂志,2018,(3):183-191.
[25]李英,朱榆红.普罗布考、阿托伐他汀钙与阿司匹林合用对动脉粥样硬化的疗效[J].临床医学,2010,(5):12-14.
[26]李建秀,于红俊,孙文亮.桃红四物汤对老年气阴两虚兼血瘀型糖尿病足患者血清CRP水平及IL-6水平影响研究[J].陕西中医,2018,(2):196-198.
[29]刘竹青,尹登科,韩岚,等.桃红四物汤含药血清对过氧化氢损伤的人脐静脉内皮细胞的保护作用[J].中国中药杂志,2013,(3):402-406.
[27]张远海.桃红四物汤对脑缺血再灌注损伤大鼠脑内血管新生及PI3K/AKT信号转导通路的影响[J].蚌埠医学院学报,2017,(1):36-40,56.
[28]吴欢茹,韩岚,彭代银,等.脑缺血再灌注大鼠海马区神经营养因子的表达及桃红四物汤的干预[J].安徽中医药大学学报,2017,(5):56-61.
[29]王瑱,符德玉,桂明泰,等.桃红四物汤治疗心血瘀阻型稳定性冠心病的临床疗效[J].河北中医,2017,(4):506-510.
[30]尹登科,杨晔,尹娟娟,等.桃红四物汤对蛋白酶激活受体激活诱导血小板释放VEGF和Endostatin的影响[J].中成药,2012,(9):1631-1635.
[31]李建秀,于红俊,孙文亮.桃红四物汤对老年气阴两虚兼血瘀型糖尿病足患者血清CRP水平及IL-6水平影响研究[J].陕西中医,2018,(2):196-198.
[32]刘竹青,尹登科,韩岚,等.桃红四物汤含药血清对过氧化氢损伤的人脐静脉内皮细胞的保护作用[J].中国中药杂志,2013,(3):402-406.
[33]张远海.桃红四物汤对脑缺血再灌注损伤大鼠脑内血管新生及PI3K/AKT信号转导通路的影响[J].蚌埠医学院学报,2017,(1):36-40,56.
[34]朱玉.颅外段颈动脉粥样硬化重度狭窄病变的药物与血管内介入治疗的比较[D].山东大学,2012.
[35]李倩,徐达,陈邓,等.颅内动脉狭窄支架植入术后支架内再狭窄危险因素Meta分析[J].中国现代神经疾病杂志,2018,(3):183-191.