刺络放血配合清热化瘀方对急性缺血性中风疗效及机制研究
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摘要
目的:探讨刺络放血配合清热化瘀方治疗急性缺血性中风患者的临床效果以及机制研究。方法:选取急性缺血性中风患者95例,采用随机数表法分为研究组(50例)和对照组(45例)。对照组给予清热化瘀方治疗,研究组给予刺络放血联合清热化瘀方治疗。对比治疗后临床效果,记录患者治疗前、治疗后中医症候积分、神经功能缺损评分、日常生活活动评分、大脑中动脉、大脑后动脉、大脑前动脉、椎动脉血流速、神经元特异性烯醇化酶(NSE)、血清肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)变化。结果:研究组治疗后总有效率92.00%明显高于对照组75.56%,差异显著(P<0.05);治疗后,两组患者中医症候积分、神经功能缺损评分均降低,且研究组低于对照组(P<0.05);治疗后,两组患者日常生活活动评分均提高,研究组高于对照组(P<0.05)。治疗后,两组患者大脑中动脉、大脑后动脉、大脑前动脉、椎动脉血流速度高于治疗前,且研究组高于对照组(P<0.05);治疗后,两组患者血清NSE、TNF-α、IL-1β表达水平均有降低,且研究组明显低于对照组(P<0.05)。治疗期间两组患者并未出现明显不良反应,且血尿常规以及肝肾功能检测均正常。结论:给予急性缺血性中风患者刺络放血联合清热化瘀方治疗,可促进患者脑血流速度变快,抑制炎症因子水平表达,促进患者神经功能恢复,提高患者日常生活能力,其机制可能与降低患者血清NSE水平有关。
Objective:To investigate the clinical effect and mechanism of blood letting puncture combined with Qingre Huayu Decoction in treating acute ischemic stroke.Methods:Ninety-five patients with acute ischemic stroke were selected and divided into study group(n=50) and control group(n=45). The control group was treated with Qingre Huayu Decoction, and the study group was treated with blood letting puncture combined with Qingre Huayu Decoction. The clinical effects were compared before and after treatment. The scores of TCM syndrome, neurological deficit score, daily living activity score, middle cerebral artery, posterior cerebral artery, anterior cerebral artery, blood flow velocity of vertebral artery, neuron specific enolase(NSE) and changes of serum tumor necrosis factor-alpha(TNF-alpha) and interleukin-1 beta(IL-1 beta) were recorded.Results:After treatment, the total effective rate(92%) of the study group was significantly higher than that of the control group(75.56%). The difference was significant(P<0.05). After treatment, the score of TCM syndrome score and nerve function defect were lower in the two groups, and the study group's was lower than the control group's(P<0.05). After treatment, the scores of daily living activities in the two groups were all increased, and the study group's was higher than that of the control group(P<0.05). After treatment, the blood flow velocity of the middle cerebral artery, the posterior cerebral artery, the anterior cerebral artery and the vertebral artery in the two groups were higher than those before the treatment, and the study group's was higher than that of the control group(P<0.05). After treatment, the levels of NSE, TNF-αand IL-1 beta in the serum of the two groups were decreased, and the study group's was significantly lower than that of the control group(P<0.05). During the treatment, no obvious adverse reactions were found in the two groups, and routine blood and urine tests and liver and kidney functions were normal.Conclusion:The treatment of acute ischemic stroke patients with blood letting puncture and clearing heat and eliminating phlegm can accelerate the speed of cerebral blood flow, inhibit the expression of inflammatory factors, promote the recovery of nerve function and improve the daily living ability of the patients, and the mechanism may be related to reducing the level of serum NSE in patients.
Objective:To investigate the clinical effect and mechanism of blood letting puncture combined with Qingre Huayu Decoction in treating acute ischemic stroke.Methods:Ninety-five patients with acute ischemic stroke were selected and divided into study group(n=50) and control group(n=45). The control group was treated with Qingre Huayu Decoction, and the study group was treated with blood letting puncture combined with Qingre Huayu Decoction. The clinical effects were compared before and after treatment. The scores of TCM syndrome, neurological deficit score, daily living activity score, middle cerebral artery, posterior cerebral artery, anterior cerebral artery, blood flow velocity of vertebral artery, neuron specific enolase(NSE) and changes of serum tumor necrosis factor-alpha(TNF-alpha) and interleukin-1 beta(IL-1 beta) were recorded.Results:After treatment, the total effective rate(92%) of the study group was significantly higher than that of the control group(75.56%). The difference was significant(P<0.05). After treatment, the score of TCM syndrome score and nerve function defect were lower in the two groups, and the study group's was lower than the control group's(P<0.05). After treatment, the scores of daily living activities in the two groups were all increased, and the study group's was higher than that of the control group(P<0.05). After treatment, the blood flow velocity of the middle cerebral artery, the posterior cerebral artery, the anterior cerebral artery and the vertebral artery in the two groups were higher than those before the treatment, and the study group's was higher than that of the control group(P<0.05). After treatment, the levels of NSE, TNF-αand IL-1 beta in the serum of the two groups were decreased, and the study group's was significantly lower than that of the control group(P<0.05). During the treatment, no obvious adverse reactions were found in the two groups, and routine blood and urine tests and liver and kidney functions were normal.Conclusion:The treatment of acute ischemic stroke patients with blood letting puncture and clearing heat and eliminating phlegm can accelerate the speed of cerebral blood flow, inhibit the expression of inflammatory factors, promote the recovery of nerve function and improve the daily living ability of the patients, and the mechanism may be related to reducing the level of serum NSE in patients.
引文
[1] 郑丽玲,臧向博.活血化瘀方在急性缺血性脑卒中治疗中的疗效及预后分析[J].陕西中医,2016,37(7):814-815.
[2] Hong KS,Ko SB,Yu KH,et al.Update of the Korean Clinical Practice Guidelines for Endovascular Recanalization Therapy in Patients with Acute Ischemic Stroke[J].Journal of Stroke,2016,18(1):102-105.
[3] Touma L,Filion KB,Sterling LH,et al.Stent Retrievers for the Treatment of Acute Ischemic Stroke:A Systematic Review and Meta-analysis of Randomized Clinical Trials[J].Jama Neurology,2016,73(3):275.
[4] 胡跃强,兰鹏,梁妮,等.清热化瘀方联合西药治疗缺血性中风90例临床观察[J].中医药导报,2017,12(20):79-81.
[5] Zhong C,Xu T,Xu T,et al.Plasma Homocysteine and Prognosis of Acute Ischemic Stroke:a Gender-Specific Analysis From CATIS Randomized Clinical Trial[J].Molecular Neurobiology,2016,54(3):1-9.
[6] 中华神经科学会,中华神经外科学会.全国第四届脑血管病学术会议标准[S].中华神经科杂志,1996,29(6):376-384.
[7] 郑筱萸.中药新药临床研究指导原则(试行)[S].北京:中国医药科技出版社,2002:99.
[8] 田德禄,蔡淦.中医内科学[M].上海:上海科学技术出版社,2006:269-279.
[9] Phan K,Zhao DF,Phan S,et al.Endovascular therapy including thrombectomy for acute ischemic stroke:A systematic review and meta-analysis with trial sequential analysis[J].Journal of Clinical Neuroscience,2016,29(3):38-45.
[10] 孟繁玲.活血化瘀方联合氯吡格雷治疗急性脑梗死临床疗效及对凝血功能的影响分析[J].中国医药指南,2017(34):177.
[11] Wahlgren N,Moreira T,Michel P,et al.Mechanical thrombectomy in acute ischemic stroke:Consensus statement by ESO-Karolinska Stroke Update 2014/2015,supported by ESO,ESMINT,ESNR and EAN[J].International Journal of Stroke,2016,11(1):134-147.
[12] 于娓娓.自拟益气凉血化瘀方治疗气虚血瘀型缺血性脑卒中的临床效果观察[J].社区医学杂志,2017,15(7):70-73.
[13] Tang CZ,Zhang YL,Wang WS,et al.Elevated Serum Levels of Neopterin at Admission Predicts Depression After Acute Ischemic Stroke:a 6-Month Follow-Up Study[J].Molecular Neurobiology,2016,53(5):3194.
[14] 纪红秀,张丁香,任凤.浅析护理干预对促进脑中风患者康复的影响[J].转化医学电子杂志,2016,3(8):85-86.
[15] 陶盟,万钢.通腑化痰方内服外擦联合刺络拔罐治疗缺血性中风肢体功能障碍疗效观察[J].现代中西医结合杂志,2016,25(18):2014-2016.
[16] Zheng QH,Li XL,Mei ZG,et al.Efficacy and safety of puerarin injection in curing acute ischemic stroke:A meta-analysis of randomized controlled trials[J].Medicine,2017,96(1):e5803.
[17] 石会.循经井穴放血疗法治疗丘脑中风后遗症的临床疗效及其对患者血清TNF-α、IL-6和IGF-Ⅱ水平的影响[J].河北中医药学报,2017,32(3):39-41.
[18] Gasecki D,Coca A,Cunha P,et al.Blood pressure in acute ischemic stroke:challenges in trial interpretation and clinical management:position of the ESH Working Group on Hypertension and the Brain[J].Journal of Hypertension,2018,36(6):1212-1221.
[19] Zheng M,Lei H,Cui Y,et al.Clinical efficacy and safety of hypernormal shortened door to needle time (DNT) plus individualized low-dose alteplase therapy in treating acute ischemic stroke[J].Pakistan Journal of Medical Sciences,2016,32(4):811-816.
[20] 颜江.中药自拟方内服外敷联合刺络拔罐治疗中风肢体功能障碍疗效观察[J].中国中医急症,2017,26(3):540-542.
[2] Hong KS,Ko SB,Yu KH,et al.Update of the Korean Clinical Practice Guidelines for Endovascular Recanalization Therapy in Patients with Acute Ischemic Stroke[J].Journal of Stroke,2016,18(1):102-105.
[3] Touma L,Filion KB,Sterling LH,et al.Stent Retrievers for the Treatment of Acute Ischemic Stroke:A Systematic Review and Meta-analysis of Randomized Clinical Trials[J].Jama Neurology,2016,73(3):275.
[4] 胡跃强,兰鹏,梁妮,等.清热化瘀方联合西药治疗缺血性中风90例临床观察[J].中医药导报,2017,12(20):79-81.
[5] Zhong C,Xu T,Xu T,et al.Plasma Homocysteine and Prognosis of Acute Ischemic Stroke:a Gender-Specific Analysis From CATIS Randomized Clinical Trial[J].Molecular Neurobiology,2016,54(3):1-9.
[6] 中华神经科学会,中华神经外科学会.全国第四届脑血管病学术会议标准[S].中华神经科杂志,1996,29(6):376-384.
[7] 郑筱萸.中药新药临床研究指导原则(试行)[S].北京:中国医药科技出版社,2002:99.
[8] 田德禄,蔡淦.中医内科学[M].上海:上海科学技术出版社,2006:269-279.
[9] Phan K,Zhao DF,Phan S,et al.Endovascular therapy including thrombectomy for acute ischemic stroke:A systematic review and meta-analysis with trial sequential analysis[J].Journal of Clinical Neuroscience,2016,29(3):38-45.
[10] 孟繁玲.活血化瘀方联合氯吡格雷治疗急性脑梗死临床疗效及对凝血功能的影响分析[J].中国医药指南,2017(34):177.
[11] Wahlgren N,Moreira T,Michel P,et al.Mechanical thrombectomy in acute ischemic stroke:Consensus statement by ESO-Karolinska Stroke Update 2014/2015,supported by ESO,ESMINT,ESNR and EAN[J].International Journal of Stroke,2016,11(1):134-147.
[12] 于娓娓.自拟益气凉血化瘀方治疗气虚血瘀型缺血性脑卒中的临床效果观察[J].社区医学杂志,2017,15(7):70-73.
[13] Tang CZ,Zhang YL,Wang WS,et al.Elevated Serum Levels of Neopterin at Admission Predicts Depression After Acute Ischemic Stroke:a 6-Month Follow-Up Study[J].Molecular Neurobiology,2016,53(5):3194.
[14] 纪红秀,张丁香,任凤.浅析护理干预对促进脑中风患者康复的影响[J].转化医学电子杂志,2016,3(8):85-86.
[15] 陶盟,万钢.通腑化痰方内服外擦联合刺络拔罐治疗缺血性中风肢体功能障碍疗效观察[J].现代中西医结合杂志,2016,25(18):2014-2016.
[16] Zheng QH,Li XL,Mei ZG,et al.Efficacy and safety of puerarin injection in curing acute ischemic stroke:A meta-analysis of randomized controlled trials[J].Medicine,2017,96(1):e5803.
[17] 石会.循经井穴放血疗法治疗丘脑中风后遗症的临床疗效及其对患者血清TNF-α、IL-6和IGF-Ⅱ水平的影响[J].河北中医药学报,2017,32(3):39-41.
[18] Gasecki D,Coca A,Cunha P,et al.Blood pressure in acute ischemic stroke:challenges in trial interpretation and clinical management:position of the ESH Working Group on Hypertension and the Brain[J].Journal of Hypertension,2018,36(6):1212-1221.
[19] Zheng M,Lei H,Cui Y,et al.Clinical efficacy and safety of hypernormal shortened door to needle time (DNT) plus individualized low-dose alteplase therapy in treating acute ischemic stroke[J].Pakistan Journal of Medical Sciences,2016,32(4):811-816.
[20] 颜江.中药自拟方内服外敷联合刺络拔罐治疗中风肢体功能障碍疗效观察[J].中国中医急症,2017,26(3):540-542.