加减八珍汤对慢性脑供血不足患者脑血管储备功能及血流变学的影响
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摘要
目的:探讨加减八珍汤对慢性脑动脉供血不足患者脑血管储备功能及血流变学的影响。方法:对2018年1月至2018年6月在江西省中医院就诊的80例符合纳入条件患者,使用Stata 13. 0产生随机序列,随机分为观察组和对照组,各40例。两组研究对象均接受降压、降糖、降脂等基础治疗,对照组同时给予尼膜地平片治疗,观察组在对照组基础上给予加减八珍汤治疗,总疗程为30 d。分别在治疗前后,通过经颅多普勒超声(TCD)检测两组脑血管储备功能,评估临床疗效,检测血流变学、血常规及肝肾功能。结果:观察组有效率为92. 5%,对照组有效率为80%,观察组临床疗效优于对照组(P <0. 05);与本组治疗前比较,观察组治疗后脑血管储备(CVR),屏气指数(BMI),平均血流速度(Vm)均明显升高(P <0. 05);与本组治疗前比较,观察组治疗后血细胞比容、全血表观黏度高切、低切、血浆黏度均明显下降(P <0. 05)。两组治疗后进行比较,观察组CVR,BMI,Vm均高于对照组(P <0. 05),观察组血细胞比容、全血表观黏度高切、低切、血浆黏度均明显低于对照组(P <0. 05);两组患者安全性指标治疗后均在正常范围,与本组治疗前比较均无统计学差异。结论:加减八珍汤能够有效治疗慢性脑供血不足,通过提高脑血管储备功能,改善血液流动性,从而缓解临床症状,且不存在安全问题,为中医药治疗慢性脑供血不足提供了理论依据。
Objective: To observe the effect of modified Bazhentang on cerebrovascular reserve and hemorheology in patients with chronic cerebral circulation insufficiency. Method: Totally 80 patients treated at Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine from January 2018 to June 2018 in line with the inclusion criteria were randomly divided into the observation group( 40 cases) and the control group( 40 cases)using the random sequence of Stata 13. 0. Both groups received basic treatments,such as antihypertensive,hypoglycemic and lipid-lowering. In addition to the therapy of the control group,the control group was also given nimodipine tablet treatment,and the observation group was given modified Bazhentang treatment,with a total course of 30 days. Before and after treatment,transcranial doppler ultrasonography( TCD) was used to detect the cerebrovascular reserve function of the two groups, so as to evaluate the clinical efficacy, and detect the hemorheology,blood routine,hepatic and renal function. Result: The effective rate of the observation group was92. 5%,and that of the control group was 80%. The clinical efficacy of the observation group was better than that of the control group( P < 0. 05). Compared with before treatment,cerebrovascular reserve( CVR),breath-holding index( BMI) and mean blood flow velocity( Vm) were significantly increased in the observation group after treatment( P < 0. 05). Compared with before treatment,hematocrit,whole blood apparent viscosity high cut,low cut,plasma viscosity were all decreased in the observation group after treatment( P < 0. 05). After treatment,CVR,BMI,and Vm of the observation group were higher than those of the control group( P < 0. 05),and hematocrit,whole blood apparent viscosity high cut,low cut,plasma viscosity of the observation group were lower than those of the control group( P < 0. 05). Safety indexes of the two groups were in the normal range after treatment,with no statistical difference compared with before treatment. Conclusion: Modified Bazhentang can effectively treat chronic cerebral circulation insufficiency. By improving the function of cerebrovascular reserve and cerebral blood flow,it can alleviate clinical symptoms without safety problems,so as to provide a theoretical basis for the treatment of chronic cerebral circulation insufficiency with traditional Chinese medicine.
Objective: To observe the effect of modified Bazhentang on cerebrovascular reserve and hemorheology in patients with chronic cerebral circulation insufficiency. Method: Totally 80 patients treated at Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine from January 2018 to June 2018 in line with the inclusion criteria were randomly divided into the observation group( 40 cases) and the control group( 40 cases)using the random sequence of Stata 13. 0. Both groups received basic treatments,such as antihypertensive,hypoglycemic and lipid-lowering. In addition to the therapy of the control group,the control group was also given nimodipine tablet treatment,and the observation group was given modified Bazhentang treatment,with a total course of 30 days. Before and after treatment,transcranial doppler ultrasonography( TCD) was used to detect the cerebrovascular reserve function of the two groups, so as to evaluate the clinical efficacy, and detect the hemorheology,blood routine,hepatic and renal function. Result: The effective rate of the observation group was92. 5%,and that of the control group was 80%. The clinical efficacy of the observation group was better than that of the control group( P < 0. 05). Compared with before treatment,cerebrovascular reserve( CVR),breath-holding index( BMI) and mean blood flow velocity( Vm) were significantly increased in the observation group after treatment( P < 0. 05). Compared with before treatment,hematocrit,whole blood apparent viscosity high cut,low cut,plasma viscosity were all decreased in the observation group after treatment( P < 0. 05). After treatment,CVR,BMI,and Vm of the observation group were higher than those of the control group( P < 0. 05),and hematocrit,whole blood apparent viscosity high cut,low cut,plasma viscosity of the observation group were lower than those of the control group( P < 0. 05). Safety indexes of the two groups were in the normal range after treatment,with no statistical difference compared with before treatment. Conclusion: Modified Bazhentang can effectively treat chronic cerebral circulation insufficiency. By improving the function of cerebrovascular reserve and cerebral blood flow,it can alleviate clinical symptoms without safety problems,so as to provide a theoretical basis for the treatment of chronic cerebral circulation insufficiency with traditional Chinese medicine.
引文
[1] ZHOU D,MENG R,LI S J,et al. Advances in chronic cerebral circulation insufficiency[J]. CNS Neurosci Ther,2018,24(1):5-17.
[2] Carrera E, Lee L K, Giannopoulos S, et al.Cerebrovascular reactivity and cerebral autoregulation in normal subjects[J]. J Neurol Sci,2009,285(1/2):191-194.
[3]杨新林,李月春,李锐铭.脑血管储备功能的临床应用进展[J].卒中与神经疾病,2015,22(1):50-52.
[4]杨海昊,刘明君,韩涛,等.慢性脑供血不足中西医研究概况[J].山东中医药大学学报,2018,42(1):90-93.
[5]黄海量,吕征,韩涛,等.养血清脑颗粒治疗慢性脑供血不足的系统评价[J].中国实验方剂学杂志,2015,21(15):193-196.
[6]闫明坤,黄刚,辛华栋,等.星蒌承气方对慢性脑供血不足患者血栓前状态因子的干预[J].中国实验方剂学杂志,2010,16(7):233-234.
[7]吴春霖,王镭,李卫兵.临床试验随机化分组及其Stata的实现[J].中国循证医学杂志,2013,13(2):242-244.
[8]近藤.无症状性脑血管病变への对应颈动脉病变の治疗[J].日内会杂志,2000,4(86):781.
[9]国家中医药管理局.中医病证诊断疗效标准[M].南京:南京大学出版社,1994:23.
[10]崔璨,马云川.脑血管储备功能的检测方法及意义[J].临床和实验医学杂志,2015,14(2):160-164.
[11]王艳玲,华扬.脑血管储备功能与经颅多普勒超声临床应用[J].中华医学超声杂志:电子版,2010,7(10):1726-1730.
[12]孙传兴.临床疾病诊断依据治疗好转标准[M]. 2版.北京:人民军医出版社,2002:410.
[13] ZHANG L,DONG W,HAN J,et al. Montreal cognitive assessment and analysis of related factors for cognitive impairment in patients with chronic cerebral circulation insufficiency[J]. Int J Psychiatry Med,2015,50(3):257-270.
[14]彭春平.慢性脑供血不足中医证候的临床调查[D].福州:福建中医药大学,2015:4.
[15]贾艳红,李月春,张京芬. TCD评价的脑血管储备功能的临床应用价值[J].医学综述,2009,15(18):2819-2821.
[16] Gupta A, Chazen J L, Hartman M, et al.Cerebrovascular reserve and stroke risk in patients with carotid stenosis or occlusion:a systematic review and Meta-analysis[J]. Stroke,2012,43(11):2884-2891.
[17]刘明勇,周立春.脑血管储备对缺血性卒中的预测价值[J].中华临床医师杂志:电子版,2013,7(9):3720-3723.
[18]朱增民.红细胞压积对全血黏度关系的影响研究[J].当代医学,2011,17(29):20-21.
[19]毛江洪,汪青山,钮心怡,等.临床血液流变学的研究现状[J].中国优生与遗传杂志,2013,21(5):148-151.
[20]郭伟.中药黄芪的药理及临床研究概况[J].山西中医,2011,27(11):52-54.
[21]赵晓梅.分析补益药党参的药理和临床应用[J].中国实用医药,2016,11(32):135-136.
[22]唐亚芳,杨岸新.中药川芎的有效成分及其药理作用研究[J].中国现代药物应用,2018,12(10):219-220.
[23]郭晓香.浅析中药当归的炮制及应用与药理初探[J].世界最新医学信息文摘,2017,17(30):175-176.
[24]冀兰鑫,黄浩,李长志,等.赤芍药理作用的研究进展[J].药物评价研究,2010,33(3):233-236.
[25]张振鹏,滕菲,刘咏梅,等.丹参多酚酸盐干预非ST段抬高心肌梗死患者microRNA与靶基因[J].中国实验方剂学杂志,2017,23(19):17-22.
[26]景玉宏,冯慎远,汤晓琴.石菖蒲对学习记忆的影响及突触机制[J].中国中医基础医学杂志,2002,8(6):38-40.
[27]张晓娟,周海纯.葛根化学成分,现代药理及临床应用研究进展[J].中医药信息,2017,34(1):124-126.
[2] Carrera E, Lee L K, Giannopoulos S, et al.Cerebrovascular reactivity and cerebral autoregulation in normal subjects[J]. J Neurol Sci,2009,285(1/2):191-194.
[3]杨新林,李月春,李锐铭.脑血管储备功能的临床应用进展[J].卒中与神经疾病,2015,22(1):50-52.
[4]杨海昊,刘明君,韩涛,等.慢性脑供血不足中西医研究概况[J].山东中医药大学学报,2018,42(1):90-93.
[5]黄海量,吕征,韩涛,等.养血清脑颗粒治疗慢性脑供血不足的系统评价[J].中国实验方剂学杂志,2015,21(15):193-196.
[6]闫明坤,黄刚,辛华栋,等.星蒌承气方对慢性脑供血不足患者血栓前状态因子的干预[J].中国实验方剂学杂志,2010,16(7):233-234.
[7]吴春霖,王镭,李卫兵.临床试验随机化分组及其Stata的实现[J].中国循证医学杂志,2013,13(2):242-244.
[8]近藤.无症状性脑血管病变への对应颈动脉病变の治疗[J].日内会杂志,2000,4(86):781.
[9]国家中医药管理局.中医病证诊断疗效标准[M].南京:南京大学出版社,1994:23.
[10]崔璨,马云川.脑血管储备功能的检测方法及意义[J].临床和实验医学杂志,2015,14(2):160-164.
[11]王艳玲,华扬.脑血管储备功能与经颅多普勒超声临床应用[J].中华医学超声杂志:电子版,2010,7(10):1726-1730.
[12]孙传兴.临床疾病诊断依据治疗好转标准[M]. 2版.北京:人民军医出版社,2002:410.
[13] ZHANG L,DONG W,HAN J,et al. Montreal cognitive assessment and analysis of related factors for cognitive impairment in patients with chronic cerebral circulation insufficiency[J]. Int J Psychiatry Med,2015,50(3):257-270.
[14]彭春平.慢性脑供血不足中医证候的临床调查[D].福州:福建中医药大学,2015:4.
[15]贾艳红,李月春,张京芬. TCD评价的脑血管储备功能的临床应用价值[J].医学综述,2009,15(18):2819-2821.
[16] Gupta A, Chazen J L, Hartman M, et al.Cerebrovascular reserve and stroke risk in patients with carotid stenosis or occlusion:a systematic review and Meta-analysis[J]. Stroke,2012,43(11):2884-2891.
[17]刘明勇,周立春.脑血管储备对缺血性卒中的预测价值[J].中华临床医师杂志:电子版,2013,7(9):3720-3723.
[18]朱增民.红细胞压积对全血黏度关系的影响研究[J].当代医学,2011,17(29):20-21.
[19]毛江洪,汪青山,钮心怡,等.临床血液流变学的研究现状[J].中国优生与遗传杂志,2013,21(5):148-151.
[20]郭伟.中药黄芪的药理及临床研究概况[J].山西中医,2011,27(11):52-54.
[21]赵晓梅.分析补益药党参的药理和临床应用[J].中国实用医药,2016,11(32):135-136.
[22]唐亚芳,杨岸新.中药川芎的有效成分及其药理作用研究[J].中国现代药物应用,2018,12(10):219-220.
[23]郭晓香.浅析中药当归的炮制及应用与药理初探[J].世界最新医学信息文摘,2017,17(30):175-176.
[24]冀兰鑫,黄浩,李长志,等.赤芍药理作用的研究进展[J].药物评价研究,2010,33(3):233-236.
[25]张振鹏,滕菲,刘咏梅,等.丹参多酚酸盐干预非ST段抬高心肌梗死患者microRNA与靶基因[J].中国实验方剂学杂志,2017,23(19):17-22.
[26]景玉宏,冯慎远,汤晓琴.石菖蒲对学习记忆的影响及突触机制[J].中国中医基础医学杂志,2002,8(6):38-40.
[27]张晓娟,周海纯.葛根化学成分,现代药理及临床应用研究进展[J].中医药信息,2017,34(1):124-126.