凉血通瘀法治疗出血性中风急性期风阳上扰证的理论及临床研究
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摘要
【目的】通过对凉血通瘀法治疗出血性中风急性期风阳上扰证临床疗效的观察,从疗效反证“瘀热阻窍”为出血性中风急性期的中心病理环节,凉血通瘀法不仅适用于瘀热阻窍证,对风阳上扰证也有较好疗效。为出血性中风急性期的中医药临床治疗提供新的思路。
【方法】临床收集出血性中风急性期风阳上扰证患者67例,随机分为治疗组34例、对照组33例。对照组采用脱水降颅压等西医内科基础治疗及对症处理,治疗组在对照组基础上加用凉血通瘀方,疗程均为21天。以治疗前后中风病类诊断评分、脑出血量、脑水肿程度、实验室指标、日常生活能力量表评分、格拉斯哥预后结果评分、修正RANKIN标准评分等作为主要观测指标,评价凉血通瘀方的临床疗效。
【结果】
1.中风病类诊断评分治疗前后比较,治疗组由治疗前的27.21±16.00分下降至治疗后的10.79±11.52分,P<0.01；对照组由治疗前的25.15±14.71分下降至15.45±13.94分,P<0.05。治疗前后差值治疗组为16.41±14.23分,对照组为9.70±9.01分,两组比较,P<0.05。结果表明,两组治疗后中风病类诊断评分均有显著下降,尤以治疗组下降为明显。
2.两组综合疗效经秩和检验,P<0.05,治疗组明显优于对照组。两组总疗效比较,治疗组34例,显效23例(67.6%),有效9例(26.5%),无效2例(5.9%),总有效率为94.1%；对照组33例,分别为12例(36.4%)、16例(48.5%)、5例(15.2%),总有效率为84.8%。两组显效率比较,治疗组优于对照组(P<0.05)。
3.两组治疗后风阳上扰证量化诊断评分较治疗前均有明显下降,治疗组优于对照组。治疗组34例,治疗前14.04±3.60分；治疗后11天11.37±3.40分,与治疗前比较,评分明显下降(P<0.01)；治疗后21天为7.02±3.49分,与治疗后11天比较评分进一步明显下降(P<0.01)。对照组33例,治疗前14.50±3.84分；治疗后11天12.73±4.46分,评分较治疗前显著下降(P<0.01)；治疗后21天9.04±4.67分,与治疗后11天比较评分进一步下降(P<0.05)。
4.预后评分,包括日常生活能力量表评分、格拉斯哥预后结果评分、修正RANKIN标准评分,两组治疗后较治疗前均有显著下降(P<0.05),尤以治疗组下降明显。
5.头颅CT结果提示,两组治疗后脑出血量均明显减少、血肿明显吸收,治疗组脑出血量由18.18±20.77ml降至5.03±5.75ml(P<0.01),对照组由20.45±17.02ml降至7.45±11.08ml(P<0.01)。治疗后脑水肿改善程度比较,治疗组34例,加重3例,无变化15例,有效4例,显效9例；对照组32例,加重6例,无变化8例,有效14例,显效4例。两组间经秩和检验Z=-0.429,P>0.05。两组显效率比较,P<0.05。
6.观察分析两组患者治疗前后的血液流变学、血脂、凝血功能等指标,提示未见凉血通瘀方有明显的改善作用。
7.两组血常规、肝功能及肾功能等部分指标(PLT、ALT)前后出现差异(P<0.05),但基本波动在正常范围,且两组间均无统计学差异(P>0.05)。
8.治疗组34例患者在服用凉血通瘀方药过程中未出现明显不良反应。
【结论】
1.凉血通瘀方可以有效改善出血性中风急性期风阳上扰证患者的临床症状,并在降低病死率、改善神志症状及神经功能缺损症状、减轻病情严重程度等方面具有优势。
2.凉血通瘀方能够促进血肿的吸收并减轻脑水肿程度。
3.凉血通瘀方具有良好的安全性,无明显毒副反应。
4.从临床疗效反证“瘀热阻窍”为出血性中风急性期的中心病理环节,凉血通瘀法不仅适用于瘀热阻窍证,对风阳上扰证也有较好疗效,为中医药治疗出血性中风开拓新的思路。
[Objectives] To observe the clinical effects in treating about acute hemorrhagic stroke with the cooling blood and clearing stasis (CBCS) treatment which caused by wind, proves that the stagnation of blood stasis-heat in the brain(SBSHB) is the central pathology link and the CBCS treatment not only applicable to the SBSHB but also to the stagnation of Wind disturbance。Then this research could provide new ideas for acute hemorrhagic stroke of TCM clinical therapy.
[Methods] To collect 67 acute hemorrhagic stroke patients with the stagnation of Wind disturbance in clinical and divide them randomly into 2 groups,34 cases in treatment group and control group 33 cases. The control group is treated by dehydration drop cranial pressure control of internal medicine, and the foundation treatment in treatment group and control group basis with CBCS treatmen, general course for 21 days.Then evaluate CBCS Treatment of hemorrhagic stroke therapy by Stroke scores of diagnosis, the bleeding, the Cerebral edema, the Laboratory, the ADL, the GOS, the Fixed RANKIN standards and so on.
【Results】
1. To compare stroke scores of diagnosis before and after the treatment, treatment group 27.21±16.00 scores before therapy dropped to the 10.79±11.52 after treatment(P<0.01) and control group 25.15±14.71 dropped to 15.45±13.94(P<0.05). The difference before and after treatmemt of treatment group is 16.41±14.23 score, and control group is 9.70±9.01 score (P<0.05).The results showed that after treatment, stroke type diagnosis rates were significantly decreased, especially in the treatment group was significantly decreased.
2. The integrated effect of the two groups rank test, P<0.05, treatment group was significantly better than the control group. Comparative efficacy of the two groups, treatment group,34 patients were cured,23 cases (67.6%),9 cases (26.5%),2 cases (5.9%), the total effective rate was 94.1%; control group,33 cases were 12 cases (36.4%),16 cases (48.5%),5 cases (15.2%), total effective rate was 84.8%. The efficiency of the two groups were compared, the treatment group than the control group (P<0.05).
3. After treatment, air yang disturbance permits quantitative diagnosis rates significantly decreased than that before treatment, the treatment group than the control group. Treatment group,34 patients before treatment,14.04±3.60 min; 11 days after treatment,11.37±3.40 minutes, compared with before treatment, scores were significantly decreased (P<0.01); 21 days after treatment was 7.02±3.49 minutes, and 11 days after treatment comparison score further decreased (P<0.01). Control group,33 patients before treatment 14.50±3.84 minutes; treatment 11 days 12.73±4.46 points, score higher than before treatment were significantly decreased (P<0.01); after treatment for 21 days 9.04±4.67 minutes, and after treatment,11 days compared rates further decreased (P<0.05).
4. Prognostic score, including the ADL score, Glasgow outcome scale score, modified RANKIN scores, the two groups after treatment than before treatment were significantly decreased (P<0.05), especially in the treatment group decreased significantly.
5. Head CT results suggest that two groups were significantly reduced brain hemorrhage, hematoma obvious absorption in the treatment group cerebral hemorrhage reduced by the 18.18±20.77ml 5.03±5.75ml (P<0.01), the control group dropped from the 20.45±17.02ml 7.45±11.08ml (P<0.01). Improvement of brain edema after treatment compared to treatment group,34 patients increased in 3 cases, no change in 15 cases,4 patients were cured,9 cases; the control group 32 cases, increased in 6 cases, remained unchanged in 8 cases, effective in 14 cases, effective in 4 cases. Between the two groups by rank sum test Z =-0.429, P> 0.05. The efficiency of the two groups were compared, P<0.05.
6. Two groups of patients before and after observation and analysis of hemorheology, blood lipid, coagulation and other indicators, suggesting no Liangxuetongyu significantly improved side effect.
7. Two groups of blood, liver and kidney functions and some other indicators (PLT, ALT) before and after the variance (P<0.05), but the basic fluctuations in the normal range, and the two groups showed no significant difference (P> 0.05).
8. Treatment group,34 patients taking the prescription process Liangxuetongyu no obvious adverse reactions.
【Conclusions】
1. The CBCS can effectively improve the general syndrome of acute hemorrhagic stroke patients with the stagnation of Wind disturbance in the clinical symptoms, and reduce mortality, improving the mind symptoms and signs neurologic deficits, reduce illness severity, etc.
2. The CBCS can promote the absorption of haematomas and reduce cerebral edema.
3. The CBCS is safety with no noticeable adverse reaction.
4. To prove that the stagnation of blood stasis-heat in the brain(SBSHB) is the central pathology link by the clinical curative effect, and the CBCS treatment not only applicable to the SBSHB but also to the stagnation of Wind disturbance.Then this research could provide new ideas for acute hemorrhagic stroke of TCM clinical therapy.
【方法】临床收集出血性中风急性期风阳上扰证患者67例,随机分为治疗组34例、对照组33例。对照组采用脱水降颅压等西医内科基础治疗及对症处理,治疗组在对照组基础上加用凉血通瘀方,疗程均为21天。以治疗前后中风病类诊断评分、脑出血量、脑水肿程度、实验室指标、日常生活能力量表评分、格拉斯哥预后结果评分、修正RANKIN标准评分等作为主要观测指标,评价凉血通瘀方的临床疗效。
【结果】
1.中风病类诊断评分治疗前后比较,治疗组由治疗前的27.21±16.00分下降至治疗后的10.79±11.52分,P<0.01；对照组由治疗前的25.15±14.71分下降至15.45±13.94分,P<0.05。治疗前后差值治疗组为16.41±14.23分,对照组为9.70±9.01分,两组比较,P<0.05。结果表明,两组治疗后中风病类诊断评分均有显著下降,尤以治疗组下降为明显。
2.两组综合疗效经秩和检验,P<0.05,治疗组明显优于对照组。两组总疗效比较,治疗组34例,显效23例(67.6%),有效9例(26.5%),无效2例(5.9%),总有效率为94.1%；对照组33例,分别为12例(36.4%)、16例(48.5%)、5例(15.2%),总有效率为84.8%。两组显效率比较,治疗组优于对照组(P<0.05)。
3.两组治疗后风阳上扰证量化诊断评分较治疗前均有明显下降,治疗组优于对照组。治疗组34例,治疗前14.04±3.60分；治疗后11天11.37±3.40分,与治疗前比较,评分明显下降(P<0.01)；治疗后21天为7.02±3.49分,与治疗后11天比较评分进一步明显下降(P<0.01)。对照组33例,治疗前14.50±3.84分；治疗后11天12.73±4.46分,评分较治疗前显著下降(P<0.01)；治疗后21天9.04±4.67分,与治疗后11天比较评分进一步下降(P<0.05)。
4.预后评分,包括日常生活能力量表评分、格拉斯哥预后结果评分、修正RANKIN标准评分,两组治疗后较治疗前均有显著下降(P<0.05),尤以治疗组下降明显。
5.头颅CT结果提示,两组治疗后脑出血量均明显减少、血肿明显吸收,治疗组脑出血量由18.18±20.77ml降至5.03±5.75ml(P<0.01),对照组由20.45±17.02ml降至7.45±11.08ml(P<0.01)。治疗后脑水肿改善程度比较,治疗组34例,加重3例,无变化15例,有效4例,显效9例；对照组32例,加重6例,无变化8例,有效14例,显效4例。两组间经秩和检验Z=-0.429,P>0.05。两组显效率比较,P<0.05。
6.观察分析两组患者治疗前后的血液流变学、血脂、凝血功能等指标,提示未见凉血通瘀方有明显的改善作用。
7.两组血常规、肝功能及肾功能等部分指标(PLT、ALT)前后出现差异(P<0.05),但基本波动在正常范围,且两组间均无统计学差异(P>0.05)。
8.治疗组34例患者在服用凉血通瘀方药过程中未出现明显不良反应。
【结论】
1.凉血通瘀方可以有效改善出血性中风急性期风阳上扰证患者的临床症状,并在降低病死率、改善神志症状及神经功能缺损症状、减轻病情严重程度等方面具有优势。
2.凉血通瘀方能够促进血肿的吸收并减轻脑水肿程度。
3.凉血通瘀方具有良好的安全性,无明显毒副反应。
4.从临床疗效反证“瘀热阻窍”为出血性中风急性期的中心病理环节,凉血通瘀法不仅适用于瘀热阻窍证,对风阳上扰证也有较好疗效,为中医药治疗出血性中风开拓新的思路。
[Objectives] To observe the clinical effects in treating about acute hemorrhagic stroke with the cooling blood and clearing stasis (CBCS) treatment which caused by wind, proves that the stagnation of blood stasis-heat in the brain(SBSHB) is the central pathology link and the CBCS treatment not only applicable to the SBSHB but also to the stagnation of Wind disturbance。Then this research could provide new ideas for acute hemorrhagic stroke of TCM clinical therapy.
[Methods] To collect 67 acute hemorrhagic stroke patients with the stagnation of Wind disturbance in clinical and divide them randomly into 2 groups,34 cases in treatment group and control group 33 cases. The control group is treated by dehydration drop cranial pressure control of internal medicine, and the foundation treatment in treatment group and control group basis with CBCS treatmen, general course for 21 days.Then evaluate CBCS Treatment of hemorrhagic stroke therapy by Stroke scores of diagnosis, the bleeding, the Cerebral edema, the Laboratory, the ADL, the GOS, the Fixed RANKIN standards and so on.
【Results】
1. To compare stroke scores of diagnosis before and after the treatment, treatment group 27.21±16.00 scores before therapy dropped to the 10.79±11.52 after treatment(P<0.01) and control group 25.15±14.71 dropped to 15.45±13.94(P<0.05). The difference before and after treatmemt of treatment group is 16.41±14.23 score, and control group is 9.70±9.01 score (P<0.05).The results showed that after treatment, stroke type diagnosis rates were significantly decreased, especially in the treatment group was significantly decreased.
2. The integrated effect of the two groups rank test, P<0.05, treatment group was significantly better than the control group. Comparative efficacy of the two groups, treatment group,34 patients were cured,23 cases (67.6%),9 cases (26.5%),2 cases (5.9%), the total effective rate was 94.1%; control group,33 cases were 12 cases (36.4%),16 cases (48.5%),5 cases (15.2%), total effective rate was 84.8%. The efficiency of the two groups were compared, the treatment group than the control group (P<0.05).
3. After treatment, air yang disturbance permits quantitative diagnosis rates significantly decreased than that before treatment, the treatment group than the control group. Treatment group,34 patients before treatment,14.04±3.60 min; 11 days after treatment,11.37±3.40 minutes, compared with before treatment, scores were significantly decreased (P<0.01); 21 days after treatment was 7.02±3.49 minutes, and 11 days after treatment comparison score further decreased (P<0.01). Control group,33 patients before treatment 14.50±3.84 minutes; treatment 11 days 12.73±4.46 points, score higher than before treatment were significantly decreased (P<0.01); after treatment for 21 days 9.04±4.67 minutes, and after treatment,11 days compared rates further decreased (P<0.05).
4. Prognostic score, including the ADL score, Glasgow outcome scale score, modified RANKIN scores, the two groups after treatment than before treatment were significantly decreased (P<0.05), especially in the treatment group decreased significantly.
5. Head CT results suggest that two groups were significantly reduced brain hemorrhage, hematoma obvious absorption in the treatment group cerebral hemorrhage reduced by the 18.18±20.77ml 5.03±5.75ml (P<0.01), the control group dropped from the 20.45±17.02ml 7.45±11.08ml (P<0.01). Improvement of brain edema after treatment compared to treatment group,34 patients increased in 3 cases, no change in 15 cases,4 patients were cured,9 cases; the control group 32 cases, increased in 6 cases, remained unchanged in 8 cases, effective in 14 cases, effective in 4 cases. Between the two groups by rank sum test Z =-0.429, P> 0.05. The efficiency of the two groups were compared, P<0.05.
6. Two groups of patients before and after observation and analysis of hemorheology, blood lipid, coagulation and other indicators, suggesting no Liangxuetongyu significantly improved side effect.
7. Two groups of blood, liver and kidney functions and some other indicators (PLT, ALT) before and after the variance (P<0.05), but the basic fluctuations in the normal range, and the two groups showed no significant difference (P> 0.05).
8. Treatment group,34 patients taking the prescription process Liangxuetongyu no obvious adverse reactions.
【Conclusions】
1. The CBCS can effectively improve the general syndrome of acute hemorrhagic stroke patients with the stagnation of Wind disturbance in the clinical symptoms, and reduce mortality, improving the mind symptoms and signs neurologic deficits, reduce illness severity, etc.
2. The CBCS can promote the absorption of haematomas and reduce cerebral edema.
3. The CBCS is safety with no noticeable adverse reaction.
4. To prove that the stagnation of blood stasis-heat in the brain(SBSHB) is the central pathology link by the clinical curative effect, and the CBCS treatment not only applicable to the SBSHB but also to the stagnation of Wind disturbance.Then this research could provide new ideas for acute hemorrhagic stroke of TCM clinical therapy.
引文
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