黄芪桂枝五物汤加减联合针灸对急性缺血性脑卒中后遗症期病人神经功能缺损和日常生活活动能力的影响
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摘要
目的观察黄芪桂枝五物汤加减联合针灸对急性缺血性脑卒中后遗症期病人神经功能缺损和日常生活活动能力的影响。方法选取我院收治的急性缺血性脑卒中后遗症期病人96例作为研究对象,按照随机数字表法分为观察组和对照组,各48例。两组均给予抗凝、降低颅内压等基础干预,在此基础上对照组给予针灸治疗,观察组在对照组基础上联合黄芪桂枝五物汤加减内服治疗。比较两组临床疗效,观察两组治疗前后美国国立卫生研究院卒中量表(NIHSS)评分、日常生活自理能力(ADL)评分、血清血管内皮生长因子(VEGF)和碱性成纤维细胞生长因子(bFGF)指标的变化,统计不良反应发生情况。结果治疗后观察组临床总有效率明显高于对照组(93.75%与77.08%,P <0.05);两组治疗后NIHSS评分明显低于治疗前(P <0.01),且观察组NIHSS评分明显低于对照组(P <0.01);两组治疗后ADL评分明显高于治疗前(P <0.01),且观察组ADL评分明显高于对照组(P <0.05);两组治疗后血清VEGF、bFGF水平明显高于治疗前(P <0.01),且观察组明显高于对照组(P <0.01);两组治疗期间均未发生明显不良反应。结论黄芪桂枝五物汤加减联合针灸可有效改善急性缺血性脑卒中后遗症期病人神经功能缺损和日常生活活动能力,提高临床疗效。
Objective To explore the influences of modified Huangqi Guizhi Wuwu decoction(MHGWD)and acupuncture on neurologicalimpairment and activities of daily living(ADL)in patients with acute ischemic stroke(AIS)at sequelae stage.Methods Ninety-six pa-tients with AIS at sequelae stage were randomly divided into two groups:control group(n =48)treated with acupuncture plus routinetreatment such as anticoagulant and lower intracranial pressure,and observation group(n =48)treated with MHGWD in the basis ofroutine treatment plus acupuncture.The clinical efficacy of the two groups was compared.The National Institutes of Health Stroke Scale(NIHSS)score,ADL score,serum vascular endothelial growth factor(VEGF)and basic fibroblast growth factor(bFGF)were observedbefore and after treatment.The incidence of adverse reactions was observed.Results After treatment,the total effective rate of the obser-vation group was significantly higher than that in the control group(93.75%vs 77.08%,P <0.05).The NIHSS scores in the two groupsafter treatment were significantly lower than those before treatment(P <0.01),which were significantly lower in the observation groupthan those in the control group(P <0.01).The ADL scores in the two groups after treatment were significantly higher than those beforetreatment(P <0.01),which were significantly higher in the observation group than those in the control group(P <0.05).Serum VEGFand bFGF levels in the two groups after treatment were significantly higher than those before treatment(P <0.01),which were signifi-cantly higher in the observation group than those in the control group(P <0.01).There was no obvious adverse reaction occurred duringthe treatment period in the two groups.Conclusion MHGWD plus acupuncture can effectively improve the neurological impairment andactivities of daily living in patients with AIS at sequelae stage,and improve clinical efficacy.
Objective To explore the influences of modified Huangqi Guizhi Wuwu decoction(MHGWD)and acupuncture on neurologicalimpairment and activities of daily living(ADL)in patients with acute ischemic stroke(AIS)at sequelae stage.Methods Ninety-six pa-tients with AIS at sequelae stage were randomly divided into two groups:control group(n =48)treated with acupuncture plus routinetreatment such as anticoagulant and lower intracranial pressure,and observation group(n =48)treated with MHGWD in the basis ofroutine treatment plus acupuncture.The clinical efficacy of the two groups was compared.The National Institutes of Health Stroke Scale(NIHSS)score,ADL score,serum vascular endothelial growth factor(VEGF)and basic fibroblast growth factor(bFGF)were observedbefore and after treatment.The incidence of adverse reactions was observed.Results After treatment,the total effective rate of the obser-vation group was significantly higher than that in the control group(93.75%vs 77.08%,P <0.05).The NIHSS scores in the two groupsafter treatment were significantly lower than those before treatment(P <0.01),which were significantly lower in the observation groupthan those in the control group(P <0.01).The ADL scores in the two groups after treatment were significantly higher than those beforetreatment(P <0.01),which were significantly higher in the observation group than those in the control group(P <0.05).Serum VEGFand bFGF levels in the two groups after treatment were significantly higher than those before treatment(P <0.01),which were signifi-cantly higher in the observation group than those in the control group(P <0.01).There was no obvious adverse reaction occurred duringthe treatment period in the two groups.Conclusion MHGWD plus acupuncture can effectively improve the neurological impairment andactivities of daily living in patients with AIS at sequelae stage,and improve clinical efficacy.
引文
[1]宋琳琳,冯晓东,刘承梅,等.改良铺灸法联合常规疗法治疗脑卒中后肱二头肌肌张力增高31例随机对照研究[J].中医杂志,2015,56(14):1224-1227.
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[3]何金峰,徐小辉,茆红霞,等.针灸联合康复治疗脑卒中后运动性失语的临床疗效观察[J].中华中医药学刊,2015,34(3):763-765.
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[5]中华医学会神经病学分会.中国急性缺血性脑卒中诊治指南2014[J].中华神经科杂志,2015,48(4):246-257.
[6]国家中医药管理局脑病急症协作组.中风病诊断与疗效评定标准[J].北京中医药大学学报(中医临床版),1996,19(1):55-56.
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[9]杨小军.NIHSS、GCS、APACHEⅡ、MEWS评分量表预测急性脑卒中患者远期预后的评价[D].乌鲁木齐:新疆医科大学,2016.
[10]夏楠,任彩丽,王红星,等.脑梗死急性期康复训练流程对患者运动功能和日常生活活动能力改善程度的影响[J].中国康复医学杂志,2017,32(4):396-401.
[11]李冀.中医方剂学[M].北京:中国中医药出版社,2012:216-218.
[12]陈效琴,赵诤,邓有琦,等.急性缺血性脑卒中溶栓治疗进展[J].中国现代药物应用,2016,10(15):286-288.
[13]裴红民,徐新亚.中西医结合治疗缺血性脑卒中后遗症的临床研究[J].中华中医药学刊,2015,34(10):2519-2522.
[14]马勇,王华伟,杨盼盼,等.黄芪桂枝五物汤联合康复训练治疗脑卒中后肩手综合征80例[J].中国中医药现代远程教育,2016,14(4):76-78.
[15]陈倩倩,王玉影,郑婉群,等.针灸通督法对缺血性脑卒中患者BF-GF、VEGF的干预作用研究[D].合肥:安徽中医药大学,2014.
[16]潘林森,吴军.醒脑开窍针刺法配合黄芪桂枝五物汤治疗卒中后动眼神经麻痹临床研究[J].河南中医,2015,35(8):1762-1764.
[17]韩兆莹,田明,刘珍,等.黄芪桂枝五物汤的药理研究现状[J].黑龙江医药,2013,26(5):777-779.
[18]张副兴,祝雨田,季也民.黄芪桂枝五物汤提取工艺与药理作用进展[J].辽宁中医药大学学报,2014,23(6):242-244.
[2]马宇彤,胥广宇.探讨补阳还五汤+针灸治疗缺血性脑卒中后遗症期的临床疗效[J].中国伤残医学,2016,24(2):135-136.
[3]何金峰,徐小辉,茆红霞,等.针灸联合康复治疗脑卒中后运动性失语的临床疗效观察[J].中华中医药学刊,2015,34(3):763-765.
[4]刘睿.化痰通络汤联合针灸治疗对脑卒中后遗症期患者神经功能修复的影响[J].辽宁中医杂志,2016,43(7):1472-1475.
[5]中华医学会神经病学分会.中国急性缺血性脑卒中诊治指南2014[J].中华神经科杂志,2015,48(4):246-257.
[6]国家中医药管理局脑病急症协作组.中风病诊断与疗效评定标准[J].北京中医药大学学报(中医临床版),1996,19(1):55-56.
[7]程海英.程海英《针灸学》精品课程教案[M].北京:中医古籍出版社,2013:153.
[8]中华医学会神经病学分会脑血管病学组急性缺血性脑卒中诊治指南撰写组.中国急性缺血性脑卒中诊治指南2010[J].中华神经科杂志,2010,43(2):146-153.
[9]杨小军.NIHSS、GCS、APACHEⅡ、MEWS评分量表预测急性脑卒中患者远期预后的评价[D].乌鲁木齐:新疆医科大学,2016.
[10]夏楠,任彩丽,王红星,等.脑梗死急性期康复训练流程对患者运动功能和日常生活活动能力改善程度的影响[J].中国康复医学杂志,2017,32(4):396-401.
[11]李冀.中医方剂学[M].北京:中国中医药出版社,2012:216-218.
[12]陈效琴,赵诤,邓有琦,等.急性缺血性脑卒中溶栓治疗进展[J].中国现代药物应用,2016,10(15):286-288.
[13]裴红民,徐新亚.中西医结合治疗缺血性脑卒中后遗症的临床研究[J].中华中医药学刊,2015,34(10):2519-2522.
[14]马勇,王华伟,杨盼盼,等.黄芪桂枝五物汤联合康复训练治疗脑卒中后肩手综合征80例[J].中国中医药现代远程教育,2016,14(4):76-78.
[15]陈倩倩,王玉影,郑婉群,等.针灸通督法对缺血性脑卒中患者BF-GF、VEGF的干预作用研究[D].合肥:安徽中医药大学,2014.
[16]潘林森,吴军.醒脑开窍针刺法配合黄芪桂枝五物汤治疗卒中后动眼神经麻痹临床研究[J].河南中医,2015,35(8):1762-1764.
[17]韩兆莹,田明,刘珍,等.黄芪桂枝五物汤的药理研究现状[J].黑龙江医药,2013,26(5):777-779.
[18]张副兴,祝雨田,季也民.黄芪桂枝五物汤提取工艺与药理作用进展[J].辽宁中医药大学学报,2014,23(6):242-244.