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1.广西中医药大学 第一附属医院,南宁 530023
2.广西中医药大学,南宁 530001
3.宾阳县中医医院,南宁 530400
4.桂林市中医医院,广西 桂林 541002
陈炜,硕士,副教授,从事中医药防治心、脑血管病的研究,E-mail:chenwei8126@163.com
唐农,博士,教授,从事中医药防治心、脑血管病的研究,E-mail:4414732@qq.com
修回日期:2019-06-12,
网络出版日期:2019-12-11,
纸质出版日期:2020-08-05
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陈炜,胡跃强,吴林等.“三焦次第疗法”治疗急性脑梗死的临床研究[J].中国实验方剂学杂志,2020,26(15):110-115.
CHEN Wei,HU Yue-qiang,WU Lin,et al.Clinical Research on Treatment of Acute Cerebral Infarction with ‘Sanjiao Regular Sequence Therapy’[J].Chinese Journal of Experimental Traditional Medical Formulae,2020,26(15):110-115.
陈炜,胡跃强,吴林等.“三焦次第疗法”治疗急性脑梗死的临床研究[J].中国实验方剂学杂志,2020,26(15):110-115. DOI: 10.13422/j.cnki.syfjx.20200333.
CHEN Wei,HU Yue-qiang,WU Lin,et al.Clinical Research on Treatment of Acute Cerebral Infarction with ‘Sanjiao Regular Sequence Therapy’[J].Chinese Journal of Experimental Traditional Medical Formulae,2020,26(15):110-115. DOI: 10.13422/j.cnki.syfjx.20200333.
目的
2
评价“三焦次第疗法”治疗急性脑梗死的临床疗效及对S100-
β
蛋白(S100-
β
),肿瘤坏死因子-
α
(TNF-
α
),超敏C反应蛋白(hs-CRP)和神经肽Y(NPY)的影响。
方法
2
将180例患者随机按数字表法分为对照组和观察组各90例。对照组口服拜阿司匹林肠溶片,100 mg/次,1次/d;依达拉奉注射液,30 mg/次,30 min内滴完,2次/d,连续14 d;口服辛伐他汀片,20 mg/次,1次/d。观察组西医治疗同对照组,并采用“三焦次第疗法”,第一步,采用以桂枝法为主疏通中上焦,1 剂/d,共 8 d;第二步,以四逆法温通中下焦,1 剂/d,共 10 d;第三步,填精固本法,1 剂/d,共 10 d。两组疗程均治疗4周。进行美国国立卫生院神经功能缺损(NIHSS)评分,于治疗前、治疗后1,2,3和4周进行评价;评价治疗前后四肢简化Fugl-Meyer功能量表(FMA),日常生活活动能力(ADL),简易精神状态量表(MMSE)和中医主要症状评分;进行治疗前后中风患者报告的临床结局(PRO)的综合评估;检测治疗前后S100-
β
,hs-CRP,TNF-
α
和NPY水平;记录住院期间肺部感染、泌尿系感染、骨骼肌痛、肩手综合征、肩关节半脱位等并发症的发生率。
结果
2
观察组临床疗效优于对照组(
Z
=2.141,
P
<
0.05);观察组在治疗后1,2,3,4周NIHSS评分均低于同期对照组(
P
<
0.01);观察组患者FMA量表上、下肢评分和总分均高于对照组(
P
<
0.01);观察组患者中医主要症状评分低于对照组(
P
<
0.01),ADL和MMSE评分均高于对照组(
P
<
0.01);观察组症状、心理和社会评分及PRO总分均低于对照组(
P
<
0.01);观察组血清S100-
β
,hs-CRP,TNF-
α
和NPY水平均低于对照组(
P
<
0.01);观察组并发症总发生率为27.27%(21/77),低于对照组的46.15%(36/78)(
χ
2
=5.941,
P
<
0.05)。
结论
2
在常规西医治疗的基础上,采用以“三焦次第疗法”治疗急性脑梗死患者,能改善神经功能缺损程度,提高认知功能、四肢运动功能和日常生活活动能力,减轻中医主要症状,降低并发症的发生率,并能减轻炎症反应,保护神经细胞,临床疗效均优于单纯的西医治疗。
Objective
2
To evaluate the clinical efficacy of Sanjiao Cidi therapy on acute cerebral infarction and its effect on levels of S100-
β
protein (S100-
β
), tumor necrosis factor-
α
(TNF-
α
), hypersensitive C-reactive protein (hs-CRP) and neuropeptide (NPY).
Method
2
One hundred and eighty patients were randomly divided into control group (90 cases) and observation group (90 cases) by random number table. Patients in control group got aspirin enteric-coated tablets, 100 mg/time, 1 time/day, edaravone injection (injected within 30 minutes) for 14 days, 30 mg/time, 2 times/day, simvastatin tablets, 20 mg/time, 1 time/day. In addition to the basic therapy of meloxicam tablets, patients in observation group were also treated with Sanjiao Cidi therapy. In the first step, patients got Guizhi therapy to dredge Zhongjiao and Shangjiao, 1 dose/day, for 8 days. In the second step, patients got Sini therapy to dredge Zhongjiao and Xiajiao, 1 dose/day, for 10 days. In the third step, patients got Tianjing Gubentherapy, 1 dose/day, for 10 days. The course of treatment was 4 weeks. Before the treatment, and at the first, second, third and fourth weeks after treatment, National Institutes of Health Stroke Scale (NIHSS) was scored. And before and after treatment, function scale of fuglmeyer (FMA), ability of daily life activities (ADL), mini-mental state examination (MMSE) and main symptoms of traditional Chinese medicine were scored. Comprehensive assessment of patient report outcome (PRO) was made. And levels of S100-
β
, hs-CRP, TNF-
α
and NPY were detected. And the incidence rate of pulmonary infection, urinary infection, skeletal myalgia, shoulder hand syndrome and shoulder subluxation of patients were recorded during hospitalization.
Result
2
The clinical efficacy in observation group was better than that in control group (
Z
=2.141,
P
<
0.05). Scores of NIHSS in observation group were lower than those in control group at the first, second, third and fourth weeks after treatment (
P
<
0.01). Scores of upper limb, legs and the total scores from FMA were higher than those in control group (
P
<
0.01). Scores of the main symptoms of traditional Chinese medicine, symptoms, psychological and social scores, total scores of PRO, S100-
β
, hs-CRP, TNF-
α
and NPY were lower than those in the observation group (
P
<
0.01). And scores of ADL and MMSE were higher than those in control group (
P
<
0.01). Total incidence of complications in observation group was 27.27%(21/77), which was lower than 46.15%(36/78) in control group (
χ
2
=5.941,
P
<
0.05).
Conclusion
2
In addition to conventional western medicine treatment, Sanjiao Cidi therapy can treat the patients with acute cerebral infarction, alleviate the degree of neurological deficit, improve the cognitive function, motor function of limbs and the ability of daily life, reduce the main symptoms of traditional Chinese medicine, the incidence of complications and the inflammatory response, protect the nerve cells, with a better clinical efficacy and comprehensive effect in patients than pure Western medicine.
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