化痰通遂汤联合康复训练治疗痰浊壅塞、瘀阻经络型脑卒中偏瘫的临床研究

发布时间：2018-04-23 14:50

本文选题：脑卒中偏瘫 + 化痰通遂汤　；参考：《河北医科大学》2017年硕士论文

【摘要】：目的:本研究以痰浊壅塞、瘀阻经络型脑卒中偏瘫患者为研究对象,观察化痰通遂汤联合康复训练对脑卒中偏瘫患者的临床疗效,并初步探讨其可能的作用机制。方法:选取河北以岭医院康复医学科2015年1月—2016年12月住院治疗的符合纳入标准的脑卒中偏瘫患者(痰浊壅塞、瘀阻经络型)120例,按照患者住院病历号随机分为对照组与治疗组,各60例,并依据患者的病情给予相对应的抗血小板聚集、降血压、降血糖等基础治疗。在基础治疗的基础上,将Brunnstrom、Bobath及运动再学习等康复疗法进行结合,主要用于改善患者的上下肢功能、运动功能、平衡能力、日常生活能力。对照组患者给予基础治疗与康复训练;治疗组在对照组的基础上,口服化痰通遂汤,1剂/天,早晚各一次。两组疗程均为45天,治疗前后分别采用《中风病诊断与疗效评定标准》对脑卒中偏瘫患者的临床症状进行评分,并采用简化Brunnstrom量表、Fugl-Meyer量表、FIM量表以及Berg量表,对患者的上下肢功能、运动功能、平衡能力及日常生活能力等进行评估。同时检测两组患者治疗前后的血液流变学指标(包括全血黏度、纤维蛋白原及血浆粘度)及血清总胆固醇(TC)、甘油三酯(TG)、IL-6、IL-1β、TNF-α含量。数据分析采用SPSS17.0统计软件进行,计数资料采用X2检验,计量资料采用t检验,等级资料采用Ridit检验,以P0.05为具有显著性差异。结果:1两组患者基线资料比较基线资料如性别、年龄、病程等无明显差异(P0.05),具有可比性。2两组患者临床疗效及症状评分比较对照组有效率为78.94%,治疗组有效率为93.22%,治疗组有效率明显高于对照组(P0.05)。临床症状评分比较结果显示,两组患者治疗后临床症状较治疗前均显著改善(P0.05);两组患者治疗后的临床症状评分比较,无显著性差异(P0.05)。3两组患者的上下肢功能、运动功能、平衡能力及生活能力评分的比较治疗后,两组患者的上下肢功能评分、运动功能评分、平衡能力评分及生活能力评分均显著高于治疗前(P0.05);且治疗后两组患者各项评分均具有显著差异(P0.05)。4两组患者血液流变学指标的比较治疗后,对照组患者的全血黏度、血浆黏度及纤维蛋白原含量与治疗前相比无明显差异(P0.05);治疗组患者的全血黏度、血浆黏度及纤维蛋白原含量较治疗前均显著降低(P0.05);与对照组相比,治疗组患者的全血黏度、血浆黏度及纤维蛋白原含量出现显著降低(P0.05)。5两组患者血清TC及TG指标比较两组患者血清TC与TG指标较治疗前均显著降低(P0.05)。治疗后,治疗组患者血清TC与TG水平的降低更为显著(P0.05),优于对照组。6两组患者治疗前后血清IL-6、IL-1β及TNF-α水平的比较治疗后,对照组患者的血清IL-6、IL-1β及TNF-α水平与治疗前相比无明显差异(P0.05);治疗组患者的IL-6、IL-1β及TNF-α水平均显著低于治疗前(P0.05)。与对照组相比,治疗组患者的血清IL-6、IL-1β及TNF-α水平均显著低于对照组(P0.05)。结论:1本研究以化痰开窍、活瘀通络为原则自拟的化痰通遂汤联合康复训练,能显著改善患者的临床症状、上下肢功能、运动功能、平衡功能、日常生活能力,提高患者的生存生活质量,对于痰浊壅塞、瘀阻经络型脑卒中偏瘫患者表现出了良好的治疗效果。2本研究进一步对化痰通遂汤治疗痰浊壅塞、瘀阻经络型脑卒中偏瘫患者的作用机制进行探讨。结果显示,本方对脑卒中偏瘫的治疗,可能与降低血脂水平,抑制炎症因子,改善血液流变学指标密切相关。
[Abstract]:Objective: To observe the clinical effect of phlegm Tong Sui decoction combined with rehabilitation training on stroke hemiplegic patients with phlegm congestion and stagnation of meridian type cerebral apoplexy, and to preliminarily discuss the possible mechanism of action. Methods: the treatment of rehabilitation medicine in Hebei Yiling hospital from January 2015 to December 2016 was selected. 120 patients with cerebral apoplexy hemiplegia (phlegm congestion and stasis meridian) were randomly divided into the control group and the treatment group according to the patient's medical record number, and 60 cases each were given the corresponding anti platelet aggregation, blood pressure reduction and blood sugar reduction according to the patient's condition. On the basis of basic treatment, Brunnstrom, Bobath and exercise restudy were carried out. A combination of rehabilitation therapy, mainly used to improve the patients' upper and lower limbs function, exercise function, balance ability and daily life ability. The control group was given basic treatment and rehabilitation training; on the basis of the control group, the treatment group took oral phlegm Tong Sui decoction, 1 doses / days, each time in the morning and evening. The two groups were 45 days, before and after the treatment, < The clinical symptoms of stroke patients with hemiplegia were evaluated and the simplified Brunnstrom scale, the Fugl-Meyer scale, the FIM scale and the Berg scale were used to evaluate the upper and lower limbs function, the exercise function, the balance ability and the daily living ability of the patients. The blood of two groups of patients before and after treatment were measured. The hemorrheology index (including whole blood viscosity, fibrinogen and plasma viscosity) and serum total cholesterol (TC), triglyceride (TG), IL-6, IL-1 beta, TNF- alpha content. The data analysis was carried out by SPSS17.0 statistical software, the counting data were tested by X2 test, the measurement data were tested with T, and the grade data were tested with Ridit test, with P0.05 as significant difference. Results: 1 the baseline data of the two groups were compared with the baseline data such as sex, age, and course of disease (P0.05). The clinical curative effect and symptom score of the group.2 two were compared with the control group, the effective rate was 78.94%, the treatment group was 93.22%, and the treatment group was significantly higher than the control group (P0.05). The clinical symptom score comparison results showed that the treatment group was more effective than the control group (P0.05). The clinical symptoms of the two groups were significantly improved after treatment (P0.05), and there was no significant difference between the two groups after treatment (P0.05) the upper and lower limbs function, motor function, balance ability and life ability score of the two groups of the two groups were compared, and the scores of upper and lower limbs, motor function score, and the score of motor function in the two groups of patients were compared. The score of balance and life ability were significantly higher than that before the treatment (P0.05), and the scores of the two groups after the treatment were significantly different (P0.05) after the comparison of hemorheological indexes in the group.4 two, the total blood viscosity, plasma viscosity and the content of fibrous egg white in the control group were not significantly different from those before the treatment (P0.05). The whole blood viscosity, plasma viscosity and fibrinogen in the treatment group were significantly lower than those before the treatment (P0.05). Compared with the control group, the total blood viscosity, plasma viscosity and fibrinogen content in the treatment group were significantly decreased (P0.05).5 two groups of serum TC and TG indexes compared with the two groups of serum TC and TG indexes were significantly higher than those before treatment. Decrease (P0.05). After treatment, the level of serum TC and TG decreased more significantly (P0.05) in the treatment group than in the control group, compared with the serum IL-6, IL-1 beta and TNF- alpha levels before and after treatment in the.6 two groups of the control group, and the serum IL-6, IL-1 beta and TNF- alpha levels in the control group were not significantly different from those before the treatment (P0.05). The level of 1 beta and TNF- alpha was significantly lower than that before the treatment (P0.05). Compared with the control group, the levels of serum IL-6, IL-1 beta and TNF- alpha in the patients in the treatment group were significantly lower than those of the control group (P0.05). Conclusion: the clinical symptoms of the patients and the upper and lower extremities can be significantly improved by using the phlegm opening and activating the phlegm and dredging collaterals as the principle of the combined rehabilitation training. Ability, exercise function, balance function, daily life ability, improve the quality of life and life of patients, have good therapeutic effect on patients with hemiplegic paralysis of phlegm obstruction and stasis meridian type cerebral apoplexy.2. This study further studies the mechanism of the effect of huatatsu Tong Sui Decoction in treating phlegm congestion and blood stasis meridian type stroke hemiplegic patients. It shows that the treatment of hemiplegia after stroke may be related to lowering blood lipid level, inhibiting inflammatory factors and improving hemorheological indexes.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3

【参考文献】