益气活血方预防寒潮促发高血压性脑卒中的临床研究

发布时间：2018-01-15 14:01

本文关键词：益气活血方预防寒潮促发高血压性脑卒中的临床研究　出处：《广州中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的观察益气活血方对寒潮来临时高血压患者的预防作用,旨在建立中风的一级预防体系,采用随机对照的实验方法,探讨益气活血方对寒潮促发脑卒中的预防作用,探明其作用机理,丰富中风"正虚邪中"理论,具有重要临床价值和巨大的社会效益与经济效益。方法1.收集2013年6月30日—2015年6月31日期间广州中医药大学第三附属医院内科符合选例标准的中风患者的病例资料共计124例,随机分为治疗组62例和对照组62例,两组基础疗法相同,治疗组加用益气活血方治疗,每个月至少服用汤药2周,疗程6个月,之后经历一次寒潮打击。2.治疗组与对照组在寒潮及强冷空气来临时终点事件发病率的对比分析,终点事件以发病时症状体征为参考,以头颅CT或MRI确诊脑卒中(包括腔隙性脑梗死、脑梗死、脑出血)的为准。3.入选时两组分别行TCD检查,经历寒潮后两组再次行TCD检查,最终在未出现终点事件的两组病人中各随机选取35例,两组经过年龄、性别的统计学分析对比无差异性。分别观察两组寒潮前后的大脑中动脉(MCA)收缩期峰值血流速度、卧位—立位MCA脑血流差值(CBFV)。收集病例完成后,采用SPSS20.0统计软件进行分析对比两组结果。成果1.经统计分析,治疗组62例患者在寒潮或强冷空气来临后出现腔隙性脑梗死2例,脑梗死3例,脑出血0例,发病率8.06%,对照组62例在寒潮或强冷空气来临后出现腔隙性脑梗死4例,脑梗死10例,脑出血1例,发病率24.19%。治疗组较对照组在寒潮来临时脑卒中发生率显著降低,差异有统计学意义(P0.05)。2.排除发生终点事件的患者后,分别从两组剩余患者中各随机抽取30例患者,经统计学分析,经过危险因素对比分析,确定入选时无统计学差异,入选时两组卧位—立位MCA脑血流差值(CBFV)比较无统计学差异(P0.05)。两组患者双侧MCA峰值流速降低,双侧对比、两组间比较无统计学差异(P0.05),两组流速均低于正常值,有统计学差异(P0.05)。3.经历寒潮后治疗组患者MCA峰值流速较对照组增快(P0.05),较正常值比较无统计学差异(P0.05),寒潮后治疗组患者卧、立位CBFV均较对照组速度增快,差异有统计学意义(P0.05);治疗组寒潮后与入选时相比,患者MCA峰值流速增快,差异有统计学意义(P0.05),治疗组患者卧、立位CBFV血流均较前寒潮前增快,差异有统计学意义(P0.05),CBFV差值较寒潮前小,差异有统计学意义(P0.01)。结论1.丰富中风"正虚邪中"的理论,明确扶助正气、避免感受外邪是预防中风的主要方法;2.益气活血方能显著降低寒潮促发的高血压性脑卒中的发病率。3.益气活血方预防卒中的可能机制是,提高血管的弹性,增加脑灌注,改善脑血流自动调节功能,有效抵御寒潮来临时血管痉挛带来的危害,从而降低寒潮所促发的脑卒中。
[Abstract]:Objective to observe the preventive effect of Yiqi Huoxue recipe (YQHXF) on patients with hypertension during cold wave, and to establish a primary prevention system for stroke, and to adopt a randomized controlled experimental method. To explore the preventive effect of Yiqi Huoxue recipe on stroke induced by cold wave, to find out its mechanism, and to enrich the theory of apoplexy. It has important clinical value and great social and economic benefits. Methods 1. Collect the cases of Internal Medicine of the third affiliated Hospital of Guangzhou University of traditional Chinese Medicine from June 30th 2013 to June 31st 2015. There were 124 standard stroke cases. Randomly divided into the treatment group of 62 cases and the control group of 62 cases, the two groups of basic therapy the same, treatment group plus Yiqi Huoxue prescription, at least 2 weeks each month, the course of treatment for 6 months. Treatment group and control group in the cold wave and the arrival of strong cold air incident incidence of the end point of the comparative analysis, the endpoint events in the onset of symptoms and signs as a reference. Ct or MRI was used to diagnose stroke (including lacunar infarction, cerebral infarction, cerebral hemorrhage). 3. TCD was performed in the two groups, and TCD was performed again in the two groups after cold wave. Finally, 35 patients were randomly selected from each group of patients who did not have an endpoint event, and the two groups passed through age. The peak systolic blood flow velocity of MCA in the middle cerebral artery before and after cold wave was observed in two groups. The cerebral blood flow difference of MCA in supine position and standing position was analyzed and compared with the two groups by SPSS20.0 software after collecting the cases. The results were analyzed and compared by statistical analysis. 1. In the treatment group, there were 2 cases of lacunar cerebral infarction, 3 cases of cerebral infarction and 0 cases of cerebral hemorrhage after cold surge or strong cold air. The incidence rate was 8.06%. In the control group, there were 4 cases of lacunar cerebral infarction, 10 cases of cerebral infarction and 1 case of cerebral hemorrhage after cold surge or strong cold air. The incidence of stroke in the treatment group was significantly lower than that in the control group at the onset of the cold wave, and the difference was statistically significant (P0.05. 2). After excluding the patients who had the terminal event, the incidence of stroke in the treatment group was significantly lower than that in the control group. 30 patients were randomly selected from each of the remaining patients in the two groups. After statistical analysis and comparative analysis of risk factors, it was confirmed that there was no statistical difference at the time of selection. There was no significant difference in cerebral blood flow difference (CBFV) between the two groups (P < 0.05). The peak flow velocity of bilateral MCA was decreased and the bilateral contrast was observed in the two groups. There was no statistical difference between the two groups (P 0.05), and the velocity of the two groups was lower than the normal value. The peak velocity of MCA in the treatment group was faster than that in the control group (P 0.05), but there was no significant difference compared with the normal value (P 0.05). In the treatment group after cold wave, the CBFV in supine and standing position increased faster than that in the control group, and the difference was statistically significant (P 0.05). In the treatment group, the peak velocity of MCA increased after cold wave, the difference was statistically significant (P 0.05). The blood flow of CBFV in the treatment group was faster than that before the cold wave. The difference of CBFV was significantly lower than that before cold wave. Conclusion 1.Conclusion 1. Enrich the theory of apoplexy, and clearly support the vital energy. 2. Avoiding external evil is the main method to prevent apoplexy. 2.Yiqi Huoxue prescription can significantly reduce the incidence of hypertensive stroke induced by cold wave .3.The possible mechanism of Yiqi Huoxue prescription to prevent stroke is to improve the elasticity of blood vessels and increase cerebral perfusion. To improve the automatic regulation of cerebral blood flow, effectively resist the harm of vasospasm in cold wave, and reduce the stroke caused by cold wave.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R277.7

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