地黄饮子加减联合针刺治疗中风后失语（肾虚痰瘀型）的临床研究

发布时间：2018-03-13 03:12

本文选题：地黄饮子加减　切入点：针刺　出处：《河南中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：研究目的:采用地黄饮子加减联合针刺的方法治疗缺血性中风后失语(肾虚痰瘀型)患者,观察治疗效果及安全性。研究方法:研究对象收集2015年4月-2016年4月在河南中医药大学第一附属医院的就诊病人,将符合纳入标准、经过排除筛选的肾虚痰瘀型缺血性中风后失语患者60例作为研究对象。其中包括男37例,女23例,年龄40-75岁,平均年龄55.3岁;包括急性期患者22例,运动性失语、感觉性失语、命名性失语、完全性失语例数分别为15例、2例、2例、3例;恢复期患者38例,运动性失语、感觉性失语、命名性失语、完全性失语人数依次为31例、2例、2例、3例。分组方法将患者随机分为治疗组和对照组各30例,治疗组运动性失语、感觉性失语、命名性失语、完全性失语例数分别为24例、2例、2例、2例,其中急性期运动性失语、感觉性失语、命名性失语、完全性失语例数分别为9例、1例、1例、1例,恢复期运动性失语、感觉性失语、命名性失语、完全性失语例数分别为15例、1例、1例、1例。对照组运动性失语、感觉性失语、命名性失语、完全性失语例数分别为22例、2例、2例、4例,其中急性期运动性失语、感觉性失语、命名性失语、完全性失语例数分别为6例、1例、1例、2例,恢复期运动性失语、感觉性失语、命名性失语、完全性失语例数分别为16例、1例、1例、2例。治疗方法(1)对照组:常规药物治疗(包括调节血压、血脂、血糖、控制颅内压、保护胃粘膜、营养支持、抗凝、活血化瘀、抗感染及其他对症处理);(2)治疗组:地黄饮子加减+针刺治疗+常规药物治疗。评价方法治疗前后对患者各进行一次安全性评价、语言评定、及神经功能缺损评定、日常生活活动能力评价、中医症候检查。安全性评价包括血、尿、便常规、肝肾功能、心电图检查;语言评定根据西部失语症检查量表确定失语类型及失语症BDAE严重程度;根据《美国国立卫生研究院卒中量表》(National Institute of Health Strock Scale,NIHSS)计算神经功能缺损情况,根据《日常生活活动能力量表》(Barthel Index)进行日常生活活动能力评价,根据《中风病辨证诊断标准》制定中医症候评分表进行中医症候评价。结果:本研究对象共60例,两组治疗后总体疗效均比治疗前有明显改善,治疗组显效4例、有效16例、无效10例,总有效率为66.66%,对照组显效2例、有效12例、无效16例,总有效率为46.66%,治疗组明显优于对照组,两组比较存在显著性差异(P0.05);两组患者治疗后失语评分指标均有所改善,包括语言流畅性、自发性言语、听语理解、复述、命名、阅读、书写等,均较治疗前得到一定程度改善,且治疗组改善程度优于对照组,两组比较存在显著性差异(P0.05);两组患者神经功能缺损评分一定程度改善,半身不遂、口眼歪斜等症状减轻,患者自主能力增强;两组患者血、尿、粪常规、肝肾功、心电图检查未见异常。结论:地黄饮子加减联合针刺治疗肾虚痰瘀型中风后失语疗效显著,安全性好,值得临床推广。
[Abstract]:Objective: to treat patients with aphasia after ischemic apoplexy (kidney deficiency and phlegm stasis type) by adding and subtracting Rehmannia decoction with acupuncture. To observe the efficacy and safety of treatment. Methods: the subjects were collected from April 2015 to April 2016 in the first affiliated Hospital of Henan University of traditional Chinese Medicine to meet the inclusion criteria. Sixty cases of aphasia after ischemic stroke with deficiency of kidney and phlegm and stasis were selected as study subjects, including 37 males and 23 females, aged 40-75 years, with an average age of 55.3 years, including 22 cases of acute stage patients with motor aphasia and sensory aphasia. The cases of nomenclature aphasia, complete aphasia were 15 cases, 2 cases and 3 cases respectively, 38 cases of convalescent patients, 38 cases of motor aphasia, 3 cases of sensory aphasia, 3 cases of nomenclature aphasia, The total number of aphasia was 31 cases, 2 cases and 3 cases respectively. The patients were randomly divided into treatment group and control group, 30 cases in treatment group, 30 cases in motor aphasia group, 3 cases in sensory aphasia group, naming aphasia group. There were 24 cases of complete aphasia, 2 cases of complete aphasia, 2 cases of motor aphasia, 2 cases of sensory aphasia, 9 cases of nomenclature aphasia, 1 case of complete aphasia, 1 case of motor aphasia and 1 case of sensory aphasia, respectively. The number of cases of nomenclature aphasia and complete aphasia were 15 cases and 1 case respectively. In the control group, the number of motor aphasia, sensory aphasia, nomenclature aphasia and complete aphasia were 22 cases and 2 cases, 2 cases and 4 cases, respectively. Sensory aphasia, nomenclature aphasia, complete aphasia were 6 cases of aphasia, 1 case of aphasia, 1 case of motor aphasia, 1 case of sensory aphasia, 2 cases of nomenclature aphasia, and 2 cases of convalescent motor aphasia, sensory aphasia and naming aphasia, respectively. The cases of complete aphasia were 16 cases, 1 case and 1 case and 2 cases respectively. The control group was treated with routine drug therapy (including regulating blood pressure, blood lipid, blood sugar, controlling intracranial pressure, protecting gastric mucosa, nutritional support, anticoagulant, activating blood circulation and resolving stasis). Treatment group: Rehmannia glutinosa decoction plus subtraction acupuncture for routine drug treatment. Before and after treatment, the patients were evaluated for safety, language, and neurological impairment, respectively, before and after treatment. The safety evaluation included blood, urine, stool routine, liver and kidney function, electrocardiogram, language assessment according to the western aphasia scale to determine the type of aphasia and BDAE severity of aphasia. The neurological impairment was calculated by the National Institute of Health Strock scale NIHSS, and the activity of Daily living (ADL) was evaluated according to the activity of Daily living scale (ADL). Results: there were 60 cases in this study. The overall curative effect of the two groups was obviously improved compared with that before treatment. In the treatment group, there were 4 cases with remarkable effect and 16 cases with effective effect. 10 cases were ineffective, the total effective rate was 66.66. In the control group, 2 cases were effective, 12 cases were effective, 16 cases were ineffective, and the total effective rate was 46.66. The treatment group was obviously superior to the control group, and there was significant difference between the two groups (P 0.05). Including language fluency, spontaneous speech, listening comprehension, retelling, naming, reading, writing and so on, all of them were improved to some extent than before treatment, and the improvement of treatment group was better than that of control group. There was significant difference between the two groups (P 0.05), the neurological deficit score of the two groups was improved to some extent, the symptoms such as hemiplegia, askew of mouth and eye were alleviated, the patients' ability of autonomy was enhanced, the blood, urine, fecal routine, liver and kidney function of the two groups were improved, Conclusion: the treatment of aphasia after apoplexy of kidney deficiency and phlegm stasis type by adding and subtraction of Dihuang decoction combined with acupuncture is effective and safe, which is worth popularizing in clinic.
【学位授予单位】：河南中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R277.7

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