不同剂量黄芪的补阳还五汤治疗脑梗死恢复期的临床研究

发布时间：2018-05-09 03:45

本文选题：脑梗死 + 补阳还五汤　；参考：《广西中医药大学》2017年硕士论文

【摘要】：目的:观察以不同剂量黄芪的补阳还五汤治疗脑梗死恢复期的临床疗效,为中医药治疗脑梗死恢复期提供中医理论基础。方法:将广西中医药大学附属瑞康医院神经内科符合纳入标准的脑梗死恢复期气虚血瘀住院或门诊病人共96例,采用随机数字表法入选的脑梗死恢复期患者分为对照组34例、治疗A组33例和治疗B组29例,观察过程中有6例因失访、出现并发症及未按要求治疗等原因剔除病例,最终病例对照组32例、治疗A组30例和治疗B组28例。对照组应用脑梗死恢复期的二级预防常规治疗(阿司匹林肠溶片100mg,每天一次,口服,抗血小板聚集,阿托伐他汀钙20mg,每天睡前一次,口服,稳定斑块)。治疗A组应用脑梗死恢复期的二级预防常规治疗+黄芪剂量为30g的补阳还五汤(黄芪30g,当归12g,赤芍10g,地龙6g,川芎12g,桃仁10g,红花10g,水煎分2次早晚服,每次200ml)。治疗B组应用脑梗死恢复期的二级预防常规治疗+黄芪剂量为120g的补阳还五汤。疗程均为2月。结束治疗后观察三组的临床疗效,包括治疗前后的神经功能缺损评分、中医证候积分的变化情况及脑血管经颅多普勒(以下简称TCD)的大脑前、中、后动脉收缩期峰值血流速度和平均血流速度。结果:1、神经功能缺损评分(NDS):3组治疗后,患者神经功能缺损评分均可改善,差异有统计学意义(P0.05);治疗B组评分低于治疗A组,治疗A组低于对照组,差异有统计学意义(P0.05),提示治疗B组120g黄芪的补阳还五汤的神经功能缺损改善情况显著优于对照组及治疗A组。2、中医证候积分:3组治疗前,患者中医症候积分差异无统计学意义(P0.05);3组治疗后,患者中医症候积分差异有统计学意义(P0.05),治疗B组积分低于治疗A组,治疗A组低于对照组,差异有统计学意义(P0.05),提示治疗后3组患者的中医证候积分与治疗前比较降低,且治疗B组120黄芪的补阳还五汤中医证候改善方面显著优于对照组及治疗A组。3、3组患者治疗后,对照组TCD的ACA、MCA、PCA收缩期峰值血流速度及平均血流速度未见明显改变,差异无统计学意义(P0.05);治疗A组的ACA、PCA收缩期峰值血流速度及平均血流速度未见明显改变,差异无统计学意义(P0.05);治疗A组的MCA收缩期峰值血流速度及平均血流速度有所提高,差异有统计学意义(P0.05);治疗B组ACA、MCA、PCA收缩期峰值血流速度及平均血流速度明显加快,差异有统计学意义(P0.05),提示120g黄芪的补阳还五汤能显著加快脑血管流速,从而改善脑血液循环。结论:不同剂量黄芪的补阳还五汤治疗脑梗死恢复期均有疗效,可不同程度改善脑梗死恢复期患者的临床症状,促进神经功能恢复,不同程度加快TCD的收缩期峰值及平均血流速度,改善脑血管循环,但以120g黄芪的补阳还五汤疗效最佳,值得临床推广。
[Abstract]:Objective: to observe the clinical effect of Buyang Huanwu decoction (BYHD) with different doses of Astragalus membranaceus for the treatment of convalescence of cerebral infarction in order to provide the theoretical basis of TCM for the treatment of convalescence of cerebral infarction. Methods: Ninety-six inpatients with Qi deficiency and blood stasis in convalescence of cerebral infarction were divided into control group (control group, 34 cases) by random digital table, according to the inclusion criteria of Department of Neurology, Ruikang Hospital affiliated to Guangxi University of traditional Chinese Medicine. There were 33 cases in group A and 29 cases in group B. during the observation, 6 cases were excluded due to missing visit, complications and non-treatment. The final cases were 32 cases in the control group, 30 cases in the treatment group and 28 cases in the B group. The control group was treated with routine secondary prophylaxis therapy at convalescent stage of cerebral infarction (aspirin enteric-coated tablets 100mg daily, oral, anti-platelet aggregation, Atto vastatin calcium 20mg, once a day before bedtime, oral, stable plaque. Group A was treated with Huangqi 30g, Angelica sinensis 12g, Radix Paeoniae rubra 10g, Dilong 6g, Chuanxiong 12g, peach kernel 10g, safflower 10g, water decoction twice in the morning and evening, 200ml / time, treatment group A was treated with Astragalus membranaceus (30 g), Radix angelica sinensis (12g), Radix Paeoniae Rubra (10g), peach kernel (10g), safflower (10g). Group B was treated with Buyang Huanwu decoction with a dose of 120g of Astragalus membranaceus in the convalescent stage of cerebral infarction. The course of treatment was 2 months. After the treatment, the clinical effects of the three groups were observed, including the neurological impairment score before and after treatment, the changes of TCM syndrome score and the anterior and middle cerebral vascular transcranial Doppler (TCDs). Peak systolic velocity and mean blood flow velocity of posterior artery. Results after treatment, the neurological impairment scores of the patients were improved significantly (P 0.05), the scores of group B were lower than those of group A, and the scores of group A were lower than those of the control group, and the scores of group B were lower than those of group A, and the scores of group A were lower than those of group A (P < 0.05). The difference was statistically significant (P 0.05). It suggested that the improvement of nerve function defect of Buyang Huanwu decoction in group B was significantly better than that in control group and treatment group A. 2. There was no significant difference in the scores of TCM symptoms between the three groups. After treatment, the scores of TCM symptoms in group B were significantly lower than those in group A, and the scores in group A were lower than those in group A, and the scores in group A were lower than those in group A, and the scores in group A were lower than those in group A. The difference was statistically significant (P 0.05), indicating that the TCM syndromes score of the three groups decreased after treatment, and the improvement of the TCM syndromes of Buyang Huanwu decoction in group B (120 Astragalus) was significantly better than that in the control group and the treatment group A. 3 after treatment. There was no significant change in peak systolic velocity and mean blood flow velocity of TCD in control group (P 0.05), but no significant change in peak systolic velocity and mean flow velocity in group A. The peak systolic blood flow velocity and mean blood flow velocity of MCA in group A were increased, the difference was statistically significant (P 0.05), the peak systolic velocity and mean flow velocity of MCA in group B were significantly increased. The difference was statistically significant (P 0.05), suggesting that the 120g Huangqi Buyang Huanwu decoction could significantly accelerate the flow rate of cerebral vessels and thus improve the cerebral blood circulation. Conclusion: Buyang Huanwu decoction with different dosages of Astragalus membranaceus has curative effect on convalescence of cerebral infarction, which can improve the clinical symptoms and promote the recovery of nerve function in patients with cerebral infarction. The peak systolic phase and mean blood flow velocity of TCD were accelerated to improve cerebral vascular circulation, but 120g Astragalus membranaceus Buyang Huanwu decoction had the best curative effect and was worth popularizing in clinic.
【学位授予单位】：广西中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R277.7

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