补阳还五汤加减方对气虚血瘀型脑梗死急性期血流灌注参数的影响
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摘要
目的:本研究观察急性脑梗死中心区及周围低灌注区脑血流灌注参数的变化,以及补阳还五汤加减方对急性脑梗死中心区及周围低灌注区脑血流灌注参数的影响。方法:发病24 h内急性脑梗死患者80例,按住院顺序随机分为观察组及对照组,各40例。对照组患者给予常规西药治疗,观察组患者在对照组治疗基础上加用补阳还五汤加减方。入院时及治疗14 d后,均应用磁共振PWI序列,观测梗死中心区及周围低灌注区脑血流灌注参数r CBV、r CBF、TTP、MTT。比较治疗前两组灌注参数,比较治疗后两组灌注参数,同一组比较治疗前后的灌注参数,并进行统计分析。结果:治疗前观察组、对照组脑梗死区的r CBV、r CBF、TTP、MTT对比无显著差异(P=0. 836、0. 714、0. 733、0. 802)。治疗后,两组r CBV、r CBF均有不同程度降低(P=0. 007、000,P=000、002); r TTP、r MTT均有不同程度延长(P=0. 009、0. 02,P=0. 01、0. 037)。治疗后两组r CBV、r CBF、TTP、MTT对比无显著差异(P=0. 776、0. 84、0. 675、0. 795)。治疗前观察组、对照组梗死周围低灌注区的r CBV、r CBF、TTP、MTT对比无显著差异(P=0. 77、0. 285、0. 651、0. 78)。治疗后,两组梗死周围低灌注区的r CBV、r CBF较治疗前均进一步降低(P=0. 034、0. 031,P=0. 033、0. 05)。治疗后两组r CBV、r CBF比较无显著差异(0. 59、0. 751)。治疗后对照组r MTT、r TTP进一步延长(P=0. 000、000),而观察组r MTT、r TTP无明显延长(P=0. 123,0. 078)。治疗后观察组r MTT、r TTP较对照组延长较少(P=0. 05,0. 047)。结论:脑梗死急性期梗死区及周围低灌注区灌注情况会进一步恶化。补阳还五汤加减方治疗不能改善梗死区的灌注情况,但能减轻脑梗死周围低灌注区灌注情况的恶化。
Objective: To observe changes of blood perfusion parameters in the central cerebral infarction and low perfusion area around cerebral infarction in acute stage of cerebral infarction,as well as the influence of Buyang Huanwu Jiajian Decoction on blood perfusion parameters in the central cerebral infarction and low perfusion area around cerebral infarction in acute stage of cerebral infarction. Methods: Eighty patients with acute cerebral infarction in 24 hours were randomly divided into observation group and control group according to the hospital order,each 40 cases. The control group's patients were treated with conventional Western medicine,and the observation group' s patients were treated with conventional Western medicine and Buyang Huanwu Jiajian Decoction. On admission and 14 days after treatment,the cerebral perfusion parameters r CBV,r CBF,TTP and MTT were observed in the central cerebral infarction and low perfusion area around cerebral infarction. Perfusion parameters of the two groups before treatment were compared and analyzed statistically. The perfusion parameters of the two groups after treatment were compared and analyzed statistically,perfusion parameters of the same group before and after treatment were compared and analyzed statistically. Results: There was no significant difference of r CBV,r CBF,TTP or MTT between observation group and control group in the central cerebral infarction before treatment( P = 0. 836,0. 714,0. 733,0. 802). After treatment,r CBV and r CBF of both groups decreased in varying degrees( P = 0. 007,000,P = 000,002); r TTP and r MTT were extended in varying degrees( P =0. 009,0. 02,P = 0. 01,0. 037). There was no significant difference of r CBV,r CBF,TTP or MTT between two groups in the central cerebral infarction after treatment( P = 0. 776,0. 84,0. 675,0. 795). There was no significant difference of r CBV,r CBF,TTP,MTT between observation group and control group in low perfusion area around cerebral infarction before treatment( P = 0. 77,0. 285,0. 651,0. 78). After treatment,r CBV and r CBF of both groups decreased in varying degrees( P = 0. 034,0. 031,P = 0. 033,0. 05). There was no significant difference of r CBV,r CBF( P = 0. 59,0. 751) between the two groups after treatment. After treatment,TTP and MTT of control group were extended compared with that before treatment( P = 0. 000,000). MTT and TTP of the observation group were not significantly prolonged compared with that before treatment( P = 0. 123,0. 078). After treatment,MTT and TTP of the observation group were shorter than that of the control group( P = 0. 05,0. 047). Conclusion: Blood perfusion in the central cerebral infarction and low perfusion area around cerebral infarction in acute stage of cerebral infarction deteriorate. Buyang Huanwu Jiajian Decoction is not able to improve blood perfusion in the central cerebral infarction,but it can reduce the deterioration of blood perfusion in low perfusion area around cerebral infarction.
Objective: To observe changes of blood perfusion parameters in the central cerebral infarction and low perfusion area around cerebral infarction in acute stage of cerebral infarction,as well as the influence of Buyang Huanwu Jiajian Decoction on blood perfusion parameters in the central cerebral infarction and low perfusion area around cerebral infarction in acute stage of cerebral infarction. Methods: Eighty patients with acute cerebral infarction in 24 hours were randomly divided into observation group and control group according to the hospital order,each 40 cases. The control group's patients were treated with conventional Western medicine,and the observation group' s patients were treated with conventional Western medicine and Buyang Huanwu Jiajian Decoction. On admission and 14 days after treatment,the cerebral perfusion parameters r CBV,r CBF,TTP and MTT were observed in the central cerebral infarction and low perfusion area around cerebral infarction. Perfusion parameters of the two groups before treatment were compared and analyzed statistically. The perfusion parameters of the two groups after treatment were compared and analyzed statistically,perfusion parameters of the same group before and after treatment were compared and analyzed statistically. Results: There was no significant difference of r CBV,r CBF,TTP or MTT between observation group and control group in the central cerebral infarction before treatment( P = 0. 836,0. 714,0. 733,0. 802). After treatment,r CBV and r CBF of both groups decreased in varying degrees( P = 0. 007,000,P = 000,002); r TTP and r MTT were extended in varying degrees( P =0. 009,0. 02,P = 0. 01,0. 037). There was no significant difference of r CBV,r CBF,TTP or MTT between two groups in the central cerebral infarction after treatment( P = 0. 776,0. 84,0. 675,0. 795). There was no significant difference of r CBV,r CBF,TTP,MTT between observation group and control group in low perfusion area around cerebral infarction before treatment( P = 0. 77,0. 285,0. 651,0. 78). After treatment,r CBV and r CBF of both groups decreased in varying degrees( P = 0. 034,0. 031,P = 0. 033,0. 05). There was no significant difference of r CBV,r CBF( P = 0. 59,0. 751) between the two groups after treatment. After treatment,TTP and MTT of control group were extended compared with that before treatment( P = 0. 000,000). MTT and TTP of the observation group were not significantly prolonged compared with that before treatment( P = 0. 123,0. 078). After treatment,MTT and TTP of the observation group were shorter than that of the control group( P = 0. 05,0. 047). Conclusion: Blood perfusion in the central cerebral infarction and low perfusion area around cerebral infarction in acute stage of cerebral infarction deteriorate. Buyang Huanwu Jiajian Decoction is not able to improve blood perfusion in the central cerebral infarction,but it can reduce the deterioration of blood perfusion in low perfusion area around cerebral infarction.
引文
[1]吴江,贾建平,崔丽英.神经病学[M]. 2版.北京:人民卫生出版社,2010:152-152.
[2]中华医学会神经病学分会脑血管病学组,急性缺血性脑卒中诊治指南撰写组.中国急性缺血性脑卒中诊治指南2010[J].中国全科医学,2011,14(35):4013-4017.
[3]国家中医药管理局.中医病证诊断疗效标准[M].北京:中国医药科技出版社,2012:30-31.
[4]周俐红,李艳丽,许江飞.脑低灌注与脑梗死的关系分析[J].中国当代医药,2010,17(10):143-144.
[5]张博,代艳伟,刘芳.急性低灌注性脑梗死临床分析[J].中华全科医学,2011,9(10):1569-1570.
[6]张志方,隋冰冰,周菲,等.磁共振DWI及PWI在急性期脑梗死中的应用[J].中国现代药物应用,2012,6(19):31-32.
[7]卢洁,李坤成,张苗,等.慢性大脑中动脉狭窄与闭塞的MR灌注成像研究[J].放射学实践,2007,22(1):13-16.
[8] Koenig M,Kraus M,Theek C,et al. Quantitative assessment of the ischemic brain by means of perfusion-related parameters derived from perfusion CT[J]. Stroke,2001,32(2):431-437.
[9]刘创宏,徐斌,宋冬雷. CT灌注成像在缺血性脑血管病中的临床应用[J].国际脑血管病杂志,2009,17(8):604-608.
[10] Schaefer PW,Roccatagliata L,Ledezma C,et al. First-pass quantitative CT perfusion identifies thresholds for salvageable penumbra in acute stroke patients treated with intra-arterial therapy[J]. AJNR,2006,27:20-25.
[11]李冰,陈立波,蔡旭东,等.补阳还五汤对不同危险因素脑梗死患者血管内皮功能的影响[J].现代实用医学,2017,29(12):1559-1560.
[12]田兆华,刘柏炎.补阳还五汤对局灶性脑缺血大鼠血管新生的影响[J].中国动脉硬化杂志,2010,18(3):193-198.
[13]明康文,洪佳明.补阳还五汤对急性脑梗死患者侧支循环的影响[J].广州中医药大学学报,2016,33(1):1-4.
[2]中华医学会神经病学分会脑血管病学组,急性缺血性脑卒中诊治指南撰写组.中国急性缺血性脑卒中诊治指南2010[J].中国全科医学,2011,14(35):4013-4017.
[3]国家中医药管理局.中医病证诊断疗效标准[M].北京:中国医药科技出版社,2012:30-31.
[4]周俐红,李艳丽,许江飞.脑低灌注与脑梗死的关系分析[J].中国当代医药,2010,17(10):143-144.
[5]张博,代艳伟,刘芳.急性低灌注性脑梗死临床分析[J].中华全科医学,2011,9(10):1569-1570.
[6]张志方,隋冰冰,周菲,等.磁共振DWI及PWI在急性期脑梗死中的应用[J].中国现代药物应用,2012,6(19):31-32.
[7]卢洁,李坤成,张苗,等.慢性大脑中动脉狭窄与闭塞的MR灌注成像研究[J].放射学实践,2007,22(1):13-16.
[8] Koenig M,Kraus M,Theek C,et al. Quantitative assessment of the ischemic brain by means of perfusion-related parameters derived from perfusion CT[J]. Stroke,2001,32(2):431-437.
[9]刘创宏,徐斌,宋冬雷. CT灌注成像在缺血性脑血管病中的临床应用[J].国际脑血管病杂志,2009,17(8):604-608.
[10] Schaefer PW,Roccatagliata L,Ledezma C,et al. First-pass quantitative CT perfusion identifies thresholds for salvageable penumbra in acute stroke patients treated with intra-arterial therapy[J]. AJNR,2006,27:20-25.
[11]李冰,陈立波,蔡旭东,等.补阳还五汤对不同危险因素脑梗死患者血管内皮功能的影响[J].现代实用医学,2017,29(12):1559-1560.
[12]田兆华,刘柏炎.补阳还五汤对局灶性脑缺血大鼠血管新生的影响[J].中国动脉硬化杂志,2010,18(3):193-198.
[13]明康文,洪佳明.补阳还五汤对急性脑梗死患者侧支循环的影响[J].广州中医药大学学报,2016,33(1):1-4.