化痰通络汤+醒脑开窍针刺联合西药治疗中风后偏瘫(痰瘀阻络)随机平行对照研究
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摘要
[目的]观察化痰通络汤+醒脑开窍针刺联合西药治疗治疗中风后偏瘫(痰瘀阻络)疗效。[方法]使用随机平行对照方法,将117例住院患者按随机数字表法随机分为两组,清淡、高维生素、易消化饮食,忌油腻、生冷。对照组58例依达拉奉30mg+100mL生理盐水,2次/d,静滴,30min滴完;阿司匹林,100mg/次,1次/d;甲钴胺0.5mg+250mL生理盐水,静滴。治疗组59例化痰通络汤、醒脑开窍针。化痰通络汤(半夏法、川芎、橘红、枳壳、远志、红花、石菖蒲各10g,茯神、丹参、党参各15g,甘草炙10g),水煎400mL,1剂/d,早晚温服;醒脑开窍针:取三阴交、人中、内关、委中、风池、极泉、尺泽,内关直刺12～25mm,捻转、提插泻法1min;人中斜刺7～12mm,重雀啄法;三阴交斜刺25～38mm,提插补法;极泉沿经下原穴25～50mm,直刺25～38mm,提插泻法;尺泽直刺25mm,提插泻法;风池针向喉结,刺25～63mm,小幅度高频捻转补法,1次/d,每7d间歇2d;西药治疗同对照组。连续治疗2个月为1疗程。观测临床表现、神经功能缺损量表(NIHSS)、日常生活能力量表(ADL)、不良反应。治疗1疗程(2个月),判定疗效。[结果]治疗组基本康复21例,显著改善25例,有效10例,无效3例,总有效率94.92%;对照组基本康复11例,显著改善29例,有效7例,无效11例,总有效率81.03%;治疗组疗效优于对照组(P<0.05)。ADL、NIHSS评分两组均有改善(P<0.01),治疗组改善优于对照组(P<0.01)。[结论]化痰通络汤+醒脑开窍针刺联合西药治疗治疗中风后偏瘫(痰瘀阻络),疗效满意,无严重不良反应,值得推广。
[Objective] To observe the curative effect of Huatan Tongluo decoction+Xingnao Kaiqiao Acupuncture combined with western medicine on hemiplegia after apoplexy(Tanyu Zuluo). [Method] 117 hospitalized patients were randomly divided into two groups by random number table method. They were fed a light, high vitamin and digestible diet, avoiding greasy and cold. The control group consisted of 58 cases of edaravone 30 mg+100 mL saline, twice a day, intravenously dripped for 30 minutes; aspirin 100 mg/time,once a day; mecobalamin 0.5 mg+250 mL saline, intravenously dripped. In the treatment group, 59 cases were treated with Huatan Tongluo decoction and Xingnao Kaiqiao Acupuncture. Huatan Tongluo decoction(Fabanxia, Chuanxiong, Juhong, Zhiqiao, Yuanzhi, Honghua, Shicangpu each 10 g, Fushen,Danshen,Dangshen each 15 g, Zhigancao 10 g), decoction 400 mL, 1 dose/d, warm clothes in the morning and evening;Xingnao Kaiqiao needle: take Sanyinjiao, Renzhong, Neiguan, Weizhong, Fengchi, Jiquan, Chize, Neiguan direct needle 12～25 mm, twisting, lifting and reducing method for 1 minute; human oblique needle 7-12 mm, heavy sparrow pecking Method: 25～38 mm oblique needling of Sanyinjiao, lifting and interpolating method; 25～50 mm and 25～38 mm straight needling along Xiayuan acupoint of Jiquan, lifting and inserting and reducing method; 25 mm straight needling of Chize, lifting and inserting and reducing method; 25-63 mm needling of Fengchi needle to laryngeal knot, small amplitude high frequency twisting and reinforcing method, once a day, intermittent 2 days every 7 days; western medicine treatment with the control group.Continuous treatment for 2 months is a course of treatment. Clinical manifestations, neurological deficit scale(NIHSS), activity of daily living scale(ADL) and adverse reactions were observed. One course of treatment(2 months) was used to determine the curative effect. [Result] There were 21 cases of basic rehabilitation in the treatment group, 25 cases were significantly improved, 10 cases were effective, 3 cases were ineffective,and the total effective rate was 94.92%. There were 11 cases of basic rehabilitation in the control group, 29 cases were significantly improved, 7 cases were effective and 11 cases were ineffective, the total effective rate was 81.03%. The curative effect of the treatment group was better than that of the control group(P<0.05).ADL and NIHSS scores were improved in both groups(P<0.01), and the improvement in treatment group was better than that in control group(P<0.01). [Conclusion] Huatan Tongluo decoction+Xingnao Kaiqiao Acupuncture combined with western medicine in the treatment of hemiplegia after apoplexy(Tanyu Zuluo)has satisfactory curative effect and no serious adverse reactions, which is worthy of promotion.
[Objective] To observe the curative effect of Huatan Tongluo decoction+Xingnao Kaiqiao Acupuncture combined with western medicine on hemiplegia after apoplexy(Tanyu Zuluo). [Method] 117 hospitalized patients were randomly divided into two groups by random number table method. They were fed a light, high vitamin and digestible diet, avoiding greasy and cold. The control group consisted of 58 cases of edaravone 30 mg+100 mL saline, twice a day, intravenously dripped for 30 minutes; aspirin 100 mg/time,once a day; mecobalamin 0.5 mg+250 mL saline, intravenously dripped. In the treatment group, 59 cases were treated with Huatan Tongluo decoction and Xingnao Kaiqiao Acupuncture. Huatan Tongluo decoction(Fabanxia, Chuanxiong, Juhong, Zhiqiao, Yuanzhi, Honghua, Shicangpu each 10 g, Fushen,Danshen,Dangshen each 15 g, Zhigancao 10 g), decoction 400 mL, 1 dose/d, warm clothes in the morning and evening;Xingnao Kaiqiao needle: take Sanyinjiao, Renzhong, Neiguan, Weizhong, Fengchi, Jiquan, Chize, Neiguan direct needle 12～25 mm, twisting, lifting and reducing method for 1 minute; human oblique needle 7-12 mm, heavy sparrow pecking Method: 25～38 mm oblique needling of Sanyinjiao, lifting and interpolating method; 25～50 mm and 25～38 mm straight needling along Xiayuan acupoint of Jiquan, lifting and inserting and reducing method; 25 mm straight needling of Chize, lifting and inserting and reducing method; 25-63 mm needling of Fengchi needle to laryngeal knot, small amplitude high frequency twisting and reinforcing method, once a day, intermittent 2 days every 7 days; western medicine treatment with the control group.Continuous treatment for 2 months is a course of treatment. Clinical manifestations, neurological deficit scale(NIHSS), activity of daily living scale(ADL) and adverse reactions were observed. One course of treatment(2 months) was used to determine the curative effect. [Result] There were 21 cases of basic rehabilitation in the treatment group, 25 cases were significantly improved, 10 cases were effective, 3 cases were ineffective,and the total effective rate was 94.92%. There were 11 cases of basic rehabilitation in the control group, 29 cases were significantly improved, 7 cases were effective and 11 cases were ineffective, the total effective rate was 81.03%. The curative effect of the treatment group was better than that of the control group(P<0.05).ADL and NIHSS scores were improved in both groups(P<0.01), and the improvement in treatment group was better than that in control group(P<0.01). [Conclusion] Huatan Tongluo decoction+Xingnao Kaiqiao Acupuncture combined with western medicine in the treatment of hemiplegia after apoplexy(Tanyu Zuluo)has satisfactory curative effect and no serious adverse reactions, which is worthy of promotion.
引文
[1]严隽陶.中风后偏瘫中西医结合优化康复方案的临床研究[D].上海:上海中医药大学,2015.
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[4]中华医学会神经病学分会神经康复学组,中华医学会神经病学分会脑血管病学组.中国脑卒中康复治疗指南(2011完全版)[J].中国康复理论与实践,2012,18(4):301-316.
[5]陶子荣.我国脑卒中患者临床神经功能缺损评分标准信度、效度及敏感度的评价[J].第二军医大学学报,2009,30(3):283-285.
[6]佚名.日常生活能力量表(ADL)[J].中国微侵袭神经外科杂志,2006,11(11):516.
[7]赵正孝.中医中风病的诊治思想及源流研究[D].长沙:湖南中医学院,2003.
[8]谢梓菁.缺血性中风恢复早期证候演变特点及其与肢体运动功能的相关性研究[D].北京:北京中医药大学,2010.
[9]陈昭英.依达拉奉的药理作用和临床应用[J].中国实用医刊,2007,34(22):62-63.
[10]孙福珍.关于阿司匹林药理作用的探析[J].中外医学研究,2013,11(19):143.
[11]胡小姜,徐敏.甲钴胺的药理及临床作用[J].中国药师,2000,3(2):100-102.
[12]周仲瑛.中医内科学[M].北京:中国中医药出版社,2004:321-325.
[13]吴勉华,王新月.中医内科学[M].9版.北京:中国中医药出版社,2012:138.
[14]高学敏.中药学[M].北京:中国中医药出版社,2007.
[15]王妙闻.中药川芎血清药化学及透血脑屏障化学成分研究[D].成都:成都中医药大学,2007.
[16]陈南迪,方妙玉,于超凡,等.毛橘红总黄酮指纹图谱与其抗氧化活性的谱效关系研究[J].广州中医药大学学报,2012,29(6):702-706.
[17]施学骄,张杰红,樊丹青,等.枳实、枳壳挥发油化学成分及抑菌活性的比较研究[J].中药与临床,2012,3(2):25-27.
[18]涂海华,刘屏,马亮,等.远志抗抑郁有效部位中寡糖酯单体的分离及活性研究[J].中国中药杂志,2008,33(11):1278-1280.
[19]汪宏雷.红花的药理作用[J].中医药临床杂志,2014,26(5):519.
[20]林晨,安红梅.石菖蒲的中枢神经系统药理作用研究[J].长春中医药大学学报,2014,30(2):230-233.
[21]石学敏.“醒脑开窍”针刺法治疗中风病9005例临床研究[J].中医药导报,2005,11(1):3-5.
[22]孙国杰.针灸学[M].上海:上海科学技术出版社,1997.
[23]蒋素容,武姿含,高音来,等.针刺大椎、百会、人中穴对脑缺血再灌注损伤大鼠脑组织p-VEGF蛋白表达的影响[J].湖南中医药大学学报,2018,38(11):40-44.
[24]刁利红.针刺内关穴为主治疗冠心病心绞痛临床观察[J].辽宁中医杂志,2003,30(8):667-668.
[2]中华人民共和国卫生部.涉及人的生物医学研究伦理审查办法(试行)[S].(2007-03-26)[2016-01-01].http://www.moh.gov.cn/qjjys/s3581/200804/b9f1bfee4ab344ec892e68097296e2a8.shtml.
[3]袁忠武,鲁绍昌.CT对脑中风诊断和治疗的价值[J].医学信息(中旬刊),2011,24(2):794-795.
[4]中华医学会神经病学分会神经康复学组,中华医学会神经病学分会脑血管病学组.中国脑卒中康复治疗指南(2011完全版)[J].中国康复理论与实践,2012,18(4):301-316.
[5]陶子荣.我国脑卒中患者临床神经功能缺损评分标准信度、效度及敏感度的评价[J].第二军医大学学报,2009,30(3):283-285.
[6]佚名.日常生活能力量表(ADL)[J].中国微侵袭神经外科杂志,2006,11(11):516.
[7]赵正孝.中医中风病的诊治思想及源流研究[D].长沙:湖南中医学院,2003.
[8]谢梓菁.缺血性中风恢复早期证候演变特点及其与肢体运动功能的相关性研究[D].北京:北京中医药大学,2010.
[9]陈昭英.依达拉奉的药理作用和临床应用[J].中国实用医刊,2007,34(22):62-63.
[10]孙福珍.关于阿司匹林药理作用的探析[J].中外医学研究,2013,11(19):143.
[11]胡小姜,徐敏.甲钴胺的药理及临床作用[J].中国药师,2000,3(2):100-102.
[12]周仲瑛.中医内科学[M].北京:中国中医药出版社,2004:321-325.
[13]吴勉华,王新月.中医内科学[M].9版.北京:中国中医药出版社,2012:138.
[14]高学敏.中药学[M].北京:中国中医药出版社,2007.
[15]王妙闻.中药川芎血清药化学及透血脑屏障化学成分研究[D].成都:成都中医药大学,2007.
[16]陈南迪,方妙玉,于超凡,等.毛橘红总黄酮指纹图谱与其抗氧化活性的谱效关系研究[J].广州中医药大学学报,2012,29(6):702-706.
[17]施学骄,张杰红,樊丹青,等.枳实、枳壳挥发油化学成分及抑菌活性的比较研究[J].中药与临床,2012,3(2):25-27.
[18]涂海华,刘屏,马亮,等.远志抗抑郁有效部位中寡糖酯单体的分离及活性研究[J].中国中药杂志,2008,33(11):1278-1280.
[19]汪宏雷.红花的药理作用[J].中医药临床杂志,2014,26(5):519.
[20]林晨,安红梅.石菖蒲的中枢神经系统药理作用研究[J].长春中医药大学学报,2014,30(2):230-233.
[21]石学敏.“醒脑开窍”针刺法治疗中风病9005例临床研究[J].中医药导报,2005,11(1):3-5.
[22]孙国杰.针灸学[M].上海:上海科学技术出版社,1997.
[23]蒋素容,武姿含,高音来,等.针刺大椎、百会、人中穴对脑缺血再灌注损伤大鼠脑组织p-VEGF蛋白表达的影响[J].湖南中医药大学学报,2018,38(11):40-44.
[24]刁利红.针刺内关穴为主治疗冠心病心绞痛临床观察[J].辽宁中医杂志,2003,30(8):667-668.
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