振废汤加味联合常规西医对症治疗气虚血瘀型缺血性脑卒中偏瘫临床研究

Clinical Study on Modified Zhenfei Decoction Combined with Conventional Western Symptomatic Treatment for Cerebral Ischemic Stroke-Induced Hemiplegia of Qi Defi⁃ ciency and Blood Stasis Type

摘要:

目的：观察振废汤加味联合西医常规对症治疗气虚血瘀型缺血性脑卒中（CIS） 偏瘫患者的临床疗效。方法：按随机数字表法将浙江新安国际医院神经内科收治的102例气虚血瘀型CIS偏瘫患者分为2组，各51例。最终对照组纳入研究49例（剔除2例），治疗组纳入研究49例（剔除2例）。对照组予常规西医对症治疗，治疗组在对照组治疗方案的基础上给予振废汤加味治疗，2组均连续治疗4周后评估疗效。比较治疗前后血液流变学（红细胞聚集指数、全血黏度低切、血浆黏度、全血黏度高切、血小板聚集率）、中医证候评分、美国国立卫生研究院卒中量表（NIHSS）、肢体功能［上肢功能（FMA-UE）、下肢功能（FMA-LE）］、平衡功能［Berg平衡量表（BBS）］、独立步行能力［功能性步行能力量表（FAC）］ 及日常生活能力［Barthel指数（BI）］ 的变化。结果：治疗4周后，2组血液流变学（红细胞聚集指数、全血黏度低切、血浆黏度、全血黏度高切、血小板聚集率） 水平均低于治疗前，且治疗组血液流变学各项指标水平均低于对照组（P＜0.05）； 2 组中医证候评分、NIHSS 评分均低于治疗前， 且治疗组低于对照组（P＜0.05）； 2 组上肢功能（FMA-UE） 评分、下肢功能（FMA-LE） 评分、BBS评分、FAC评分、BI均高于治疗前，且治疗组各项评分均高于对照组（P＜0.05）。临床疗效总有效率治疗组93.88%（46/49），对照组79.59%（39/49），2组临床疗效总有效率比较，差异有统计学意义（P＜0.05）。结论：振废汤加味联合常规西医对症治疗气虚血瘀型CIS偏瘫，能改善患者血液流变学情况，改善中医症状，减轻神经功能受损程度，提高肢体功能、平衡功能、独立步行能力及日常生活能力，优于单纯使用常规西医对症治疗。

Abstract:

Abstract：Objective：To observe the clinical efficacy of modified Zhenfei Decoction combined with conventional western symptomatic treatment in patients with cerebral ischemic stroke （CIS）-induced hemiplegia of qi deficiency and blood stasis type. Methods：A total of 102 patients with CIS-induced hemiplegia of qi deficiency and blood stasis type admitted to the Department of Neurology，Zhejiang Xin'an International Hospital were randomly divided into two groups using the random number table method， with 51 cases in each group. Finally， 49 cases were included in the control group （2 excluded） and 49 cases in the treatment group （2 excluded）. The control group received conventional western symptomatic treatment， while the treatment group received modified Zhenfei Decoction in addition to the treatment of the control group. Both groups were treated continuously for four weeks before efficacy evaluation. Changes in hemorheology （erythrocyte aggregation index， low-shear whole blood viscosity， plasma viscosity， highshear whole blood viscosity， platelet aggregation rate）， traditional Chinese medicine syndrome score， National Institutes of Health Stroke Scale （NIHSS） score，limb function [Fugl-Meyer Assessment of Upper Extremity （FMAUE）， Fugl-Meyer Assessment of Lower Extremity （FMA-LE）]， balance function [Berg Balance Scale （BBS）]， independent walking ability [Functional Ambulation Category Scale （FAC）]， and activities of daily living [Barthel Index （BI）] were compared before and after treatment. Results： After four weeks of treatment， the hemorheology parameters （erythrocyte aggregation index， low-shear whole blood viscosity， plasma viscosity， high-shear whole blood viscosity， platelet aggregation rate） in both groups decreased compared with those before treatment， and the levels of all hemorheology indicators in the treatment group were lower than those in the control group （P＜0.05）. The traditional Chinese medicine syndrome scores and NIHSS scores in both groups decreased compared with those before treatment，and the treatment group showed lower scores than the control group （P＜0.05）. The FMA-UE，FMA-LE， BBS， FAC， and BI scores in both groups increased compared with those before treatment， and all scores in the treatment group were higher than those in the control group （P＜0.05）. The total clinical efficacy rate was 93.88% （46/ 49） in the treatment group and 79.59% （39/49） in the control group，with a statistically significant difference between the two groups （P＜0.05）. Conclusion：Modified Zhenfei Decoction combined with conventional western symptomatic treatment for CIS-induced hemiplegia of qi deficiency and blood stasis type can improve patients' hemorheology， alleviate traditional Chinese medicine symptoms， reduce neurological impairment， and enhance limb function， balance function， independent walking ability， and activities of daily living. This therapy is superior to conventional western symptomatic treatment alone.