祛瘀通络脑泰汤结合循环灸对脑梗死急性期肢体痉挛状态的治疗效果及机制探讨

目的评价祛瘀通络脑泰汤结合循环灸对脑梗死急性期患者肢体痉挛状态的治疗效果及机制探讨。方法选择2018年1月—2020年1月医院收治的急性脑梗死患者95例,依据治疗方法的不同,分为试验组(48例)和参照组(47例),参照组依据《中国急性缺血性脑卒中诊治指南2014》给予西医规范治疗。试验组在参照组治疗的基础上,口服祛瘀通络脑泰汤结合循环灸治疗。两组均治疗2周。比较两组治疗前后中医证候积分、治疗疗效,比较治疗前后美国国立卫生研究院卒中量表(NIHSS)、Barthel指数(BI)、运动肌群肌张力评定量表(Ashworth)、血清脑源性神经影响因子(BDNF)和γ-氨基丁酸(GABA)含量。结果试验组治疗疗效较参照组高(P<0.05);试验组治疗后半身不遂、口舌歪斜、言语謇涩、头晕目眩、舌苔黄腻和脉象弦滑等中医证候积分低于参照组(P<0.05);试验组治疗后NIHSS评分、Ashworth评分低于参照组,BI评分高于参照组(P<0.05);试验组治疗后血清BDNF和GABA含量高于参照组(P<0.05)。结论祛瘀通络脑泰汤结合循环灸对脑梗死急性期肢体痉挛患者治疗效果确切,可有效改善患者的临床症状,恢复神经功能,改善肢体痉挛状态,提高日常生活能力,其作用机制可能与上升血清BDNF和GABA含量有关。

Effect and Mechanism of Quyu Tongluo Naotai Decoction(祛瘀通络脑泰汤) Combined with Circulating Moxibustion on Limb Spasm in Patients with Acute Cerebral Infarction

Objective To evaluate the therapeutic effect and mechanism of Quyu Tongluo Naotai Decoction(祛瘀通络脑泰汤)combined with circulating moxibustion on limb spasm in patients with acute cerebral infarction.Methods A total of 95 patients with acute cerebral infarction admitted to our hospital from January 2018 to January 2020 were selected and divided into the experimental group(48 cases)and the reference group(47 cases)according to different treatment methods.The reference group was given standard western medicine treatment according to Chinese Guidelines for Diagnosis and Treatment of Acute Ischemic Stroke 2014.In the experimental group,on the basis of the control group’s treatment,oral Quyu Tongluo Naotai Decoction combined with circulating moxibustion treatment was used.Both groups were treated for 2 weeks.The scores of TCM syndromes and treatment efficacy of the two groups were compared before and after treatment,and the NIHSS score,BI score,Ashworth score,serum levels of BDNF and GABA were compared before and after treatment.Results The therapeutic effect of the experimental group was higher than that of the control group(P<0.05).After treatment,the scores of hemiplegia,askew tongue,acerbity of words,dizzy,yellow and sticky tongue coating,pulse string slip and other TCM symptoms in the experimental group were lower than those in the control group(P<0.05).After treatment,NIHSS score and Ashworth score in the experimental group were lower than those in the control group,and BI score was higher than that in the control group(P<0.05).The levels of BDNF and GABA in the experimental group were higher than those in the control group(P<0.05).Conclusion Quyu Tongluo Naotai Decoction combined with circulating moxibustion has a definite therapeutic effect on patients with limb spasm in the acute stage of cerebral infarction,which can effectively improve clinical symptoms,restore neurological function,improve limb spasm and daily life ability.The mechanism of action may be related to the increase of serum levels of BDNF and GABA.