缺血性中风证候演变规律初探及川芎嗪联合中药复方疗效观察

目的：依据缺血性中风中医证候的动态演变规律,并观察相应中药复方联合川芎嗪进行治疗的临床疗效。方法：将缺血性中风82例患者随机分为治疗组40例,对照组42例,其中治疗组根据不同时段中医证型,在常规对症支持等治疗基础上,运用川芎嗪联合中药复方治疗：（1）肝阳上亢型,给予羚羊钩藤汤;（2）痰热蒙蔽清窍型,给予黄连温胆汤;（3）痰热腑实型,给予大承气汤合菖蒲郁金汤;（4）气虚血瘀型,给予补阳还五汤。对照组按西医的常规治疗。结果：缺血性中风中医证候存在着一定的演变规律,即发病前3天以肝阳暴亢型、痰热蒙蔽清窍型、痰热腑实型多见,经临床治疗后,肝阳暴亢型患者比例逐渐下降,而痰热瘀阻和痰热腑实所占比例逐渐增多;而且随访半年则以气虚血瘀型、阴虚火旺型、肝肾阴虚型和脾胃虚寒型多见,气虚血瘀型为主,其次为脾胃虚寒型。经4周的治疗后,中药治疗组临床证候总有效率为97.50%,对照组为85.71%,两组比较P〈0.05,差异有统计学意义。结论：缺血性中风中医证候存在着一定的演变规律,即急性期以实证为主,经对证治疗后则相应的实证减轻或消退,进而凸现的是虚证本质;依据患者不同时间段的中医证型,运用与证型相应的中药复方联合川芎嗪进行治疗是安全、有效的。

Ischemic Stroke and the Regulation of Syndrome of Traditional Chinese Medicine Compound Efficacy TMP Combined

Objective： According to ischemic stroke syndromes of the dynamic evolution laws and observe the clinical efficacy of Chinese medicine formula combined with TMP treatment.Methods： 82 ischemic stroke patients were randomly divided into treatment group 40 cases,42 cases of the control group,treatment group at different times according to TCM,in support of conventional symptomatic treatment based on the combined use of Chinese medicine formula combined to TMP：（1） Type of liver-yang hyperactivity,to Linhyanggouteng formula;（2） Type of phlegm blind orifices,Huanglianwendan formula;（3） Type of phlegm Fu solid,Dachengqi formula combined to Changpuyujin formula;（4） Qi deficiency and blood stasis,Buyabghuanwu formula.Control group treated by conventional Western medicine.Results： there is a certain evolution law of Ischemic stroke syndromes,namely,3 days prior to the onset,the mainly were liver-yang hyperactivity type,phlegm blind orifices type,phlegm Fu solid type.with clinical treatment,the proportion of liver-yang hyperactivity type patients decreased,while the proportion of phlegm stasis and phlegm Fu solid type gradually increased;and follow-up six months,Qi deficiency and blood stasis type,Yin deficiencyand Fire Prosperous type,Yin of Liver-kidney Deficiency and spleen-Stomach Deficiency Type become more common.After four weeks of treatment,the total effective rate of Chinese medicine syndromes in treatment group was 97.50%,control group 85.71%,P0.05.Conclusions： there is a certain evolution law in Ischemic stroke syndromes,namely,at acute phase,there were mainly excess syndromes,and then there were reduce or dissipated after close treatment,while the nature of deficiency syndromes highlighted;There is safe and effective by using TMP combined to appropriate Chinese Medicine formula according to different phase of patients.