通窍活血汤加减联合支架取栓术治疗急性脑血管闭塞的临床观察

目的:观察通窍活血汤加减联合支架取栓术治疗急性脑血管闭塞的临床疗效,并探讨其机制。方法:120例患者按照随机数字表法随机分为对照组和观察组,各60例。对照组给予支架取栓术,观察组给予加减通窍活血汤联合支架取栓术。观察两组患者的临床症状神经功能缺损评分(NIHSS),日常生活能力量表(ADL)和简易智力筛查量表(MMSE)];检测血流动力学指标高切还原黏度(HSRV),中切还原黏度(MSRV),低切还原黏度(LSRV)和血浆黏度(WBV)];血管内皮功能一氧化氮合酶(NOS),内皮素-1(ET-1)和血管内皮生长因子(VEGF)];比较两组临床疗效;观察治疗期间两组患者血、尿常规、心肝肾功能、脑出血发生率等。结果:研究期间对照组脱落4例,观察组脱落2例。观察组总有效率94. 8%(55/58),高于对照组的83. 9%(47/56)(P 0. 05);与对照组比较,观察组NIHSS评分明显降低(P 0. 05),ADL和MMSE评分明显升高(P 0. 05);观察组血流变学指标较对照组明显降低(P 0. 05);观察组NOS和VEGF较对照组明显升高(P 0. 05),ET-1较对照组明显降低(P 0. 05);研究期间对照组患者脑出血发生率7. 14%(4/56),观察组患者脑出血发生率8. 6%(5/58),两组无统计学差异。结论:加减通窍活血汤联合支架取栓术可明显改善急性脑血管闭塞患者的临床症状、血流变学指标和血管内皮功能,值得临床推广应用。

Clinical Efficacy of Modified Tongqiao Huoxuetang Combined with Stent Thrombectomy in Treatment of Acute Cerebrovascular Occlusion

Objective: To observe the effect of modified Tongqiao Huoxuetang combined with stent thrombectomy in treating acute cerebrovascular occlusion. Method: A total of 120 cases were randomly divided into control group and observation group, with 60 cases in each group. The control group received stent thrombectomy, while the observation group received modified Tongqiao Huoxuetang combined with stent thrombectomy. The clinical symptomshealth neural function defect scale stroke scale scores(NIHSS), activities of daily living(ADL), mini mental state examination(MMSE)], hemodynamic indexeshigh-shear reduction viscosity(HSRV), medium-shear reduction viscosity(MSRV), low-shear reduction viscosity(LSRV), whole blood plasma viscosity(WBV)], vascular endothelial functionsserum nitric oxide synthase(NOS), endothelin-1(ET-1), vascular endothelial growth factor(VEGF)] were observed. The clinical efficacy and the incidence of adverse reactions were compared between two groups. The blood routine, urine routine, heart, liver and kidney function, incidence of cerebral hemorrhage in two groups were observed during the treatment. Result: There were 4 cases were shed in control group and 2 cases in observation group during the study period. The total effective rate in observation group was 94.8%(55/58), which was higher than 83.9% of the control group(47/56)(P<0.05). The NIHSS in observation group was lower than that in control group(P<0.05), whereas ADL and MMSE were higher than those in control group(P<0.05). The hemorheological indexes in observation group were lower than those in control group(P<0.05), NOS and VEGF in observation group were higher than those in control group(P<0.05), and ET-1 score was lower than that in control group(P<0.05). During the study period, the incidence of cerebral hemorrhage was 7.14%(4/56) in control group and 8.6%(5/58) in observation group, with no significant difference. Conclusion: Modified Tongqiao Huoxuetang combined with stent thrombectomy could significantly improve the clinical symptoms, hemorheology and vascular endothelial function of patients with acute cerebrovascular occlusion, and so is worthy of clinical promotion and application.