缺血预适应与痰证、血瘀证缺血性卒中预后的关系

目的研究缺血性卒中的中医辨证属痰证、血瘀证者与缺血预处理的关系,以及对缺血性卒中的远期预后影响。方法对缺血性卒中患者（179例）既往短暂性脑缺血发作（TIA）情况调研;记录发病时中医辨证分型、颅内血流情况（TCD）;以3月后的BI（barthal index）评估预后情况。数据采用SPSS 17.0软件进行统计学处理。结果证类分布情况,血瘀证109例,既往发作过TIA的患者,辨证属痰证与血瘀证的比例,具有统计学意义（P=0.022）;既往发生过TIA者,左大脑中动脉、左大脑前动脉、基底动脉流速均低于既往无TIA者（P〈0.05）。预后方面,既往发作过TIA的患者,痰证、血瘀证预后无统计学意义;既往无TIA发作者,痰证、血瘀证预后也无明显差异。但既往曾发生过TIA者预后（35.7%）好于无TIA者（23.8%）。结论既往无TIA者,起病后症状较重,中医辨证以痰证为主,而既往TIA发作者,血瘀证居多,提示介于缺血预适应与卒中发生之间,存在着长期的血瘀状态,而痰证与血瘀证预后无明显差异。

Relationship between Ischemic Preconditioning and the Prognosis of Ischemic Stroke with Phlegm Syndrome and Blood Stasis Syndrome

Objective To investigate the relationship between ischemic preconditioning and the prognosis of ischemic stroke with phlegm syndrome and blood stasis syndrome.Methods The clinical data of 179 ischemic stroke patients with previous medical history of transient ischemic attack（TIA）were analyzed,and traditional Chinese medicine（TCM） syndrome types and hemodynamic changes of transcranial Doppler（TCD）were studied.The prognosis were evaluated by Barthal index（BI） after three months.SPSS17.0 was used to analysis the correlation.Results The dominant syndrome types were blood-stasis syndrome（109/179）.There was significant difference between phlegm syndrome and blood stasis syndrome in patients with previous medical history of TIA（P=0.022）.The flow speed of the left middle cerebral artery（L-MCA）,left cerebral artery（L-ACA） and basilar artery（BA） in patients with previous medical history of TIA were lower than that in patients without previous medical history of TIA.There was no difference in the prognosis of ischemic stroke between phlegm syndrome and blood stasis syndrome.The prognosis of patients with previous medical history of TIA（35.7%） was better than that of patients without previous medical history of TIA（23.8%）.Conclusion The phlegm syndrome was main syndrome types in patients with previous medical history of TIA while blood stasis syndrome was main syndrome types in patients without previous medical history of TIA.There was no difference in the prognosis of ischemic stroke between phlegm syndrome and blood stasis syndrome.