三七提取物并早期康复对脑梗死患者微循环及血液流变学的影响

背景三七总皂甙具有活血化瘀,增加脑血管和冠状动脉血流量,改善微循环等作用,应用中医药方法和采用易化技术进行早期康复是否对脑卒中患者的康复有明显促进作用?目的观察中药三七提取物血塞通并早期康复对脑梗死患者微循环、血液流变学的影响,探讨其治疗作用的机制.设计以诊断为依据的随机对照试验.方法对经头颅CT或MRI确诊的高血压动脉硬化性脑梗死患者200例,按入院次序采用随机数字表法分为两组,研究组100例给予血塞通每次200mg加50g/L葡萄糖或生理盐水250～500mL静脉滴注,1次/d,当生命体征稳定后采用易化技术进行早期康复治疗;对照组100例,按传统方法治疗.两组治疗前后采用临床神经功能缺损程度评分标准评定疗效、Brunstrom分级评定偏瘫恢复程度、Barthel指数(BI)评定日常生活活动(ADL)能力.同时观察两组治疗前后甲襞微循环、血液流变学的变化.主要观察指标①两组患者ADL恢复情况.②两组患者偏瘫恢复程度.③两组患者临床疗效.④两组患者甲襞微循环变化.⑤两组患者血液流变学变化.结果研究组患者ADL能力的恢复、偏瘫的功能恢复比对照组的效果要好;其有效率为93%,显效率52%,与对照组比较差异有显著性意义(x2=19.46,P＜0.005),通过对实验室各项观察指标结果的对比分析看出,研究组患者治疗后其微循环、血液流变性有明显的改善.结论中药三七提取物血塞通并早期康复是通过改善微循环、血液流变性等机制,而达到较好的临床治疗效果,是脑梗死急性期治疗的优选方法.

Effects of notoginseng extract and early rehabilitation on the microcirculation and hemorheology in patients with cerebral infarction

BACKGROUND:Notoginseng saponins has effects of activating blood circulation to dissipate blood stasis, increasing blood supplies in cerebral vessels and coronal artery, ameliorating microcirculation, etc. Whether the early rehabilitation with the utilizations of traditional Chinese herbs and facilitation techniques would significantly improve the rehabilitation of the patients with cerebral apoplexy?OBJECTIVE: To observe the effects of notoginseng extract, xuesaitong,and early rehabilitation on the microcirculation and hemorheology in patients with cerebral infarction for the discussion of the mechanism of its therapeutic effectiveness.DESIGN: A randomised and controlled trial based on diagnosis .INTERVENTION:A total of 200 cerebral infarction patients due to bypertensive arteriosclerosis diagnosedby head CT or MRI were randomly divided into two groups. A total of 100 cases of study group were treated with 250 mL to 500 mL of normal saline or 50 g/L of glucose containing 200 mg of xuesaitong each time through intravenous instillation once a day, and early rehabilitation conducted by facilitation techniques after the stabilisation of the physical signs. A total of 100 cases of control group were treated with traditional method. The therapeutic effectiveness of the patients in both groups were evaluated by Clinical Nerve Functional Deficiency Scale before and after the treatment, the rehabilitation of hemiplegia was evaluated by Brunstrom Scale, and the ability of activity of daily lffe(ADL) was evaluated by Barthel Index(BI) . The changes in nailfold microcirculation and hemorheology were observed simultaneously in patients of both groups before and after treatment.MAIN OUTCOME MEASURES: ① ADL rehabilitation in patients of both groups. ② rehabilitation of hemiplegia in patients of both groups. ③clinical therapeutic effectiveness in patients of both groups.④ changes of nailfold microcirculation in patients of both groups. ⑤ changes of hemorheology in patients of both groups.RESULTS: The restorations of ADL ability and the functional restoration of hemiplegia in patients of study group were better than those of control group with 93％ of effective rate and 52% of marked rate, which were significantly different from that of control group(x2 = 19.46,P< 0.005).It could be seen from the comparisons between each observatory index, the microcirculation and hemorheology of patients in study group were significantly improved after therapy.CONCLUSION: Traditional Chinese medicine notoginseng extract, xuesaitong, and the early rehabilitation receives favourable clinical therapeutic effectiveness through the mechanisms of improving microcirculation and hemorheology, etc., which is an optimal method in the treatment of cerebral infarction in acute stage.