目的 探讨扎冲十三味丸联合丁苯酞治疗急性脑梗死的临床疗效。方法 选取2019年9月-2021年9月漯河市中医院治疗的80例急性脑梗死患者,按照随机数字法将所有患者分为对照组和治疗组,每组各40例。对照组患者口服丁苯酞软胶囊, 0.2 g/次, 3次/d。治疗组在对照组的基础上口服扎冲十三味丸, 5~9粒/次, 1次/d。两组患者用药14 d观察治疗效果。对比两组的疗效及症状好转时间;比较两组治疗前后全血高切黏度、血浆黏度、血小板黏附率、纤维蛋白原、神经功能缺损评分(NIHSS)、日常生活能力评分(Barthel)、白细胞介素6(IL-6)、同型半胱氨酸(Hcy)、白细胞介素8(IL-8)、C-反应蛋白(CRP)的变化情况。结果 治疗后,治疗组患者总有效率是97.50%,显著高于对照组的77.50%(P<0.05)。治疗组患者失语、肢体麻木、头晕、口角歪斜等症状好转时间均明显短于对照组(P<0.05)。治疗后,两组血浆黏度、血小板黏附率、纤维蛋白原、全血高切黏度均显著降低(P<0.05);治疗后,治疗组血液流变学指标改善优于对照组(P<0.05)。治疗后,两组NIHSS评分均显著降低, Barthel评分显著增高(P<0.05);治疗后,治疗组NIHSS评分和Barthel评分改善优于对照组(P<0.05)。治疗后,两组IL-6、IL-8、Hcy、CRP水平均较治疗前显著降低(P<0.05);治疗后,治疗组血清因子水平低于对照组(P<0.05)。结论 扎冲十三味丸联合丁苯酞治疗急性脑梗死具有较好的临床疗效,可显著改善急性脑梗死患者的症状和日常生活能力,并能有效改善机体血液流变学指标,降低机体炎症反应,值得临床借鉴。

Objective To investigate the clinical study of Zhachong Shisanwei Pills combined with butylphthalide in treatment of acute cerebral infarction.Methods A total of 80 patients with acute cerebral infarction treated in Luohe Hospital of Traditional Chinese Medicine from September 2019 to September 2021 were selected and randomly divided into control group and treatment group according to the random number method, with 40 patients in each group. Patients in the control group were po administered with Butylphthalide Soft Capsules, 0.2 g/time, three times daily. Patients in the treatment group were po administered with Zhachong Shisanwei Pills on the basis of the control group, 5 — 9 pills/time, once daily. Two groups were treated for 14 d to observe the therapeutic effect. The curative effect and symptom improvement time of the two groups were compared. The changes of whole blood high shear viscosity, plasma viscosity, platelet adhesion rate, fibrinogen, neurological deficit score (NIHSS), daily living ability score (Barthel), interleukin-6 (IL-6), homocysteine (Hcy), interleukin-8 (IL-8) and C-reactive protein (CRP) were compared between the two groups before and after treatment.Results After treatment, the total effective rate in treatment group was 97.50%, significantly higher than 77.50% in control group (P < 0.05). The improvement time of aphasia, limb numbness, dizziness and mouth angle in treatment group was significantly shorter than that in control group (P < 0.05). After treatment, plasma viscosity, platelet adhesion rate, fibrinogen and whole blood hypershear viscosity were significantly decreased in both groups (P < 0.05). After treatment, the hemorheology index of the treatment group improved better than that of the control group (P < 0.05). After treatment, NIHSS score was significantly decreased and Barthel score was significantly increased in both groups (P < 0.05). After treatment, NIHSS score and Barthel score in the treatment group were better than those in the control group (P < 0.05). After treatment, the levels of IL-6, IL-8, Hcy and CRP in two groups were significantly decreased compared with before treatment (P < 0.05). After treatment, the level of serum factor in treatment group was lower than that in control group (P < 0.05).Conclusion Zhachong Shisanwei Pills combined with butylphthalide has good clinical effect in treatment of acute cerebral infarction, can significantly improve the symptoms and daily living ability of patients with acute cerebral infarction, effectively improve the body's hemorheology index and reduce the body's inflammatory response, which is worthy of clinical reference.

R971

河南省中医药科学研究专项课题(2015ZY02029)