醒脑开窍针联合加味涤痰汤治疗风痰瘀阻证脑卒中后失语症患者的疗效

doi:10.3760/cma.j.cn441417-20241010-05027

摘要/Abstract

摘要：

目的　探讨醒脑开窍针联合加味涤痰汤对风痰瘀阻证脑卒中后失语症患者的疗效。方法　前瞻性选取2022年1月至2024年3月陕西省康复医院收治的94例风痰瘀阻证脑卒中后失语症患者，采用随机数字表法分为对照组和研究组，各47例。对照组男28例、女19例，年龄（65.83±7.24）岁，脑梗死33例、脑出血14例；研究组男30例、女17例，年龄（63.29±8.15）岁，脑梗死35例、脑出血12例。所有患者均给予脑卒中常规言语康复治疗，对照组在此基础上联合加味涤痰汤治疗，研究组在对照组基础上联合醒脑开窍针刺法治疗。两组均连续治疗3个月。比较两组临床疗效、失语商（AQ）、洛文斯顿认知功能成套评估工具（LOTCA）、美国国立卫生研究院卒中量表（NIHSS）、中医证候评分和血清炎症因子水平。采用重复测量方差分析、t检验、χ²检验进行统计分析。结果　治疗3个月后，研究组的总有效率高于对照组［93.62%（44/47）比72.34%（34/47）］，差异有统计学意义（χ²=7.532，P=0.006）。治疗1、2、3个月后，研究组的AQ、LOTCA评分均高于对照组，NIHSS、中医证候评分均低于对照组，差异均有统计学意义（均P<0.05）。治疗3个月后，研究组的血清超敏C反应蛋白、白细胞介素-6、白细胞介素-1β、肿瘤坏死因子-α、细胞黏附分子-1水平均低于对照组［（0.73±0.18）mg/L比（0.96±0.22）mg/L、（8.52±2.14）ng/L比（10.36±2.59）ng/L、（5.13±1.28）ng/L比（6.24±1.52）ng/L、（1.33±0.29）ng/L比（1.68±0.42）ng/L、（137.25±28.89）µg/L比（155.41±32.06）µg/L］，脑源性神经营养因子水平高于对照组［（8.39±2.02）µg/L比（7.23±1.56）µg/L］，差异均有统计学意义（t=5.547、3.755、3.829、4.701、2.885、3.116，均P<0.05）。结论　醒脑开窍针联合加味涤痰汤治疗风痰瘀阻证脑卒中后失语症患者，可明显改善其语言功能，提高认知水平，减轻脑损伤相关炎症反应，疗效显著。

关键词:

脑卒中, 失语症, 醒脑开窍针, 加味涤痰汤, 语言功能, 认知, 炎症因子

Abstract:

Objective　To investigate the effect of Xingnao Kaiqiao acupuncture combined with Jiawei Ditan decoction on post-stroke aphasia patients with wind phlegm obstruction syndrome. Methods　A total of 94 post-stroke aphasia patients with wind phlegm obstruction syndrome admitted to Shaanxi Rehabilitation Hospital from January 2022 to March 2024 were prospectively selected and were divided into a control group and a study group with 47 patients in each group by the random number table method. In the control group, there were 28 males and 19 females, aged (65.83±7.24) years, 33 cases of cerebral infarction and 14 cases of cerebral hemorrhage. In the study group, there were 30 males and 17 females, aged (63.29±8.15) years, 35 cases of cerebral infarction and 12 cases of cerebral hemorrhage. All patients were given routine speech rehabilitation therapy for stroke. On this basis, the control group was treated with Jiawei Ditan decoction, and the study group was treated with Xingnao Kaiqiao acupuncture combined with Jiawei Ditan decoction. Both groups were treated continuously for 3 months. The clinical efficacy, aphasia quotient (AQ), Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) score, National Institutes of Health Stroke Scale (NIHSS) score, traditional Chinese medicine (TCM) syndrome score, and levels of serum inflammatory factors were compared between the two groups. Repeated measures ANOVA, t test, and χ² test were used for statistical analysis. Results　After 3 months of treatment, the total effective rate of the study group was higher than that of the control group [93.62% (44/47) vs. 72.34% (34/47)], with a statistically significant difference (χ²=7.532, P=0.006). After 1, 2 and 3 months of treatment, the AQ and LOTCA scores of the study group were higher than those of the control group, and the NIHSS and TCM syndrome scores were lower than those of the control group (all P<0.05). After 3 months of treatment, serum levels of hypersensitive C-reactive protein, interleukin-6, interleukin-1β, tumor necrosis factor-α, and cell adhesion molecule-1 in the study group were lower than those in the control group [(0.73±0.18) mg/L vs. (0.96±0.22) mg/L, (8.52±2.14) ng/L vs. (10.36±2.59) ng/L, (5.13±1.28) ng/L vs. (6.24±1.52) ng/L, (1.33±0.29) ng/L vs. (1.68±0.42) ng/L, (137.25±28.89) µg/L vs. (155.41±32.06) µg/L], the level of brain-derived neurotrophic factor was higher than that in the control group [(8.39±2.02) µg/L vs. (7.23±1.56) µg/L], and the differences were statistically significant (t=5.547, 3.755, 3.829, 4.701, 2.885, and 3.116, all P<0.05). Conclusion　Applying Xingnao Kaiqiao acupuncture combined with Jiawei Ditan decoction in the treatment of post-stroke aphasia patients with wind phlegm obstruction syndrome can significantly improve their language function, enhance their cognitive level, and alleviate brain injury related inflammatory reactions, with significant effect.

Key words:

Stroke, Aphasia, Xingnao Kaiqiao , acupuncture, Jiawei , Ditan , decoction, Language function, Cognition, Inflammatory factors

韩昭张薇张旭龙.

醒脑开窍针联合加味涤痰汤治疗风痰瘀阻证脑卒中后失语症患者的疗效 [J]. 国际医药卫生导报, 2025, 31(5): 833-838.

Han Zhao, Zhang Wei, Zhang Xulong.

Effect of Xingnao Kaiqiao acupuncture combined with Jiawei Ditan decoction on post-stroke aphasia patients with wind phlegm obstruction syndrome [J]. International Medicine and Health Guidance News, 2025, 31(5): 833-838.

参考文献

[1] Vitti E, Hillis AE. Treatment of post-stroke aphasia: a narrative review for stroke neurologists[J]. Int J Stroke, 2021, 16(9): 1002-1008. DOI: 10.1177/17474930211017807.
[2] Shah-Basak P, Boukrina O, Li XR, et al. Targeted neurorehabilitation strategies in post-stroke aphasia[J]. Restor Neurol Neurosci, 2023, 41(3-4): 129-191. DOI: 10.3233/RNN-231344.
[3] Godecke E, Armstrong E, Rai T, et al. A randomized control trial of intensive aphasia therapy after acute stroke: The Very Early Rehabilitation for SpEech (VERSE) study[J]. Int J Stroke, 2021, 16(5): 556-572. DOI: 10.1177/1747493020961926.
[4] Liu Q, Li W, Yin Y, et al. The effect of music therapy on language recovery in patients with aphasia after stroke: a systematic review and meta-analysis[J]. Neurol Sci, 2022, 43(2): 863-872. DOI: 10.1007/s10072-021-05743-9.
[5] 宗芳,陈永华,代玉强. 真方白丸子联合注射用阿替普酶对急性缺血性卒中风痰入络证患者血清炎症因子及血管内皮活性物质的影响[J]. 国际中医中药杂志,2023,45(9):1075-1080. DOI:10.3760/cma.j.cn115398-20221126- 00435.
[6] 席卫国. 化瘀涤痰汤加减辅治中风恢复期临床观察[J]. 实用中医药杂志,2022,38(12):2125-2126.
[7] 刘希良,程美英,姚洪杰,等. 醒脑开窍针刺法联合星蒌承气汤加减对脑卒中患者日常生活能力及上肢功能的疗效评价[J]. 中国中医急症,2022,31(11):1993-1996. DOI:10.3969/j.issn.1004-745X.2022.11.030.
[8] 刘启雄,邱爱霞,熊百炼. 解语丹加减联合醒脑开窍针对脑梗死恢复期肢体运动功能影响临床研究[J]. 中华中医药学刊,2020,38(1):187-190. DOI:10.13193/j.issn.1673-7717. 2020.01.045.
[9] 董春雪,于楠楠,丛珊,等. 三七通舒胶囊联合醒脑开窍针刺法治疗急性脑梗死疗效及神经保护机制[J]. 中成药,2022,44(5):1718-1722. DOI:10.3969/j.issn.1001-1528.2022. 05.066.
[10] 王全忠,汤锐,李坤. 化痰通络汤联合针刺治疗中风急性期风痰阻络证临床观察[J]. 光明中医,2023,38(12):2252-2255. DOI:10.3969/j.issn.1003-8914.2023.12.005.
[11] Fong MWM, Van Patten R, Fucetola RP. The factor structure of the Boston diagnostic aphasia examination, Third edition[J]. J Int Neuropsychol Soc, 2019, 25(7): 772-776. DOI: 10.1017/S1355617719000237.
[12] 中华中医药学会脑病分会,广东省中医药学会脑病专业委员会,广东省中西医结合学会卒中专业委员会. 中西医结合脑卒中循证实践指南(2019)[J]. 中国循证医学杂志,2020,20(8):901-912. DOI:10.7507/1672-2531.202001075.
[13] 叶明明,翁瑛丽,赵博伦,等. 脑卒中后失语症患者筛查和护理的最佳证据总结[J]. 中华护理杂志,2021,56(3):439-444. DOI:10.3761/j.issn.0254-1769.2021.03.022.
[14] 袁玉娇,任大为,关雅素,等. 针药联合水罐治疗中风病急性期风痰阻络证疗效研究[J]. 针刺研究,2021,46(5):416-420. DOI:10.13702/j.1000-0607.201110.
[15] 中风的诊断依据、证候分类、疗效评定-中华人民共和国中医药行业标准«中医内科病证诊断疗效标准»(ZY/T001.1-94)[J]. 辽宁中医药大学学报,2016,18(10):16-18.
[16] Yan Z, Wei D, Xu S, et al. Author correction: determining levels of linguistic deficit by applying cluster analysis to the aphasia quotient of western aphasia battery in post-stroke aphasia[J]. Sci Rep,2022,12(1):20746. DOI: 10.1038/s41598-022-25024-5.
[17] Li KY, Lin LJ. Minimal clinically important difference of the Loewenstein Occupational Therapy Cognitive Assessment-Geriatric (LOTCA-G) in people with dementia[J]. Am J Occup Ther, 2020, 74(6): 7406205020p1-7406205020p7. DOI: 10.5014/ajot.2020.040550.
[18] Kazi SA, Siddiqui M, Majid S. Stroke outcome prediction using admission nihss in anterior and posterior circulation stroke[J]. J Ayub Med Coll Abbottabad, 2021, 33(2):274-278.
[19] Cichon N, Wlodarczyk L, Saluk J, et al. Novel advances to post-stroke aphasia pharmacology and rehabilitation[J]. J Clin Med,2021,10(17):3778. DOI: DOI: 10.3390/jcm10173778.
[20] 张建平,王震,王文,等. 小续命汤联合常规西医治疗风火上扰型急性缺血性脑卒中患者的疗效[J]. 国际医药卫生导报,2024,30(13):2123-2129. DOI:10.3760/cma.j.issn.1007-1245.2024.13.003.
[21] 陈丽. 涤痰汤加减联合醒脑开窍针治疗中风病的前瞻性随机对照研究[J]. 实用中西医结合临床,2024,24(15):30-32,108. DOI:10.13638/j.issn.1671-4040.2024.15.008.
[22] 盛兴柏,李城华,齐丽珍. 化痰通络汤加减辅治缺血性脑卒中风痰阻络型临床观察[J]. 实用中医药杂志,2023,39(5):887-889.
[23] 常永霞,李姣,侯文丽,等. 涤痰汤合桃红四物汤加减对脑梗死恢复早期痰瘀阻络证脑神经的保护作用[J]. 中国实验方剂学杂志,2021,27(1):135-140. DOI:10.13422/j.cnki.syfjx.20201031.
[24] 张强,孟祥刚,姚晶晶,等. 醒脑开窍针刺法的应用注意事项及快速激发针感技巧[J]. 吉林中医药,2020,40(9):1236-1238. DOI:10.13463/j.cnki.jlzyy.2020.09.033.
[25] 杨辉,唐世球,邵方玲.肾脑复元汤联合醒脑开窍针刺法用于缺血性中风的临床观察[J].世界中西医结合杂志,2020,15(1):160-164,169.DOI:10.13935/j.cnki.sjzx.200135.
[26] 李章晗,黎华茂,艾年年. 醒脑开窍针刺法联合呼吸训练治疗脑卒中后吞咽障碍临床研究[J]. 针刺研究,2021,46(10):875-879,884. DOI:10.13702/j.1000-0607.201011.
[27] 朱巍明,李波漩,邓士哲,等. 不同针刺法联合言语训练治疗卒中后失语的网状Meta分析[J]. 世界中医药,2024,19(3):347-355. DOI:10.3969/j.issn.1673-7202.2024.03.009.