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

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