Abstract:

Objective　To explore the clinical effect of Tongqiao Ditan Tang combined with acupuncture for patients with acute ischemic stroke. Methods　Ninety-six patients with acute ischemic stroke treated at Luohe Hospital of Traditional Chinese Medicine from February 2021 to February 2024 were selected, and were divided into a control group and an observation group according to the treatment methods, with 48 cases in each group. There were 27 males and 21 females in the control group; they were (74.35±3.28) years old; the onset time was (5.42±1.26) h. There were 25 males and 23 females in the control group; they were (73.84±3.46) years old; the onset time was (5.63±1.18) h. The control group were treated with atorvastatin, for 2 months. The observation group were treated with Tongqiao Ditan Tang for 2 months and acupuncture once per day, 6 times per week, for 2 months. The efficacies, levels of neurofactors [brain-derived neurotrophic factor (BDNF), neuron-specific enolase (NSE), and nerve growth factor (NGF)], coagulation function [activated partial thromboplastin time (APTT), fibrinogen (FIB), and D-dimer (D-D)], scores of Neurological Impairment Scale (NIHSS), Fugl-Meyer Motor Function Assessment Scale (FMA), Ability to Perform Daily Life Scale (ADL), and Comprehensive Quality of Life Questionnaire (GQOLI74), and incidence rates of adverse reactions were compared between the two groups. The independent sample t and χ² tests were used for the statistical analysis. Results　After two months' treatment, the total effective rate in the observation group was higher than that in the control group [95.83% (46/48) vs. 83.33% (40/48)]; the levels of BDNF, NSE, and NGF in the observation group were better than those in the control group [(35.06±3.12) μg/L vs. (31.87±2.75) μg/L, (48.25±3.17) ng/L vs. (44.16±3.02) ng/L, and (13.72±1.24) μg/L vs. (15.85±1.43) μg/L]; the APTT and levels of FIB and D-D in the observation group were better than those in the control group [(18.95±1.21) s vs. (22.79±1.46) s, (2.65±0.34) g/L vs. (3.48±0.41) g/L, and (0.38±0.07) mg/L vs. (0.49±0.09) mg/L]; the scores of NIHSS, FMA, ADL, and GQOLI74 in the observation group were better than those in the control group (14.92±1.24 vs. 21.87±1.68, 67.52±4.15 vs. 40.26±3.43, 61.56±3.24 vs. 50.48±2.75, and 69.46±3.68 vs. 61.57±3.45); there were statistical differences in the above indicators between the two groups (all P<0.05). There was no statistical difference in the incidence rate of adverse reactions between the two groups (P>0.05). Conclusion　Tongqiao Ditan Tang combined with acupuncture for patients with acute ischemic stroke is effective and safe, and can improve their neurological function, limb function, ability of daily life, and quality of life and promote their recovery of cerebral function.

Key words:

Ischemic stroke, Acute stage, Acupuncture, Tongqiao Ditan Tang, Treatment effect

摘要：

目的　探讨通窍涤痰汤联合针刺治疗缺血性脑卒中急性期患者的临床效果。方法　采用回顾性研究，选取2021年2月至2024年2月漯河市中医院收治的缺血性脑卒中急性期患者96例，根据用药方案不同分为对照组与观察组，各48例。对照组中男27例、女21例，年龄（74.35±3.28）岁，发病时间（5.42±1.26）h，采用阿托伐他汀治疗；观察组中男25例、女23例，年龄（73.84±3.46）岁，发病时间（5.63±1.18）h，采用通窍涤痰汤联合针刺治疗（1次/d，6次/周）；均连续治疗2个月。对比两组疗效、神经因子指标［脑源性神经营养因子（BDNF）、神经元特异性烯醇化酶（NSE）、神经生长因子（NGF）］、凝血功能［活化部分凝血活酶时间（APTT）、纤维蛋白原（FIB）、D-二聚体（D-D）］与美国国立卫生研究院卒中量表（NIHSS）、Fugl-Meyer运动功能评定量表（FMA）、日常生活能力量表（ADL）、生活质量综合评定问卷（GQOLI74）评分及不良反应情况。采用独立样本t检验和χ²检验进行统计比较。结果　治疗2个月后，观察组总有效率为95.83%（46/48），高于对照组［83.33%（40/48）］；观察组BDNF［（35.06±3.12）μg/L］、NSE［（48.25±3.17）ng/L］水平高于对照组［（31.87±2.75）μg/L、（44.16±3.02）ng/L］，NGF［（13.72±1.24）μg/L］、FIB［（2.65±0.34）g/L］、D-D［（0.38±0.07）mg/L］水平低于对照组［（15.85±1.43）μg/L、（3.48±0.41）g/L、（0.49±0.09）mg/L］，APTT［（18.95±1.21）s］短于对照组［（22.79±1.46）s］；观察组NIHSS评分低于对照组［（14.92±1.24）分比（21.87±1.68）分］，FMA、ADL、GQOLI74评分高于对照组［（67.52±4.15）分比（40.26±3.43）分、（61.56±3.24）分比（50.48±2.75）分、（69.46±3.68）分比（61.57±3.45）分］；两组上述指标比较，差异均有统计学意义（均P<0.05）。两组不良反应比较差异无统计学意义（P>0.05）。结论　通窍涤痰汤联合针刺治疗缺血性脑卒中急性期效果显著，可改善神经功能、肢体功能，促进脑功能恢复，提高日常生活能力及生活质量，安全性较佳。

关键词:

缺血性脑卒中, 急性期, 针刺, 通窍涤痰汤, 疗效