Abstract:

Objective　To explore the efficacy of Pinggan Huoxue powder in the adjuvant treatment of patients with acute cerebral infarction of wind-phlegm-stasis obstruction type and its influence on cerebral blood perfusion. Methods　One hundred and eight patients with acute cerebral infarction of wind-phlegm-stasis obstruction type treated at Ankang Hospital of Traditional Chinese Medicine from July 2021 to June 2023 were selected for the randomized controlled trial, and were divided into a western medicine group and a traditional Chinese medicine group by the random number table method, with 54 cases in each group. There were 33 males and 21 females in the western medicine group; they were (64.25±6.12) years old. There were 30 males and 24 females in the traditional Chinese medicine groups; they were (64.71±6.35) years old. The western medicine group orally took butyphthalide soft capsules for 2 weeks on the basis of routine fluid rehydration, reduction of intracranial pressure, and dilatation; in addition, the traditional Chinese medicine group orally took Pinggan Huoxuxue powder for 2 weeks. The clinical efficacies, scores of traditional Chinese medicine syndromes, neurological function [neuron-specific enolase (NSE), brain-derived neurotrophic factor (BDNF), and glial fibrillary acidic protein (GFAP)], cerebral blood perfusion [perfusion index (PI) and bilateral arterial mean flow velocity], and inflammatory response [C-reactive protein (CRP) and interleukin-10 (IL-10)] before and 2 weeks after the treatment, and incidences of adverse reactions were compared between the two groups by t test, χ² test, Fisher's precision probability test, and rank sum test. Results　The total effective rate in the traditional Chinese medicine group was higher than that in the western medicine group [88.89% (48/54) vs. 72.22% (39/54)], with a statistical difference (χ²=4.788; P=0.029). After 2 weeks' treatment, the scores of NIHSS, primary syndromes, and secondary syndromes and levels of NSE, GFAP, PI, and CRP in the traditional Chinese medicine group were lower than those in the western medicine group (t=3.855, 4.284, 2.894, 5.949, 3.889, 2.852, and 8.424; all P<0.05). The BDNF level, bilateral arterial mean flow velocity, and IL-10 level after 2 weeks' treatment in the traditional Chinese medicine group were higher than those in the western medicine group (t=3.661, 2.803, and 4.203; all P<0.05). There was no statistical difference in the total incidence of adverse reactions between the two groups [16.67% (9/54) vs. 12.96% (7/54); χ²=0.293; P=0.588]. Conclusion　Pinggan Huoxue powder in the adjuvant treatment of patients with acute cerebral infarction of wind-phlegm-stasis obstruction type is effective, can relieve their clinical symptoms, improve their neurological function and cerebral blood flow perfusion, and alleviate their inflammatory response, and does not increase adverse reactions.

Key words:

Acute cerebral infarction, Wind-phlegm-stasis obstruction type, Pinggan Huoxue powder, Cerebral blood perfusion, Inflammatory indicators, Neurological function

摘要：

目的　探究平肝活血散佐治风痰瘀阻型急性脑梗死的疗效及对脑血流灌注的影响。方法　本研究为随机对照试验，前瞻性选取2021年7月至2023年6月安康市中医医院收治的108例风痰瘀阻型急性脑梗死患者，采用随机数字表法分为西药组和中药组，各54例。其中，西药组男33例，女21例，年龄（64.25±6.12）岁，在常规补液、降低颅内压、扩容等治疗基础上口服丁苯酞软胶囊，连续治疗2周；中药组男30例，女24例，年龄（64.71±6.35）岁，在西药组治疗基础上口服平肝活血散，连续治疗2周。比较两组临床疗效，治疗前和治疗2周后比较两组患者中医证候积分、神经功能［神经元特异性烯醇化酶（NSE）、脑源性神经营养因子（BDNF）、胶质纤维酸性蛋白（GFAP）］、脑血流灌注［血流灌注指数（PI）、双侧动脉平均流速］及炎症反应［C反应蛋白（CRP）、白细胞介素-10（IL-10）］，统计治疗期间两组患者不良反应发生情况。统计方法采用t检验、χ²检验、Fisher确切概率法、秩和检验。结果　中药组总有效率高于西药组［88.89%（48/54）比72.22%（39/54）］，差异有统计学意义（χ²=4.788，P=0.029）；治疗2周后，中药组NIHSS评分、主症积分、次症积分、NSE、GFAP、PI、CRP水平低于西药组（t=3.855、4.284、2.894、5.949、3.889、2.852、8.424，均P<0.05）；中药组BDNF、双侧动脉平均流速及IL-10水平高于西药组（t=3.661、2.803、4.203，均P<0.05）。两组不良反应发生率［16.67%（9/54）比12.96%（7/54）］比较，差异无统计学意义（χ²=0.293，P=0.588）。结论　平肝活血散佐治风痰瘀阻型急性脑梗死疗效显著，可减轻患者临床症状，改善神经功能和脑血流灌注，降低炎症反应，且不增加不良反应。

关键词:

急性脑梗死, 风痰瘀阻型, 平肝活血散, 脑血流灌注, 炎症指标, 神经功能