中国中西医结合急救杂志
中國中西醫結閤急救雜誌
중국중서의결합급구잡지
INTEGRATED TRADITIONAL CHINESE AND WESTERN MEDICINE IN PRACTICE OF CRITICAL CARE MEDICINE
2014年
3期
180-182
,共3页
化痰通腑法%急性脑梗死%组织型纤溶酶原激活物%组织型纤溶酶原激活物抑制物%同型半胱氨酸
化痰通腑法%急性腦梗死%組織型纖溶酶原激活物%組織型纖溶酶原激活物抑製物%同型半胱氨痠
화담통부법%급성뇌경사%조직형섬용매원격활물%조직형섬용매원격활물억제물%동형반광안산
Huatan Tongfu decoction%Acute cerebral infarction%Tissue type plasminogen activator%Plasminogen activator inhibitor%Homocysteine
目的：探讨化痰通腑汤对急性脑梗死患者血浆组织型纤溶酶原激活物（t-PA）、组织型纤溶酶原激活物抑制物（PAI）、同型半胱氨酸（Hcy）的影响。方法采用随机对照研究方法，选择2010年至2012年在首都医科大学附属北京朝阳医院中医科住院的患者78例，按随机数字表法分为治疗组40例和对照组38例。对照组采用常规治疗，治疗组在对照组基础上加用化痰通腑汤（组成：全瓜蒌30 g，胆南星6 g，厚朴10 g，炒谷芽15 g）治疗；另外将生大黄单独制成汤剂，每20 mL含生药量6 g。于入组后前1～4 d，两组汤剂混合，每日分2次温服；入组后5～12 d，每日服用组方汤剂200 mL，分2次温服，根据患者排便情况调整生大黄的用量，疗程为12 d。观察患者治疗前及治疗7 d后t-PA、PAI、Hcy水平，治疗前及治疗12 d后中医证候积分（按痰证、火热证及腑实证评分），并用美国国立卫生院卒中量表（NIHSS）评分评价神经功能缺损程度。结果两组治疗前t-PA、PAI、Hcy水平及NIHSS评分和痰证、火热证、腑实证证候积分比较差异均无统计学意义；治疗后所有指标均较治疗前明显改善，且以治疗组变化更显著〔t-PA（mg/L）：13.03±2.15比12.95±2.16，PAI（mg/L）：23.64±9.07比26.81±10.00，Hcy（μmol/L）：9.13±1.15比11.52±3.17，痰证（分）：9.16±1.71比11.17±2.89，火热证（分）：7.51±1.59比8.81±2.26，腑实证（分）：0.61±0.87比1.19±1.14，NIHSS评分（分）：5.70±3.16比5.90±2.97〕。结论化痰通腑汤治疗痰热腑实证急性脑梗死患者的机制可能是通过降低PAI和Hcy水平，保护血管内皮、促进纤溶的发生，从而提高临床疗效。
目的：探討化痰通腑湯對急性腦梗死患者血漿組織型纖溶酶原激活物（t-PA）、組織型纖溶酶原激活物抑製物（PAI）、同型半胱氨痠（Hcy）的影響。方法採用隨機對照研究方法，選擇2010年至2012年在首都醫科大學附屬北京朝暘醫院中醫科住院的患者78例，按隨機數字錶法分為治療組40例和對照組38例。對照組採用常規治療，治療組在對照組基礎上加用化痰通腑湯（組成：全瓜蔞30 g，膽南星6 g，厚樸10 g，炒穀芽15 g）治療；另外將生大黃單獨製成湯劑，每20 mL含生藥量6 g。于入組後前1～4 d，兩組湯劑混閤，每日分2次溫服；入組後5～12 d，每日服用組方湯劑200 mL，分2次溫服，根據患者排便情況調整生大黃的用量，療程為12 d。觀察患者治療前及治療7 d後t-PA、PAI、Hcy水平，治療前及治療12 d後中醫證候積分（按痰證、火熱證及腑實證評分），併用美國國立衛生院卒中量錶（NIHSS）評分評價神經功能缺損程度。結果兩組治療前t-PA、PAI、Hcy水平及NIHSS評分和痰證、火熱證、腑實證證候積分比較差異均無統計學意義；治療後所有指標均較治療前明顯改善，且以治療組變化更顯著〔t-PA（mg/L）：13.03±2.15比12.95±2.16，PAI（mg/L）：23.64±9.07比26.81±10.00，Hcy（μmol/L）：9.13±1.15比11.52±3.17，痰證（分）：9.16±1.71比11.17±2.89，火熱證（分）：7.51±1.59比8.81±2.26，腑實證（分）：0.61±0.87比1.19±1.14，NIHSS評分（分）：5.70±3.16比5.90±2.97〕。結論化痰通腑湯治療痰熱腑實證急性腦梗死患者的機製可能是通過降低PAI和Hcy水平，保護血管內皮、促進纖溶的髮生，從而提高臨床療效。
목적：탐토화담통부탕대급성뇌경사환자혈장조직형섬용매원격활물（t-PA）、조직형섬용매원격활물억제물（PAI）、동형반광안산（Hcy）적영향。방법채용수궤대조연구방법，선택2010년지2012년재수도의과대학부속북경조양의원중의과주원적환자78례，안수궤수자표법분위치료조40례화대조조38례。대조조채용상규치료，치료조재대조조기출상가용화담통부탕（조성：전과루30 g，담남성6 g，후박10 g，초곡아15 g）치료；령외장생대황단독제성탕제，매20 mL함생약량6 g。우입조후전1～4 d，량조탕제혼합，매일분2차온복；입조후5～12 d，매일복용조방탕제200 mL，분2차온복，근거환자배편정황조정생대황적용량，료정위12 d。관찰환자치료전급치료7 d후t-PA、PAI、Hcy수평，치료전급치료12 d후중의증후적분（안담증、화열증급부실증평분），병용미국국립위생원졸중량표（NIHSS）평분평개신경공능결손정도。결과량조치료전t-PA、PAI、Hcy수평급NIHSS평분화담증、화열증、부실증증후적분비교차이균무통계학의의；치료후소유지표균교치료전명현개선，차이치료조변화경현저〔t-PA（mg/L）：13.03±2.15비12.95±2.16，PAI（mg/L）：23.64±9.07비26.81±10.00，Hcy（μmol/L）：9.13±1.15비11.52±3.17，담증（분）：9.16±1.71비11.17±2.89，화열증（분）：7.51±1.59비8.81±2.26，부실증（분）：0.61±0.87비1.19±1.14，NIHSS평분（분）：5.70±3.16비5.90±2.97〕。결론화담통부탕치료담열부실증급성뇌경사환자적궤제가능시통과강저PAI화Hcy수평，보호혈관내피、촉진섬용적발생，종이제고림상료효。
Objective To study the influence of resolving phlegm and relaxing bowels decoction(Huatan Tongfu decoction)on plasma tissue type plasminogen activator(t-PA),plasminogen activator inhibitor(PAI)and homocysteine(Hcy)in patients with acute cerebral infarction. Methods With randomized and controlled clinical research,78 inpatients from 2010 to 2012 in Traditional Chinese Medicine(TCM)Department of Beijing Chaoyang Hospital,Capital Medical University were chosen,including 40 patients in observation group and 38 patients in control group. The patients in control and observation groups were treated by conventional treatment,and additionally the patients in observation group received Huatan Tongfu decoction(ingredients:Trichosanthis 30 g,Arisaema with bile 6 g,Magnolia bark 10 g,Fried rice sprout 15 g),and the rhubarb decoction was made alone,each 20 mL decoction containing crude drug 6 g. 1-4 days after the beginning of the study,the two decoctions were mixed,and the patients took the lukewarm mixture orally twice daily(once 1/2 the dosage);5-12 days after the start of the study, the patients took 200 mL lukewarm mixed decoction daily,being divided into 2 times to administer,and according to the patient defecation situation,the dosage of rhubarb decoction was adjusted individually,the therapeutic course being 12 days. The t-PA,PAI and Hcy were detected before treatment and on the 7th day after treatment. TCM syndrome scores(phlegm syndrome,fire-heat syndrome and sthenic-fu syndrome)were recorded before and on the 12th day after treatment,and the scores of National Institute of Health Stroke Scale(NIHSS)were recorded at the same time. Results Before treatment,the differences in t-PA,PAI,Hcy levels and NIHSS score and phlegm syndrome,fire-heat syndrome and sthenic-fu syndrome scores were not statistically significant;all the indicators improved significantly after treatment compared with those before treatment,and the changes in observation group were more remarkable〔t-PA(mg/L):13.03±2.15 vs. 12.95±2.16,PAI(mg/L):23.64±9.07 vs. 26.81±10.00, Hcy(μmol/L):9.13±1.15 vs. 11.52±3.17,phlegm syndrome:9.16±1.71 vs. 11.17±2.89,fire-heat syndrome:7.51±1.59 vs. 8.81±2.26, sthenic-fu syndrome:0.61±0.87 vs. 1.19±1.14, NIHSS score:5.70±3.16 vs. 5.90±2.97〕. Conclusion The mechanism of Huatan Tongfu decoction in treatment of patients with acute cerebral infarction accompanied by TCM syndromes of phlegm heat and sthenic-fu may be related to the reduction of plasma PAI and Hcy levels,protection of vascular endothelium and promotion of fibrinolysis,thereby the decoction can improve the clinical efficacy.
