摘要
[目的]观察芪寄补肾活血通络汤联合西药治疗肾虚血瘀型脑梗塞疗效。[方法]使用随机平行对照方法,将79例住院患者按抛硬币法简单随机分为两组。对照组39例降低颅内压：甘露醇,甘油果糖、速尿、类固醇激素、白蛋白等;控制收缩压120~180mm Hg或舒张压110~120mm Hg,血压〉220/120mm Hg,缓慢降压;注意保持呼吸道通畅、抗感染等;溶栓：病发后3~6h进行,静脉或动脉给药溶栓,6~12h未见明显脑水肿,也考虑溶栓,尿激酶、纤溶酶原激活剂（t-PA）;溶栓后奥美拉唑避免消化道出血;抗凝：肝素、低分子肝素,必须作凝血检测;抗血小板：阿司匹林25mg/次,急性期可增至100mg/次,3次/d;抵克立得125~250mg/次,1次/d;或氯吡格雷75mg/次,1次/d;降纤：增加纤溶系统活性和抑制血栓形成,降纤酶、东菱精纯克栓酶及蝮蛇抗栓酶等。治疗组40例芪寄补肾活血通络汤（生黄芪、桑寄生各20g,杜仲、红花、当归各15g,川芎、延胡索、石菖蒲、蒲黄、茜草各10g,蜈蚣1条;气血不足黄芪加至30g,加党参15g,阿胶6g;疼痛剧烈、梗死灶面积大加木香6g,桃仁15g;肾气亏虚加淫羊藿、肉苁蓉各15g,怀牛膝10g）,1剂/d,水煎400m L,早晚口服,200m L/次;西药治疗同对照组。连续治疗14d为1疗程。观测临床症状、全血比黏度低切值、全血比黏度高切值、血浆黏度、红细胞比积、纤维蛋白原、不良反应。治疗1疗程,判定疗效。[结果]治疗组痊愈10例,显效24例,有效3例,无效3例,总有效率92.50%。对照组痊愈6例,显效20例,有效2例,无效11例,总有效率71.79%。治疗组疗效优于对照组（P〈0.05,P〈0.01）。血液指标两组均有改善（P〈0.05）,治疗组改善优于对照组（P〈0.05）。[结论]芪寄补肾活血通络汤联合西药治疗肾虚血瘀型脑梗塞疗效满意,无严重不良反应,值得推广。
[Objective]To observe the effect of Qiji Bushen Huoxuetongluo soup efficacy combined with Western medicine treatment of cerebral infarction.[Methods]Randomized parallel controlled method,79 cases of hospitalized patients by a coin toss method is simple randomized into two groups.39 cases in the control group to reduce intracranial pressure： dehydrating agents are mannitol,glycerol,fructose,furosemide,steroid hormones,such as albumin;systolic blood pressure control in 120~180mm Hg or diastolic blood pressure control in 110~120mm Hg,such as blood pressure220/120 mm Hg slow down;keep the airway open,anti-infection.Thrombolytic therapy： after onset were within 3 ~ 6h.Venous or arterial thrombolysis administered;within 6~12 h no obvious brain edema,but also consider thrombolysis with urokinase plasminogen activator（t-PA）.Omeprazole after thrombolysis avoid gastrointestinal bleeding.Anticoagulant： heparin,low molecular weight heparin,we must make clotting test.The main side effect is bleeding,which is more secure than the low molecular weight heparin with unfractionated heparin.Antiplatelet： aspirin,25 mg/times,the acute phase may be increased to 100 mg/time,3 times/d.Ticlid,125~250 mg/d,1 times/d;or clopidogrel,75 mg/times,1 times/d.Fibrinolytic therapy： increased fibrinolytic system activity and inhibition of thrombosis,defibrase,DF pure gram suppository enzyme viper antithrombotic enzymes.Send a treatment group of 40 patients Qiji Bushen Huoxuetongluo soup（Qi,Yang Shen,blood circulation,pain network,Shenghaungqi,Sangjis heng each 20 g,Duzhong,Honghua,Danggui 15 g,Chuanxiong,Yanhusuo,Shichangpu,Puhaung,Qiancao 10 g,Wugong 1;lack of blood is added to Huangqi 30 g,plus Dangshen 15 g,E＇jiao 6g;severe pain,the infarct area big plus Muxiang 6g,Taoren 15g;kidney deficiency plus Yinyanghuo,Roucongrong 15 g,Niuxihuai 10g）,1/d,decoction 400 m L,sooner or later,oral,200 m L/times.Western medicine with the control group.14 d for a course of continuous treatment.Observation of clinical symptoms,whole blood viscosity lower than the cut value,whole blood viscosity is higher than the cut value,plasma viscosity,hematocrit,fibrinogen,adverse reactions.One course of treatment,to determine efficacy.[Results]The cure 10 cases,24 cases markedly effective in 3 cases,3 cases,the total efficiency of 92.50%.The control group recovered six cases,effective in 20 cases,2 cases,11 cases ineffective,the total efficiency of 71.79%.Treatment group than the control group（P〈0.05）.Blood indicators improved in both groups（P〈0.05）,treatment group was better than that in the control group（P〈0.05）.[Conclusion]Send Kidney Qi Tang Huoxuetongluo Cerebral Infarction Combined with Western treatment satisfaction,no serious adverse reactions,it is worth promoting.
出处
《实用中医内科杂志》
2015年第11期91-93,共3页
Journal of Practical Traditional Chinese Internal Medicine
