摘要
目的:基于头颈部计算机断层扫描(CT)血管成像(CTA)联合颅脑CT灌注成像(CTP)技术,探讨急性脑梗死患者服用中药通脑饮后脑血流灌注的变化。方法:选取江苏省中医院自2018年3月至2023年9月治疗的240例脑梗死痰瘀阻络证患者,随机分为对照组(99例),通脑饮组(141例)。基于指南对照组采用抗聚、抗凝、降脂稳斑、脑保护及支持治疗等常规治疗方案;通脑饮组在对照组治疗基础上加用中药通脑饮200 mL,早晚温服。两组患者均于入院24 h内行CTA联合CTP检查,并于6个月时复查CTA和CTP。根据北美症状性颈动脉内膜切除试验(NASCET)法判断颅内动脉血管的狭窄程度,并对治疗前后病变区的相对脑血容量(rCBV)、相对脑血流量(rCBF)、平均通过时间(MTT)和达峰时间(TTP)进行比较,并比较两组患者出院6个月不良结局。结果:与本组治疗前比较,通脑饮组患者血管狭窄不同程度明显减轻,差异具有统计学意义(Z=105.369,P<0.01);对照组患者血管狭窄减轻不明显,差异无统计学意义。与对照组治疗后比较,通脑饮组患者血管狭窄好转率更高(χ^(2)=84.179,P<0.01),疗效更好(好转率86.5%)。与本组治疗前比较,通脑饮组患者rCBV与rCBF均显著升高(P<0.01),MTT、TTP有缩短趋势,但差异无统计学意义;对照组rCBV、rCBF、MTT、TTP差异无统计学意义。与对照组治疗后比较,通脑饮组患者rCBV、rCBF均显著升高,MTT、TTP均显著降低(P<0.01)。与本组治疗前比较,通脑饮组患者出院6个月后NIHSS评分显著降低(Z=15.097,P<0.01);对照组患者出院后6个月NIHSS评分变化较小,差异无统计学意义。与对照组治疗后比较,通脑饮组患者NIHSS评分降低更明显,患者预后更好,差异具有统计学意义(Z=5.96,P<0.05)。出院6个月后通脑饮组患者预后不良风险较对照组明显降低(P<0.05)。结论:协定方通脑饮有较好的改善急性脑梗死患者脑血流灌注的作用,可以作为缺血性脑卒中常规治疗的有效补充以提高临床疗效。
Objective To investigate the changes of cerebral blood perfusion in patients with acute cerebral infarction after taking Tongnaoyin,a traditional Chinese medicine,based on head and neck computed tomography angiography(CTA)combined with brain CT perfusion imaging(CTP).Method A total of 240 patients with cerebral infarction treated in Jiangsu Province Hospital of Traditional Chinese Medicine from March 2018 to September 2023 were randomly divided into control group(99 cases)and Tongnaoyin group(141 cases).Based on the guidelines,the control group was treated with conventional treatment such as anti-aggregation,anticoagulation,lipid-lowering and plaque stabilization,brain protection,and supportive treatment.The Tongnaoyin group was treated with traditional Chinese medicine Tongnaoyin 200ml on the basis of the control group,warm in the morning and evening.Both groups underwent CTA combined with CTP within 24 hours after admission,and CTA and CTP were reexamined at 6 months after admission.The degree of intracranial artery stenosis was determined according to the North American Symptomatic Carotid Endarterectomy Trail(NASCET)method.The relative cerebral blood volume(rCBV),relative cerebral blood flow(rCBF),mean transit time(MTT)and time to peak(TTP)of the lesion area before and after treatment were compared.The adverse outcomes of the two groups were compared at 6 months after discharge.Result Compared with the group before treatment,vascular stenosis in Tongnaoyin group was significantly reduced in different degrees,and the difference was statistically significant(Z=105.369,p<0.01).There was no significant reduction in different degrees of vascular stenosis in control group(Z=2.779,p>0.05).Compared with the control group after treatment,the improvement rate of vascular stenosis in Tongnaoyin group was higher(2=84.179,P<0.01),and the curative effect was better(86.6%).Compared with this group before treatment,rCBV and rCBF in Tongnaoyin group were significantly increased,the difference was statistically significant(P<0.01),and MTT and TTP had a tendency to shorten,but the difference was not statistically significant.There was no significant difference in rCBV,rCBF,MTT and TTP in control group.Compared with the control group,rCBV and rCBF in Tongnaoyin group were significantly increased,while MTT and TTP were significantly decreased(P<0.01).Compared with before treatment,NIHSS score of Tongnaoyin group was lower than before 6 months after discharge,the difference was statistically significant(Z=15.097,P<0.01).There was no significant difference in NIHSS score in control group at 6 months after discharge(Z=0.036,P>0.05).Compared with the control group after treatment,the NIHSS score of Tongnaoyin group was significantly reduced,and the prognosis of patients was better,with statistical significance(Z=5.96,P<0.05).The risk of adverse prognosis in Tongnaoyin group was significantly lower than that in control group 6 months after discharge(P<0.05).Conclusion Tongnaoyin,a traditional Chinese medicine,has a good effect on improving cerebral blood perfusion in patients with acute cerebral infarction.It can be used as an effective supplement for the conventional treatment of ischemic stroke to improve the clinical efficacy.
作者
季连红
刘沛桉
厉励
李昀泽
朱清
唐晓刚
蒋辉
刘永康
袁翠平
李文磊
朱元
吴明华
JI Lianhong;LIU Peian;LI Li;LI Yunze;ZHU Qing;TANG Xiaogang;JIANG Hui;LIU Yongkang;YUAN Cuiping;LI Wenlei;ZHU Yuan;WU Minghua(The Affiliated Hospital of Nanjing University of Chinese Medicine/Jiangsu Province Hospital of Chinese Medicine,Nanjing 210029,China)
出处
《中国实验方剂学杂志》
CAS
CSCD
北大核心
2024年第12期105-111,共7页
Chinese Journal of Experimental Traditional Medical Formulae
基金
国家自然科学基金项目(82274428)
江苏省中医药科技项目(ZT202102)。
