丹参注射液、川芎嗪注射液辨证论治偏头痛的临床观察

【作者】 方铁根；

【导师】 熊家平；

【作者基本信息】 湖北中医学院 ， 中医内科学， 2003， 硕士

【摘要】 目的： 偏头痛是临床神经内科疾病中的一种常见病、多发病，归属于祖国医学“头风”、“头痛”、“厥头痛”等范畴。随着人们生活节奏的加快和工作压力的增大，偏头痛的发病率和患病人数也在不断地增加，严重影响了人们地生活质量和工作效率。目前，现代医学及传统中医药治疗该病的方法很多，对于降低该病的复发率，减轻患者的痛苦起到了重要的作用。这里，我们将通过观察丹参注射液(正大天晴药业生产10ml／支)和川芎嗪注射液(齐齐哈尔第二制药厂生产2ml／支，每支含盐酸川芎嗪40mg)辨证治疗偏头痛患者的临床疗效，进一步证实丹参注射液和川芎嗪注射液静脉点滴治疗偏头痛的有效性，讨论其中医功效和作用机理，并初步探讨中成药尤其是单味药注射液辨证论治的可行性及有效性。 方法： 采用随机、平行对照的方法，将60例符合纳入标准的偏头痛患者随即分为治疗组和对照组两组，分别为30例和30例，在一般治疗的基础之上，治疗组还详辨证候以明确病机。临床证候以气滞为主要表现者，予以川芎嗪注射液160mg，加入5％GS或10％GS或0.9％Nacl250ml之中，静脉滴注，一日一次；以血淤为主要表现者，予以丹参注射液30ml，静脉5％GS或10％GS或0.9％Nacl250ml之中，静脉滴注，一日一次，以上两药均以连续用药14天为一个疗程，一般连用两个疗程，观察患者治疗前后临床症状、体征、以及部分患者(以治疗组为主)的血液流变学、血脂等指标的变化。对照组则随机选用两种注射液，用法同前。 结果： (1)偏头痛疗效评定：治疗组的总有效率为96.67％，对照组的总有效率为80.00％；治疗组的显效率为66.67％，对照组的显效率为20.00％。两组之间有显著性差异(P＜0.01)，治疗组疗效优于对照组。 (2)中医症状疗效评定：治疗组的有效率和显效率分别为100.00％和83.33％；对照组的有效率证侯和显效率分别为：76.67％和43.33％。两组之间有显著性差异(P＜0.05或P＜0.01)，治疗组疗效优于对照组。 (3)在临床症状综合评分和中医症状评分中：治疗组和对照组治疗前后积分有显著性差异(P＜0.01)，且治疗后治疗组和对照组积分有显著性差异(P＜0.05或P＜0.01)。 (4)治疗组中辨证分型以气滞血淤型的显效率为高，而以气滞夹痰型的较其他证型为低，各型疗效之间统计学无显著性差异(P＞0.05)。 (5)部分治疗组所观察的治疗前后的血液流变学(除血沉外)和血脂指标有明显的改善，数据指标治疗前后的结果比较有显著性差异(P＜0.05或P＜0.01)。 结论：湖北中医学院2000级硕士研究生毕业论文ESR外)的相关指标有明显的改善作用，而血脂各项指标的改善作用不明显;在治疗组所观察病例的中医症候的改善上，各型之中，以气滞血淤型的显效率较高，而气滞夹痰型则较低，但其显效率和有效率经统计学分析无明显差异;辨证治疗组(治疗组)的临床治疗效果较非辨证治疗组(对照组)为佳。更多还原

【Abstract】 Objective:Magraine is one of the common and muiti-happaned diseases in neurologic medicine. It belongs to "Toufeng" , " headache" , " Jue headache" in Traditional Chinese Medicine(TCM).Following the fastening of the life rhythm and bursting of working space, the happaning rate and number of magraine is increasing continuously. It affects searlously the people’s life quality and working efficiency. Nowdays there are many methods of curing magraine in the modem medicine and TCM , it is very important that it lowers the re-happaning rate of magraine and relieve the patients’pains.Now through observing the curative effect of Salvia Miltiorrhiza InjectionC SMI) and Ligusticum Chuanxiong Hort Injection ( LCHI) seing used in clinical therapy on Bianzheng Lunzhi, we will originally explore the therapeusis effect and mechanism of them on curing the magraine ,meanwhile investigate the feasibility of the TCM especially the injection of TCM which to be use:! in clinical therapy on Bianzheng Lunzhi.Methods:60 cases with magraine were divided randomly into tow groups ,the treatment group and control group. There are 30 cases and 30 cases in corresponding group. On the base of fundamental therapy ,30 cases (treatment group)were treated differently according to make the syndrome-sign clear. Those stagnation of Qi syndrome would be treated by I,CHI 160mg;and those stagnation of blood syndrome by SMI 30ml.30cases (control group)were treated randomly by any one of above tow injections without syndrome differentiation. They vere all treated once a day, 10 ~ 14 days as a therapeutic course , the time can’t surpass 14 days. They were used in ivdrop with 5%GS or 10%GS or 0.9%Nacl 250ml.Tne symptoms and signs of two groups, the emorrheologic parameters and blood lipid of some in treatment group were observed before and after therapy.Results:1. The total effective rates of clinical symptoms ai-e90.00% and 80.00%in treatment group and control group respectively. The significant effective rates are 70.00% and 20.00%.There is significant difference between tow groups (P<0.01 ) .To the therapy effect treatment group is superior to oontroi group.2. The total effective rates of the TCM symptoms are 90.00% and 70.00%.The significant effective rates are 76.67% and 36.67%. There is significant difference between low groups ( P<0.01 ). T o the therapy effect treatment group is superior to control group.3. In all of the syndrome clinical symptom-signs and the TCM symptom-signs,there is significant difference before and after therapy iu two groups ( P<0.01 ), and thereis significant difference between the two groups after therapy ( P<0.05, P<0.01 ).4. In all symptom-complex the significant effective rate of the stagnation of Qi with stagnation of blood syndrome is higher than others ,and the stagnation of Qi with sputum-damp syndrome is lower.lt has no statistical difference in every syndrome (P>0.05).5. The emorrheologic parameters and blood lipid which were observed in treatment group had some improvements alter therapy. In the emorrheologic parameters, results there are significant differences before and after therapy except ESR( P<0.01 ),but the parameters of biood lipid have no significant changes( P>0.05 ).Conclusions:SMI and LCHF s curative effect on curing die magraine with Bianzheng Lunzhi is belter, especially on stagnation of Qi syndrome and stagnation of blood syndrome. They can relieve the clinical symptoms and symptoms of TCM of magraine patients. There are significant improvements on the parameters of emorrheologic except ESR, but the parameters of blood lipid have no significant changes.In all symptom-complex in TCM,to the significant effective rates, the stagnation of Qi with stagnation of blood syndrome is higher, and the stagnation of Qi with sputum-damp syndrome is lower,but there is no significant difference among those syndromes.The clinical curitive effect in treatment group is better than that in control group.更多还原