【作者】 魏锦慧；

【导师】 张英强；

【作者基本信息】 成都中医药大学 ， 中医内科学， 2009， 硕士

【摘要】 目的：通过运用补肾强肝活血法对缺血再灌注大鼠的实验研究及中风偏瘫临床病例治疗的介绍,探讨补肾强肝活血法防治中风偏瘫的作用机理及其临床疗效。方法：实验部分：采用改良的Longa法建立大鼠左侧大脑中动脉梗阻(MACO)再灌注模型,造模成功后随机分为假手术组,模型组,西药尼莫地平组,回春偏瘫方高剂量组,回春偏瘫方中剂量组,回春偏瘫方低剂量组(回高组／回中组／回低组)6组,用药14天,治疗结束后观察大鼠一般情况和体重改变,按照改良Berdson评分分级法观察神经行为学的改变,处死大鼠断头取脑,采用TTC染色观察大鼠脑梗死体积变化,取脑制成10%脑匀浆溶液,测定脑内兴奋性谷氨酸(Glu)的水平；采用比色法测定血清NO、NOS水平。临床观察部分：收集60例符合研究标准的肝肾亏虚证型的中风偏瘫患者,随机分为治疗组和对照组各30例纳入观察。两组均予以西医常规治疗,对照组另加口服步长脑心通胶囊；治疗组在对照组治疗措施之外加用口服补肾强肝活血法指导下的回春偏瘫方汤药(200m1/袋,浓度lg/ml,成都中医药大学附属医院药剂科提供),200ml/次,每8小时一次,进食后服用。两组每个疗程均4周,共3个疗程。观察并对两组患者的临床疗效、中医证候疗效、两组治疗前后运动功能(Brunstrom偏瘫运动功能分级法)、两组治疗前后日常生活活动能力评测(Barthel指数)及安全性评价进行比较、统计学分析及评价。结果：实验部分：MACO再灌注大鼠经灌服补肾强肝活血法指导下的经验方(回春偏瘫方)治疗后,体重有所恢复,神经功能缺失情况得到不同程度改善,其中中剂量组和低剂量组对于恢复体重优于尼莫地平西药对照组(以下简称西药组),同时中剂量组对于恢复神经功能缺失情况而言,其疗效与西药组相当,但未达到正常水平；脑梗死体积和梗死百分比均显著降低,其中以中剂量组的疗效最佳,与尼莫地平疗效相当,无明显差异性；血清中NO和NOS(包括TNOS和iNOS)水平有不同程度的下降。各治疗组均可明显降低血清内NOS(包括TNOS和iNOS)水平,高剂量组和低剂量组疗效与西药组相当,但中剂量组对于降低血清内NOS水平优于西药组和回春偏瘫方另外两个治疗组。同时回中组和回低组还可明显降低血清内NO水平；脑内谷氨酸Glu水平均明显下降,其中以高剂量组和中剂量组较佳,疗效与西药组相当,无统计学差异。临床观察部分：1、临床疗效比较：治疗组和对照组治愈率和显效率分别为70.0%、43.3%,总有效率分别为96.7%、76.7%；两组治愈率和显效率之和有非常显著性差异(P<0.01),总有效率有显著性差异(P<0.05)。说明治疗组疗效优于对照组。2、中医证候疗效比较：治疗组与对照组总有效率分别96.7%、93.3%,有显著性差异(P<0.05)。两组中医证候均有不同程度的改善,但治疗组疗效优于对照组。3、两组治疗前后运动功能比较(Brunstrom偏瘫运动功能分级法)：治疗前后两组组间比较提示：对运动功能的改善方面,治疗组优于对照组(Ridit分析u=-2.0 P=0.046,P<0.05)。4、两组治疗前后日常生活活动能力评(?)(?)(Barthel指数)显示：治疗前后两组组间比较提示：两组对日常生活能力的改善无明显差别,差异无统计学意义。结论：回春偏瘫方作为体现补肾强肝活血法的有效方剂,具有促进MCAO再灌注后大鼠模型和缺血性中风患者的神经功能恢复的作用,其机理可能与减少脑梗死体积,降低颅内Glu、NO、NOS水平相关；而运用补肾强肝活血法在治疗中风偏瘫的临床观察中亦取得了较满意的临床疗效。更多还原

【Abstract】 Objective:Through the use of tonifying liver and kidney and activating blood circulation in rats and the treatment of clinical cases introduction, Discussion on this reperfusion Stroke Prevention Mechanism and clinical efficacy.Method:Experimental part:The rats after successful modeling the the models of left side of rat middle cerebral artery occlusion (MCAO) were randomized into six groups:sham operation group, model group, high dose group,middle dose group,low dose group and control group. After 14 days treatment course, the changes of weight,behavior,infarct size,,the contents of Glu in brain, and Using colorimetric determination of serum NO, NOS levels.Clinical observation of parts:Collected 60 cases of standards in line with the study of liver and kidney deficiency syndrome types of stroke patients with hemiplegia were randomly divided into treatment group and control group into 30 cases of the observation, Conventional Western medicine are to be two sets of treatment, the control group plus oral buchangNaoxintong Capsule; Treatment group in the control group treatment measures add Huichunpiantan Decoction,200ml/ times, once every eight hours. Each treatment group were four weeks, a total of three treatments. Observation of the clinical effect of two groups of patients, efficacy of traditional Chinese medicine syndromes, the two groups, such as motor function before and after treatment targetResults:Experimental part:MACO reperfusion rats were fed with tonifying liver and kidney and activating blood circulation experience under the guidance of side (Huichunpiantan Decoction) after treatment,①Huichunpiantan Decoction decreases neural functional deficits in the evaluation of rats and the score with long medication was lower, suggesting that medication can even better improve neural functional deficits;②Huichunpiantan Decoction could obviously reduce the infarct size;③Huichunpiantan Decoction could reduce Glu content in brain④Huichunpiantan Decoction could reduce NO,NOS (including TNOS and iNOS)content level in blood.Clinical observation of parts:1, clinical effects:Effect that the treatment group than the control group.2, Comparison of efficacy of TCM Syndrome:Two groups of traditional Chinese medicine syndromes in varying degrees of improvement, but the efficacy of the treatment group than the control group.3, the two groups before and after treatment compared motor function:the treatment group than the control group (Ridit analysis u=-2.0 P=0.046, P<0.05).4, the two groups before and after treatment evaluation activities of daily living showed that:The two groups on the improvement of activities of daily living was no significant difference, the difference was not significant.Conclusion:The use of tonifying liver and kidney and activating blood circulation treatment for stroke hemiplegia must have a theoretical basis, and have achieved satisfactory clinical efficacy.更多还原