周山++杨丽燕++梁昊

摘要：目的 觀察补肾活血方对老年慢性脑供血不足（CCCI）患者临床症状、眩晕程度、认知功能的改善作用并探讨其作用机制。方法 采用随机数字表法将70例患者分为观察组和对照组各35例。2组均予降压、降糖、调脂等基础治疗。对照组在常规治疗基础上，予盐酸氟桂利嗪胶囊，每次5 mg，每日1次，睡前口服；观察组在常规治疗基础上，予补肾活血方，每日1剂，分2次口服。均连续治疗30 d。观察治疗前后中医症状评分、眩晕残障程度评定量表（DHI）中文版评分及蒙特利尔认知评估量表（MoCA）评分，检测基底动脉（BA）、双侧椎动脉（VA）、双侧大脑中动脉（MCA）的平均血流速度（Vm）及血浆酸性磷脂（AP）含量，评价临床疗效。结果 观察组总有效率为94.3%（33/35），对照组为82.9%（29/35），2组比较差异有统计学意义（P<0.05）；2组患者治疗后中医症状评分、DHI评分及血浆AP含量较治疗前下降，MoCA评分及VA、LBA、RBA、LMCA、RMCV的Vm较治疗前升高（P<0.05）；治疗后观察组中医症状评分、DHI评分、MoCA评分、LVA、LMCA、RMCA的Vm及血浆AP含量改善优于对照组（P<0.05）。结论 补肾活血方治疗老年CCCI疗效显著，可改善患者临床症状及眩晕程度，提高认知水平，其作用机制可能与提高患者脑Vm、降低血浆AP含量有关。

关键词：慢性脑供血不足；老年；补肾活血方；脑血流速度

DOI：10.3969/j.issn.1005-5304.2017.10.007

中图分类号：R277.73 文献标识码：A 文章编号：1005-5304（2017）10-0027-04

Clinical Study on Bushen Huoxue Decoction for Elderly Patients with Chronic Cerebral Circulation Insufficiency ZHOU Shan1， YANG Li-yan1， LIANG Hao2 （1. Haikou Hospital of Traditional Chinese Medicine， Haikou 570216， China； 2. College of Traditional Chinese Medicine， Hunan University of Chinese Medicine， Changsha 410208， China）

Abstract： Objective To observe the effects of Bushen Huoxue Decoction on clinical symptom， vertigo degree and cognitive function for elderly patients with chronic cerebral circulation insufficiency （CCCI）； To explore its possible mechanism. Methods Totally 70 cases were randomly divided into observation group and control group according to the random digits table method， with 35 cases in each group. The two groups were given Western medicine consisting of blood pressure control， glucose control and blood lipid control. Based on this， the control group was given Flunarizine Hydrochloride capsules， 5 mg once a day orally before sleeping. The observation group was given Bushen Huoxue Decoction， one dose a day and taken twice a day. The treatment lasted for 30 days. The TCM symptom score， Chinese version of dizziness handicap inventory （DHI） and Montreal cognitive assessment （MoCA） score were observed. The mean blood flow velocity （Vm） of basilar artery （BA）， bilateral vertebral artery （VA）， bilateral middle cerebral artery （MCA） and the content of plasma acid phospholipid （AP） were detected， and the clinical efficacy was evaluated. Results The total effective rate of the observation group was 94.3% （33/35）， which was significantly higher than that of 82.9% （29/35） in the control group， with statistical significance （P<0.05）； after treatment， the TCM symptom score， DHI score， and the content of plasma AP were significantly lower than those of pre-treatment in the same group （P<0.05）； the MoCA score and the Vm of VA， LBA， RBA， LMCA， RMCV were significantly higher than those of pre-treatment in the same group （P<0.05）； the TCM symptom score， DHI score， MoCA score， the Vm of LVA， LMCA， RMCA and the content of plasma AP in the observation group were improved better than those in the control group， with statistical significance （P<0.05）. Conclusion Bushen Huoxue Decoction has an obvious therapeutic effects for elderly patients with CCCI， which can improve clinical symptom， vertigo degree and cognitive level， which possible mechanism is related to increasing the cerebral blood flow velocity and reducing the content of plasma AP.endprint

Key words： chronic cerebral circulation insufficiency； elderly； Bushen Huoxue Decoction； cerebral blood flow velocity

慢性脑供血不足（chronic cerebral circulation insufficiency，CCCI）为临床常见的慢性缺血性脑血管疾病，好发于老年人，临床主要表现为头重、头晕等脑部功能障碍[1]。研究表明，CCCI产生的慢性缺血是缺血性脑卒中、皮质下动脉硬化性脑病、短暂性脑缺血发作、血管性痴呆、阿尔茨海默病等发生、发展的一个重要环节[2]。笔者临床发现，多数老年CCCI患者存在认知功能障碍，积极治疗CCCI对防止脑血管疾病的发生及预防痴呆具有重要意义。调查显示，CCCI以本虚标实证为主，本虚以肾虚为主，标实以血瘀为主，肾虚血瘀证是常见证型[3]。笔者从补肾益气、活血通络入手，采用补肾活血方治疗老年CCCI，旨在探讨本方临床疗效及对患者脑血流速度、血浆酸性磷脂（AP）的影响，现报道如下。……