王华强 李迪 凌军 周立峰

[摘要] 目的 探討散瘀通络汤治疗风痰瘀阻型急性缺血性脑卒中的临床疗效及其对患者血清5-羟色胺、多巴胺及脑血流灌注的影响。 方法 随机将2018年1月至2019年12月在本院神经内科就诊的94例急性缺血性脑卒中患者分为两组，给予对照组常规治疗方案，给予观察组常规方案结合散瘀通络汤治疗。比较两组患者的临床疗效、脑血流动力学参数、血液流变学指标、中医证候积分、5-羟色胺（5-HT）、多巴胺（DA）、脑源性神经营养因子（BDNF）水平、临床神经功能缺损程度（NIHSS量表）。 结果 观察组的总有效率明显高于对照组，差异有统计学意义（P<0.05）。两组患者治疗后脑血流动力学参数（MTT、TTP、CBV、CBF）及血液流变学指标（BV、PV、FIB、Hct）与治疗前比较有明显改善，且观察组MTT、TTP短于对照组，BV、PV 、FIB、Hct均低于对照组，CBV、CBF高于对照组，差异有统计学意义（P<0.05）。两组治疗后风痰瘀阻证各评分及NIHSS评分均显著降低，差异有统计学意义（P<0.05），且观察组风痰瘀阻证各评分及NIHSS评分均低于对照组，差异有统计学意义（P<0.05）。治疗后两组神经损伤指标5-HT、DA及BDNF水平均显著升高，且治疗后观察组神经损伤指标均显著较对照组高，差异有统计学意义（P<0.05）。 结论 散瘀通络汤治疗风痰瘀阻型急性缺血性脑卒中可有效改善临床症状，还可以调节5-HT、DA及BDNF水平，促进患者脑内微循环，增加脑血流量，值得临床推广。

[关键词] 缺血性脑卒中;散瘀通络;风痰瘀阻型;5-羟色胺

[中图分类号] R743.33          [文献标识码] B&nbsp;         [文章编号] 1673-9701（2021）31-0001-05

[Abstract] Objective To explore the clinical efficacy of Sanyu Tongluo Decoction in patients with acute ischemic stroke of phlegm wind resistance type and its effect on serum 5-hydroxy-trytamine， dopamine， and brain perfusion. Methods A total of ninety-four patients with acute ischemic stroke treated in Neurology Department of our hospital from January 2018 to December 2019 were randomly divided into two groups， with 47 patients in each group. Regular treatment regimen was adopted in the control group， and Sanyu Tongluo Decoction treatment was adopted in the observation group on the basis of the control group. The two groups were treated for 4 weeks. The clinical efficacy， cerebral blood dynamics parameters， blood rheological indexes， TCM syndrome score， 5-hydroxy-trytamine（5-HT）， dopamine （DA）， brain-derived neurotrophic factor （BDNF） level and national institute health stroke scale（NIHSS）in the two groups before and after treatment were compared. Results The total effective rate of observation group was significantly higher than that of control group， with statistically significant difference（P<0.05）. After treatment， the cerebral blood dynamics parameters （MTT， TTP， CBV， CBF） and blood rheological indexes （BV， PV， FIB， Hct） in the two groups were significantly improved compared with before treatment， with statistically significant difference（P<0.05）， and MTT， TTP in the observation group were shorter than those in the control group， BV， PV， FIB and Hct in the observation group were lower than those in the control group， while CBV and CBF were higher than those in the control group， with statistically significant difference （P<0.05）. The scores of TCM syndrome and NIHSS in the two groups after treatment were significantly reduced，with statistically significant difference （P<0.05）， and the scores of TCM syndrome and NIHSS in the observation group were lower than those in the control group， with statistically significant difference（P<0.05）. The nerve injury indexes， 5-HT， DA and BDNF in the two groups after treatment were significantly elevated， and the nerve injury indexes in the observation after treatment were significantly higher than those in the control group ，with statistically significant difference（P<0.05）. Conclusion In the treatment of acute ischemic stroke of phlegm wind resistance type， Sanyu Tongluo Decoction can effectively improve clinical symptoms， regulate the levels of 5-HT， DA and BDNF， promote cerebral microcirculation and increase cerebral blood flow in patients， which is worthy of clinical promotion.

[Key words] Ischemic stroke; Sanyu Tongluo Decoction; Wind-phlegm stagnation syndrome; 5-hydroxy-trytamine

急性缺血性脑卒中（AICVD）又称缺血性中风，属于西医急性缺血性脑血管病范畴。……