汪慧 陈延 李平 黄敏 郭珍立

〔摘要〕 目的 观察体外培育牛黄治疗缺血性中风中脏腑（痰热内闭证）患者的临床疗效。方法 选取湖北省中西医结合医院2017年2月至2020年2月新发缺血性中风中脏腑（痰热内闭证）患者108例，分为治疗组和对照组，每组54例。所有患者均给予西医常规治疗，治疗组患者另外加服体外培育牛黄0.3 g/d，温水化开后鼻饲，疗程为1周。观察治疗前及治疗后1周、4周及3个月两组患者格拉斯哥昏迷指数（GCS）、美国国立卫生研究院卒中量表（NIHSS）、改良Rankin量表（mRS）评分的变化情况;检测治疗前及治后1周超敏C反应蛋白（Hs-CRP）、神经元特异性烯醇化酶（NSE）、S-100β蛋白水平的变化情况。结果 治疗后1周，治疗组和对照组GCS评分、NIHSS評分、mRS评分比较差异无统计学意义（P>0.05），治疗后4周及3个月，治疗组GCS评分高于对照组，NIHSS评分、mRS评分低于对照组，差异均有统计学意义（P<0.05）。治疗后1周，两组患者血清Hs-CRP、NSE、S-100β蛋白水平均较治疗前下降，且治疗组低于对照组，差异有统计学意义（P<0.05）。结论 体外培育牛黄治疗缺血性中风中脏腑（痰热内闭证）可有效降低患者的炎性反应、减轻神经损伤、改善中远期预后，有一定的临床应用价值。

〔关键词〕 中风;中脏腑;痰热内闭证;体外培育牛黄;格拉斯哥昏迷指数;美国国立卫生研究院卒中量表;改良Rankin量表

〔中图分类号〕R255.2       〔文献标志码〕B       〔文章编号〕doi：10.3969/j.issn.1674-070X.2021.07.022

〔Abstract〕 Objective To observate the clinical effect of in-vitro-cultured calculus bovis on ischemic apoplexy involving Zang and Fu-viscera （syndrome of phlegm heat blocking internally）. Methods Patients with first-ever ischemic apoplexy involving Zang and Fu-viscera （syndrome of phlegm heat blocking internally） who hospitalized in Hubei Provincial Hospital of Integrated Chinese and Western Medicine from February 2017 to February 2020 were selected. The patients were separated into treatment group and control group randomly， 54 patients in each group. All the patients were given the routine treatment of western medicine. The treatment group were treated with in-vitro-cultured calculus bovis 0.3 g everyday extraly， nasal feeded after warm hydration. The course of treatment was one week. The Glasgow coma scale （GCS）， National Institutes of Health stroke scale （NIHSS） and improved Rankin scale （mRS） were calculated before treatment and after 1 week， 4 weeks， 3 months of treatment; the levels of hypersensitive C-reactive protein （Hs-CRP）， neuron-specific enolase （NSE） and S-100β protein were calculated before treatment and after 1 week of treatment. Results After 1 week of treatment， the scores of GCS， NIHSS and mRS were compared between the two groups， there was no significant difference between the treatment group and the control group （P<0.05）. After 4 weeks and 3 months of treatment， the scores of GCS of the treatment group was higher than the control group， the scores of NIHSS and mRS were lower than the control group， and there was a significant difference between the two groups （P<0.05）. After 1 week of treatment， the levels of Hs-CRP， NSE and S-100β protein were lower than before treatment， and treatment group was lower than the control group， there was a significant difference between the two groups （P<0.05）. Conclusion The application of in-vitro-cultured calculus bovis on the patients of ischemic apoplexy involving Zang and Fu-viscera （syndrome of phlegm heat blocking internally） could reduce the inflammatory response and neurologic impairment， improve the medium term and forward prognosis， it has a certain value of clinical applications.

〔Keywords〕 apoplexy; apoplexy involving Zang and Fu-viscera; syndrome of phlegm heat blocking internally; in-vitro-cultured calculus bovis; Glasgow coma scale; National Institutes of Health stroke scale; improved Rankin scale

脑梗死属中医学“中风”范畴，有高发病率、高致残率、高病死率、高复发率、高经济负担等特点[1]。中风中脏腑者病情尤为严重，多伴随神昏、高热、惊厥，且西医疗效欠佳。中风中脏腑（痰热内闭证）的患者痰热内结、痰壅神窍、心神失主，乃至昏迷，其治疗重在清热化痰、醒脑开窍[2]。牛黄是牛胆结石，有清心、豁痰、开窍、凉肝、息风、解毒的功能，用于治疗高热神昏、中风惊厥等疾病[3]，但药源匮乏、价格昂贵。体外培育牛黄的性状、成分、含量及药效与天然牛黄相似度极高，可替代天然牛黄[4]。超……