广西医学

目的探讨涤痰熄风通络汤联合温针灸治疗急性缺血性脑卒中（AIS）患者的临床效果，并分析其对患者脑血流动力学及相关神经因子水平的影响。方法将104例AIS患者随机分成对照组和观察组，每组52例。两组均采用常规西医治疗，观察组同时采用涤痰熄风通络汤联合温针灸治疗。治疗2周后，评估两组患者的疗效。比较治疗前后两组患者的神经功能［美国国立卫生院卒中量表（NIHSS）评分］、脑血流动力学指标［大脑中动脉的平均血流速度（MFV）、搏动指数（PI）、阻力指数（RI）］、血清神经营养因子［脑源性神经营养因子（BDNF）、神经营养因子3（NT-3）、神经生长因子（NGF）］水平、神经损伤标志蛋白［胶质纤维酸性蛋白（GFAP）、神经元特异性烯醇化酶（NSE）、S100钙结合蛋白B（S100B）］水平。结果治疗后，观察组总有效率为92.31%，高于对照组的76.92%（P＜0.05）。治疗后，两组的NIHSS评分，大脑中动脉的PI、RI，以及血清GFAP、NSE、S100B水平低于治疗前，大脑中动脉的MFV及血清BDNF、NT-3、NGF水平高于治疗前，且观察组上述指标优于对照组（P＜0.05）。结论与单一常规治疗相比，联合应用涤痰熄风通络汤及温针灸治疗能够更有效地改善AIS患者脑血流动力学，从而促进神经功能的恢复及临床症状和体征的缓解，同时可更好地促进神经营养因子的表达及降低神经损伤标志蛋白的水平。

ObjectiveTo explore the clinical effect of Ditan Xifeng Tongluo Decoction combined with warming needle moxibustion for the treatment of patients with acute ischemic stroke (AIS), and to analyze its influence on cerebral hemodynamics and relevant neurological factors levels. MethodsA total of 104 AIS patients were randomly assigned to control group or observation group, with 52 cases in each group. Both groups were treated with routine Western therapy, simultaneously, the observation group was treated with Ditan Xifeng Tongluo Decoction combined with warming needle moxibustion. After 2 weeks of treatment, efficacy was evaluated in both groups. The pre- and post-treatment neurological functions (National Institutes of Health Stroke Scale ［NIHSS］ score), cerebral hemodynamics indices with respect to medium-sized cerebral artery mean flow velocity (MFV), pulsation index (PI), and resistance index (RI), serum neurotrophins (brain-derived neurotrophic factor ［BDNF］, neurotrophin 3 ［NT-3］, nerve growth factor ［NGF］) levels, and nerve damage marker proteins (glial fibrillary acidic protein ［GFAP］, neuron-specific enolase ［NSE］, S100 calcium-binding protein B ［S100B］) levels were compared between patients of the two groups. ResultsAfter treatment, the total effective rate of the observation group was 92.31%, which was higher than 76.92% of the control group (P＜0.05). After treatment, NIHSS score, medium-sized cerebral artery PI and RI, as well as serum GFAP, NSE, and S100B levels in the two groups were lower than those before treatment, whereas medium-sized cerebral artery MFV, and serum BDNF, NT-3, and NGF levels in the two groups were higher than those before treatment, and the observation group yielded superior indices as above to compare with the control group (P＜0.05). ConclusionCompared with single routine therapy, combined application of Ditan Xifeng Tongluo Decoction and warming needle moxibustion to AIS patients can more effectively ameliorate cerebral hemodynamics, so as to promote neural functional recovery, relieve clinical symptoms and physical signs, and it can preferably promote expressions of neurotrophins and decrease levels of nerve damage marker proteins at the same time.