2022 年第 1 期 第 17 卷

醒脑开窍方联合双联抗血小板治疗对缺血性脑卒中患者血小板活性及临床疗效的影响

Influence of Xingnaokaiqiao recipe combined with double antiplatelet therapy on the platelet activity and clinical effect in patients with ischemic stroke

作者：冯曼莎1张勇1黎希年1林宇飞2

英文作者：Feng Mansha1 Zhang Yong1 Li Xinian1 Lin Yufei2

单位：1广州中医药大学附属阳江市中医医院神经内科，广东省阳江市529500;2广东医科大学附属医院中医科，广东省湛江市524000

英文单位：1Department of Neurology Yangjiang Hospital of Traditional Chinese Medicine Guangzhou University of Chinese Medicine Yangjiang 529500 China; 2Department of Traditional Chinese Medicine Affiliated Hospital of Guangdong Medical University Guangdong Province Zhanjiang 524000 China

关键词：缺血性脑卒中；醒脑开窍方；双联抗血小板治疗；血小板活性；侧支循环

英文关键词：Ischemicstroke;Xingnaokaiqiaorecipe;Dualantiplatelettherapy;Plateletactivity;Collateralcirculation

• 摘要：

• 目的 探讨醒脑开窍方联合双联抗血小板治疗对缺血性脑卒中患者血小板活性及临床疗效的影响。方法 选取广州中医药大学附属阳江市中医医院2019年9月至2020年9月收治的缺血性脑卒中患者110例，应用随机数字表法分为对照组和观察组，各55例。对照组在常规治疗基础上联合双联抗血小板和降脂治疗,观察组在对照组治疗基础上联合醒脑开窍方加减治疗,2组均连续治疗2个月。比较 2组治疗前后血清炎症因子［肿瘤坏死因子α（TNF-α）、白细胞介素6（IL-6）、高敏C反应蛋白（hs-CRP）］、血管内皮生长因子(VEGF)、血小板活性指标（血小板活化率、血小板黏附率）、大脑中动脉血流量指标水平以及美国国立卫生研究院卒中量表（NIHSS）评分和治疗后的临床疗效。结果 剔除治疗过程中退出治疗以及未按时服药的患者，观察组纳入研究53例，对照组纳入54例。治疗前，2组血清炎症因子、VEGF、血小板活性指标、大脑中动脉脑血流量指标水平和NIHSS评分比较，差异均无统计学意义（均P＞0.05）。治疗后，2组血清TNF-α、IL-6、hs-CRP水平，血小板活化率、血小板黏附率以及NIHSS评分均低于治疗前，且观察组均低于对照组［（27±4）ng/L比（39±4）ng/L、（23±4）ng/L比（31±4）ng/L、（7.1±1.2）mg/L比（9.4±1.3）mg/L、（38±4）%比（44±5）%、（56±6）%比（65±7）%、(5.7±1.4)分比（9.8±1.3）分］，差异均有统计学意义（均P＜0.05）；2组血清VEGF水平和大脑中动脉峰流速、平均流速均高于治疗前，且观察组均高于对照组（均P＜0.05）。治疗2个月后观察组临床疗效优于对照组（P＜0.05）。结论  醒脑开窍方联合双联抗血小板治疗可降低缺血性脑卒中患者的炎症反应和血小板活性，改善大脑微循环和患者的临床症状，促进血管的新生，提高疗效。

• Objective   To investigate the influence of Xingnaokaiqiao recipe combined with double antiplatelet therapy on platelet activity and clinical effect in patients with ischemic stroke. Methods  From September 2019 to September 2020, 110 patients with ischemic stroke admitted to the Yangjiang Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine were selected. They were randomly divided into control group and observation group, with 55 cases in each group. The control group was combined with dual antiplatelet and lipid-lowering treatment on the basis of conventional treatment, and the observation group was combined with Xingnaokaiqiao recipe plus or minus treatment on the basis of the control group. Both groups were treated for 2 consecutive months. Serum inflammatory factors ［tumor necrosis factor-α(TNF-α), interleukin-6 (IL-6), high-sensitivity C-reactive protein (hs-CRP)］, vascular endothelial growth factor (VEGF), platelet activity indicators (platelet activation rate, platelet adhesion rate), middle cerebral artery blood flow index levels and National Institutes of Health Stroke Scale (NIHSS) score before and after treatmen, and clinical efficacy after treatment were compared between the two groups. Results  Excluding patients who withdrew from treatment and did not take medication on time during treatment, 53 cases were included in the observation group and 54 cases were included in the control group. Before treatment, there were no significant differences in serum inflammatory factors, VEGF, platelet activity indicators, middle cerebral artery blood flow index levels and NIHSS score between the two groups (all P>0.05). After treatment, the serum TNF-α, IL-6 and hs-CRP levels, platelet activation rate, platelet adhesion rate and NIHSS score of the two groups were lower than those before treatment, and those of the the observation group were lower than those of the control group ［(27±4)ng/L vs (39±4)ng/L, (23±4) ng/L vs (31±4)ng/L, (7.1±1.2)mg/L vs (9.4±1.3) mg/L, (38±4)% vs (44±5) %, (56±6)% vs (65±7)%, (5.7±1.4) vs (9.8±1.3)］(all P<0.05). The serum VEGF level and the peak flow velocity and average flow velocity of the middle cerebral artery of the two groups were higher than those before treatment, and those of the observation group were higher than those of the control group (all P<0.05). After 2 months of treatment, the clinical effect of the observation group was higher than that of the control group (P<0.05). Conclusion  Xingnaokaiqiao recipe combined with dual antiplatelet therapy can reduce inflammatory response and platelet activity in patients with ischemic stroke, improve cerebral microcirculation and clinical symptoms of patients, promote angiogenesis, and improve curative effect.