【摘要】 【目的】研究急性脑梗死超早期闭塞血管开通治疗前后的中医证候的变化特点,为脑血管再通治疗后中医临床治疗方案的制定奠定基础。【方法】以《中风病诊断与疗效评定标准》为依据,制定中风病证候诊断量表,收集29例接受了超早期闭塞血管介入开通治疗的急性脑梗死患者,分析患者接受治疗前及治疗后1 d、3 d、7 d的临床证候特点。【结果】共纳入29例接受闭塞血管开通治疗的急性脑梗死患者,脑血管造影显示,以大脑中动脉闭塞为主,基底动脉闭塞次之。血管开通治疗前,患者的中医证候要素构成以风证居首位,痰证和血瘀证次之。经过开通治疗后,各类型中医证候要素的构成比均逐渐减少,其中风证减少最早也最明显,痰证、血瘀证和气虚证逐渐减少,差异有统计学意义(均P <0.05)。到开通治疗后7 d,以痰证居多,血瘀证和气虚证次之。血管开通治疗前,以四证并见和三证并见居多,经开通治疗后,二证并见及一证独见的患者逐渐增多,在开通治疗后3 d和7 d,甚至出现了六证全无的患者。【结论】急性脑梗死患者经过超早期血管开通治疗后,中医证候特点由风痰瘀血相兼逐渐变成痰瘀阻络合并气虚;而且证候要素的组合由复杂逐渐变得简单。更多还原

【Abstract】 Objective To study the distribution of traditional Chinese medicine(TCM)syndromes of patients with acute cerebral infarction(ACI) before and after mechanical thrombectomy, thus to provide a basis for theestablishment of clinical treatment regimen of TCM after cerebrovascular recanalization therapy. Methods Adiagnostic scale for TCM syndromes of stroke was established based on Diagnosis and Response Criteria of Stroke.Twenty-nine ACI patients treated with mechanical thrombectomy were enrolled in the trial, and then thedistribution of TCM syndromes of AIS patients were analyzed before treatment and 1, 3 and 7 day(s)after treatment. Results A total of 29 ACI patients treated with mechanical thrombectomy were admitted in the trial.Digital subtraction angiography(DSA)results showed that the occlusion was mainly located in the middle cerebralartery,and then came the basilar artery. Before mechanical thrombectomy,wind syndrome was the leading type ofTCM syndrome elements, and phlegm syndrome and blood-stasis syndrome came next. However, aftertreatment,there was a gradual decrease in the composition ratio of TCM syndrome elements,of which the windsyndrome was decreased firstly and markedly,and phlegm syndrome,blood-stasis syndrome and Qi deficiencysyndrome were reduced gradually, the differences being significant(P < 0.05). Seven days after treatment,phlegm syndrome was dominant,next came blood-stasis syndrome and Qi deficiency syndrome. Before treatment,the combination of 4 or 3 kinds of TCM syndromes in patients was commonly seen,the combination of two TCMsyndromes or single TCM syndrome in patients was gradually present after treatment,but none of the 6 syndromeswas found 3 and 7 days after treatment. Conclusion After ultra-early mechanical thrombectomy, the distributionof TCM syndrome of ACI is characterized firstly by the combination of wind,phlegm and blood-stasis, and thenby the combination of phlegm and blood-stasis obstructing collaterals complicated with Qi deficiency; the combination of syndrome elements is cheracterized by developing from complexity to simplicity.更多还原