基于病症结合探讨中西医结合卒中单元对急性缺血性脑卒中病人预后的影响

摘要

Objective To investigate the effects of integrative medicine stroke unit (IMSU) on the prognosis in patients with acute ischemic stroke based on combination of disease with syndrome theory by multicentre,prospective,cohort control study.Methods One hundred and eighty patients with acute ischemic stroke were collected from five hospitals in Beijing and Shanghai,and divided into IMSU group (n=90) treated with herb,acupuncture,massage,and rehabilitation on the basis of modern stroke unit standardized treatment for 21 days,and control group (n=90) treated with modern stroke unit standardized treatment for 21 days.All patients were followed up at 90 days to objectively evaluate the clinical efficacy.National institute of Health Stroke Scale (NIHSS),Barthel Index (BI),traditional Chinese medicine (TCM) syndrome scores were evaluated.Results After 7,14,21 and 90 days of treatment,the scores of NIHSS,BI,TCM syndrome improved in two groups (P<0.01).NIHSS scores in IMSU group were better than that in control group after 21 and 90 days of treatment (P<0.01).BI scores in IMSU group were better than that in control group after 14,21 and 90 days of treatment (P<0.01).TCM syndrome scores in IMSU group were lower than that in control group after 14,21 and 90 days of treatment (P<0.01).Conclusion IMSU for acute ischemic stroke could significantly reduce the level of disability,improve activities of daily life,which can guide the application and enlarge of stroke unit in the treatment of ischemic stroke under the use of the combination of disease with syndrome theory,so as to further develop the characteristics of integrated medicine.%目的 通过多中心、前瞻性、队列对照研究,基于病症结合理论,探讨中西医结合卒中单元干预对急性缺血性卒中病人预后的影响.方法 将上海、北京五家家三甲医院收集的180例急性缺血性脑卒中病人分为中西医结合卒中单元组(试验组)和卒中单元组(对照组),每组90 例.试验组在卒中单元治疗的基础上,介入融中药、针灸、推拿、康复等于一体的中西医结合综合治疗方案;对照组为卒中单元组.两组疗程均为21 d,随访3个月.观察两组治疗前以及治疗后第7 天、第14天、第21天、第3个月美国国立卫生研究院卒中量表(NIHSS)积分、Barthel 指数、中医证候积分变化.结果 两组在治疗后第7天、第14天、第21天、第3个月NIHSS积分、Barthel 指数、中医证候积分均有不同程度的改善;试验组第21天、第3个月NIHSS评分改善程度优于对照组,差异有统计学意义(P<0.01);试验组第14天、第21天、第3个月Barthel 指数改善程度优于对照组(P<0.01);试验组第21天、第3个月中医证候积分低于对照组(P<0.01).结论 中西医结合卒中单元可改善急性缺血性脑卒中病人症状及日常生活能力,提示运用病症结合理论可更好地指导卒中单元治疗缺血性脑卒中的应用和拓展,发挥中西医结合特色.