活血化瘀法治疗下肢动脉硬化闭塞症的临床研究

摘要

目的：采用活血化瘀治疗下肢动脉硬化闭塞症患者，探讨芪麦通络饮加减对下肢动脉硬化闭塞症的临床疗效。方法：随机选取2013年9月至2015年5月，于我科就诊的下肢动脉硬化闭塞症患者60例，单盲随机分为治疗组和对照组，每组各30例。其中治疗组女16例，男14例；平均年龄（56.08±9.71）岁；对照组女15例，男15例；平均年龄（56.98±9.43）岁。2组年龄、性别等差异无统计学意义（P＞0.05），具有可比性。对照组予以基础治疗和前列地尔治疗。治疗组：基础治疗和芪麦通络饮加减治疗。2组患者治疗前和治疗后采集静脉血，血糖、血脂、血液流变学指标；治疗前后下肢超声检测股浅动脉和足背动脉的血流量、血管内径和峰值流速。结果：2组患者组内比较治疗后除高密度脂蛋白（ HDL水平升高（P＜0.05）外，其余空腹血糖（FBG）、餐后2 h血糖（2 hPG）、三酰甘油（TG）、总胆固醇（TC）、低密度脂蛋白（LDL）均降低（P＜0.05），差异有统计学意义。治疗后，治疗组对FBG、2 hPG、TG、TC、LDL等的降低程度优于对照组（P＜0.05），对HDL的升高水平也优于对照组（P＜0.05）。2组组内比较治疗后血液流变学水平均比治疗前低（P＜0.05）；且治疗组治疗后血浆黏度、全血黏度高切、全血黏度中切和全血黏度低切等血液流变学水平较对照组显著降低（ P＜0.05）。2组治疗后股浅动脉和足背动脉血流量、血管内径均比治疗前大（P＜0.05），峰值流速较治疗前慢（P＜0.05）；治疗后，与对照组相比，治疗组显著提高股浅动脉和足背动脉血流量、血管内径（P＜0.05），同时明显降慢峰值流速（P＜0.05）。结论：芪麦通络饮加减可以通过活血化瘀的方法改善下肢动脉硬化闭塞症的血小板功能，同时改善血液高凝状态，疗效显著。%Objective:To probe the clinical effect of Activating Blood and Removing Stasis Method by Qimai Tongluo Decoction on lower extremity arteriosclerosis obliterans patients .Methods:Lower extremity arteriosclerosis obliterans of 60 cases during Septem-ber 2013 and May 2015 in our hospital were randomly divided into treatment group and control group by single blinded method , with 30 cases in each group .There were 16 female cases in the treatment group and 14 male;the average age is (56.08 ±9.71) years;and 15 famle and male cases in the control group;the average age (56.98 ±9.43) years old.The two groups had no statis-tically significant differences in age, gender (P>0.05), which was comparable.The control group was given basic treatment and alprostadil treatment;treatment group basic treatment and Qimai Tongluo Decoction .The venous blood , hemorheology , blood glu-cose and blood lipid before and after treatment; lower extremity ultrasound in superficial femoral artery and dorsalis pedis artery blood flow, blood vessel diameter and peak velocity were compared before and after treatment .Results: Except for the increased HDL level(P<0.05), the levels of FBG, PG, 2 h the TG, TC, and LDL decreased significantly in both two groups (P<0.05). But the treatment group had better results on FBG , 2 h, TG, TC, PG, LDL as well as HDL compared with the control group , difference was statistically significant (P<0.05).The average level of blood rheology dropped in both two groups after the treat -ment(P<0.05);and treatment group experienced obvious decrease in plasma viscosity , whole blood high shear viscosity , whole blood viscosity in cutting and whole blood viscosity low cut level;After treatment , femoral superficial artery and dorsalis pedis ar-tery blood flow, blood vessel diameter rose in the two groups after the treatment (P<0.05), peak flow velocity became slower (P<0.05);compared with the control group , there was a significant increase in femoral superficial artery and dorsalis pedis artery blood flow, blood vessel diameter and decrease in slow peak velocity in the treatment group ( P <0.05 ) Conclusion: Qimai Tongluo Decoction can improve the blood circulation through the method of Activating Blood and Removing Stasis in lowering ex -tremity arterial occlusive disease , and improving blood hypercoagulability , which has curative effect .