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Objective:To explore the curative effect and mechanism of Tongnao pill in the treatment of senile posterior circulation ischemic vertigo with phlegm and blood stasis type. Method:The 80 elderly patients with posterior circulation ischemic vertigo (phlegm and blood stasis type) admitted to Gansu Provincial Hospital of Traditional Chinese Medicine were selected as the research subjects and were randomly divided into two groups according to the hospital admission number. Those with odd numbers were classified into control group and those with even numbers were classified into observation group, with 40 cases in each group. All of the patients in both groups were given basic treatment, and the patients in control group additionally received intravenous infusion of vinpocetine on the basis of basic treatment, while the patients in observation group additionally received Tongnao pill on the basis of the treatment in control group. The clinical efficacy, traditional Chinese medicine (TCM) syndrome score, European Evaluation of Vertigo(EEV) score, dizziness handicap inventory-screening (DHI-S) score, vertebral basilar artery average blood flow velocity(Vm) and pulsatility index(PI), hemodynamic changes[mean arterial pressure(MAP), central venous pressure(CVP), right atrial pressure (RAP), left atrial pressure(LAP), cardiac output(CO), cardiac stroke volume(SV)], changes in blood viscosity and blood lipid levels，symptom disappearance time, and safety of the two groups were compared. Result:The total effective rate in the observation group was 95.00% (38/40), significantly higher than 75.00% (30/40) in the control group (χ2=4.804, P<0.05). After treatment, the symptoms were significantly improved in both groups (P<0.05), and the scores of dizziness, nausea and vomiting, tinnitus and deafness, tiredness and fatigue in the observation group were lower than those in the control group (P<0.05), the EEV and DHI-S scores were decreased significantly in both groups(P<0.05), and such scores in the observation group were significantly lower than those in the control group(P<0.05), the Vm of bilateral vertebral artery (VA) and basilar artery (BA) on both sides were significantly increased in both groups, while the PI was significantly reduced (P<0.05), and these two indicators in the observation group were better than those in the control group (P<0.05), the MAP, CVP, RAP and LAP were significantly reduced in both groups after treatment, while the CO and SV were increased after treatment(P<0.05), and the SV of the observation group was significantly higher than that of the control group(P<0.05). The high blood viscosity, low blood viscosity, plasma viscosity and TG, TC, LDL-C levels were decreased significantly while HDL-C increased significantly in both groups (P<0.05), and the blood viscosity and blood lipid levels in the observation group were significantly better than those in the control group(P<0.05). The time to disappearance of dizziness, nausea, vomiting, tinnitus and deafness, malaise, fatigue, and confused mind in observation group was less than that in the control group (P<0.05), no serious adverse events occurred in both groups. Conclusion:Tongnao pills for the treatment of senile posterior circulation ischemic vertigo (phlegm and blood stasis type) can significantly alleviate the symptoms of vertigo, improve hemorrheology, increase the blood flow velocity of the vertebrobasilar artery, improve the abnormal blood supply to the brain, and improve the quality of life for patients, with fewer adverse reactions, high safety, and good therapeutic effect. Therefore, it is worth to be applied in clinical use.
RESUMO
<p><b>OBJECTIVE</b>To study the clinical characteristics of acute myocardial infarction (AMI) among younger adults and to explore the possible mechanisms of early myocardial infarction, combined with the newly discovered risk factors of coronary heart disease.</p><p><b>METHODS</b>Data on comparative analysis to the exposure rates of the risk factors and inducing factors of non-CAD patients with two groups of AMI patients including younger adults group (< or =40 years old) and aged adults group (> or =50 years old). Coronary angiography was applied.</p><p><b>RESULTS</b>There were differences noticed between the frequencies of risk factors of the two AMI groups. In younger adults group the exposure rates of smoking, hyperlipidemia, positive family history, C-reactive protein (CRP) and fibrinogen were markedly higher, while in elderly group the exposure rates of hypertension, smoking, hyperlipidemia, diabetes, CRP, fibrinogen and homocysteine (HCY) were markedly higher (P < 0.05). Although the clustering status of risk factors of the younger adult group was not higher than that of the elderly group. There were obvious inducing factors before the patients were attacked by AMI and the inducing factors inclined to cluster, which had obvious dose-reaction relationships with the occurrence of AMI in young people.</p><p><b>CONCLUSION</b>Early AMI of younger adults might relate to the clustering status of inducing factors. The coexistence of several kinds of inducing factors was resulted in the occurrence of AMI of the atherosclerosis (As) and non-As patients by means of myocardial ischemia accumulation effect.</p>