【目的】 分析复脉逐瘀汤联合发散式冲击波（RSWT）治疗脑卒中恢复期下肢痉挛患者的疗效及其对血清神经元特异性烯 醇化酶（NSE）、转化生长因子β1（TGF-β1）的影响。【方法】 选取2022年1月至2024年1月在河北北方学院附属第一医院就诊 的111例脑卒中恢复期下肢痉挛气虚血瘀证患者，根据治疗方法的不同将其分为2组，其中西医组55例给予RSWT治疗，中 医组56例在西医组的基础上加用复脉逐瘀汤治疗，疗程均为6个月。观察2组患者治疗前后偏瘫肢体肌张力改良Ashworth量 表（MAS）评分、临床痉挛指数（CSI）评分、生活自理能力 Barthel 指数（BI）评分、三维步态参数（步速、步频、步长）、血清 NSE、TGF-β1水平及血液流变学指标[血浆黏度（PV）、全血低切黏度（LBV）、全血高切黏度（HBV）和血小板聚集率（PAR）]的 变化情况，并评价2组患者的临床疗效。【结果】（1）疗效方面，治疗6个月后，中医组的总有效率为94.64%（53/56），西医组 为 76.36%（42/55），组间比较（χ2检验），中医组的疗效明显优于西医组（P＜0.01）。（2）量表评分方面，治疗后，2 组患者的 MAS、CSI评分均较治疗前降低（P＜0.05），BI评分均较治疗前升高（P＜0.05），且中医组对 MAS、CSI评分的降低幅度及对 BI评分的升高幅度均明显优于西医组（P＜0.01）。（3）三维步态参数方面，治疗后，2组患者的步速、步频、步长等三维步态 参数均较治疗前升高（P＜0.05），且中医组的升高幅度均明显优于西医组（P＜0.01）。（4）血清 NSE、TGF-β1水平方面，治疗 后，2组患者的血清 NSE水平均较治疗前明显降低（P＜0.05），血清 TGF-β1水平均较治疗前明显升高（P＜0.05），且中医组 对血清 NSE水平的降低幅度及对血清 TGF-β1水平的升高幅度均明显优于西医组（P＜0.01）。（5）血液流变学指标方面，治疗 后，2组患者的PV、LBV、HBV、PAR等血液流变学指标水平均较治疗前明显降低（P＜0.05），且中医组的降低幅度均明显 优于西医组（P＜0.01）。【结论】 复脉逐瘀汤联合RSWT治疗脑卒中恢复期下肢痉挛气虚血瘀证患者，可有效改善患者肢体痉 挛程度以及步行功能，降低血清NSE水平，提高血清TGF-β1水平，纠正血液流变学异常，疗效显著，其疗效明显优于单纯 RSWT治疗。

Objective To investigate the efficacy of Fumai Zhuyu Decoction combined with radial shock wave therapy（RSWT） in treating convalescent stroke patients with lower limb spasm，and to observe its effect on serum neuron-specific enolase （NSE） and transforming growth factor- β1（TGF- β1）. Methods From January 2022 to January 2024，a total of 111 convalescent stroke patients with lower limb spasm of qi deficiency and blood stasis syndrome were selected from the First Affiliated Hospital of Hebei North University. According to the treatment method， the patients were divided into two groups. The 55 patients in the western medicine（WM） group were treated with RSWT，and 56 patients in the traditional Chinese medicine（TCM） group were treated with Fumai Zhuyu Decoction orally and RSWT. The course of treatment for the two groups covered 6 months. Before and after treatment，the two groups were observed in the changes of modified Ashworth Scale （MAS） score for the evaluation of muscle tone of hemiplegic limbs， Clinical Spasticity Index （CSI） score， Barthel Index （BI） score for the evaluation of activities of daily living， three-dimensional gait parameters （velocity， cadence， step length）， serum levels of NSE and TGF-β1，and hemorheological indicators of plasma viscosity （PV），low-shear blood viscosity （LBV），high-shear blood viscosity （HBV） and platelet aggregation rate （PAR）. After treatment，the clinical efficacy of the two groups was evaluated. Results （1） After 6 months of treatment，the total effective rate of the TCM group was 94.64% （53/56），and that of the WM group was 76.36%（42/55）. The intergroup comparison （tested by chi-square test） showed that the efficacy of the TCM group was significantly superior to that of the WM group （P＜0.01）.（2） After treatment，the MAS and CSI scores of the two groups were lowered （P＜0.05） and the BI scores were increased compared with those before treatment （P＜0.05）. The decrease of MAS and CSI scores and the increase of BI scores in the TCM group were significantly superior to those in the WM group （P＜0.01）. （3）After treatment， the three-dimensional gait parameters of velocity， cadence， and step length in the two groups were increased compared with those before treatment （P＜0.05），and the increase of gait parameters in the TCM group was significantly superior to that in the WM group （P＜0.01）.（4） After treatment，the serum NSE level of the two groups was significantly decreased that before treatment （P＜0.05），and the serum TGF-β1 level was significantly increased compared with that before treatment （P＜0.05）. The decrease of serum NSE level and the increase of serum TGF-β1 level in the TCM group were significantly superior to those in the WM group（P＜ 0.01）.（5） After treatment，the hemorheological indexes such as PV，LBV，HBV and PAR in the two groups were significantly lowered compared with those before treatment （P＜0.05），and the decrease in the TCM group was significantly superior to that in the WM group （P＜0.01）. Conclusion Fumai Zhuyu Decoction combined with RSWT can effectively improve the limb spasm degree and walking function，reduce serum NSE level，increase serum TGF-β1 level，and correct the abnormal blood hemorheology in convalescent stroke patients with lower limb spasm of qi deficiency and blood stasis syndrome. The curative effect of the combined treatment is significantly superior to that of RSWT alone.

R277.7

国家自然科学基金资助项目（编号：82302879）；张家口市重点研发计划项目（编号：2322138D）