【目的】 分析起瘫汤辅助发散式冲击波（RSWT）治疗对脑卒中恢复期下肢痉挛患者步行、平衡能力及神经损伤标志物 的影响。【方法】 采用回顾性研究方法，选取2021年12月至2023年12月在河北北方学院附属第一医院就诊的100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患者分为常规组49例和试验组51例。2组患者均接受脑卒中基础治 疗（包括改善脑细胞代谢、营养脑神经、抗血小板聚集等），在此基础上，常规组给予RSWT治疗，试验组在常规组基础上联 合起瘫汤治疗，疗程为 6个月。观察 2组患者治疗前后改良 Ashworth 肌张力（MAS）评分、功能性步态测试量表（FGA）评分、 Berg平衡量表（BBS）评分、脑卒中专用生活质量量表（SS-QOL）评分和血清神经损伤标志物[包括γ-氨基丁酸（GABA）、脑源性 神经营养因子（BDNF）]水平以及运动学参数（屈膝峰值、屈髋峰值）的变化情况，并比较2组患者的临床疗效。【结果】（1）疗 效方面，治疗6个月后，试验组的总有效率为94.12%（48/51），常规组为75.51%（37/49），组间比较（χ2 检验），试验组的疗效 明显优于常规组（P＜0.01）。（2）相关量表评分方面，治疗后，2 组患者的 MAS 评分均较治疗前降低（P＜0.05），FGA、BBS、 SS-QOL评分均较治疗前升高（P＜0.05），且试验组对MAS评分的降低幅度及对FGA、BBS、SS-QOL评分的升高幅度均明显 优于常规组（P＜0.01）。（3）神经损伤标志物方面，治疗后，2组患者血清GABA、BDNF水平均较治疗前升高（P＜0.05），且试 验组对血清GABA、BDNF水平的升高幅度均明显优于常规组（P＜0.01）。（4）运动学参数方面，治疗后，2组患者的屈膝峰值、 屈髋峰值均较治疗前升高（P＜0.05），且试验组对屈膝峰值、屈髋峰值的升高幅度均明显优于常规组（P＜0.01）。【结论】 起瘫 汤辅助RSWT可有效缓解脑卒中恢复期下肢痉挛气虚血瘀证患者痉挛症状，改善步行、平衡能力，减轻神经功能受损程度， 提高生活质量。

Objective To evaluate the effects of Qitan Decoction （QTD） combined with radial shockwave therapy （RSWT） on walking ability， balance function， and neural injury markers in stroke patients with lower limb spasticity during convalescence. Methods A retrospective study was conducted on 100 stroke patients with lower limb spasticity of qi deficiency and blood stasis type treated at the First Affiliated Hospital of Hebei North University from December 2021 to December 2023. Patients were divided into a conventional group （n=49， receiving RSWT alone） and an trial group （n=51，receiving RSWT plus QTD） based on treatment protocols. Both groups received standard stroke care （including cerebral metabolism improvement， neurotrophic support， and antiplatelet therapy）. The intervention lasted 6 months. The changes in Modified Ashworth Scale （MAS） scores， Functional Gait Assessment （FGA） scores，Berg Balance Scale （BBS） scores，Stroke-Specific Quality of Life （SS-QOL） scores，serum neural injury markers [gama-aminobutyric acid （GABA），brain-derived neurotrophic factor （BDNF）]， and kinematic parameters （peak knee flexion， peak hip flexion） were observed， and the clinical efficacy was compared between groups. Results （1） After 6 months of treatment，the total effective rate of the trial group was 94.12% （48/51），and that of the conventional group was 75.51% （37/49），and the intergroup （by chi-square test） comparison showed that the efficacy of the trial group was significantly superior to that of the conventional group （P＜0.01）.（2） After treatment，the MAS scores of patients in the two groups were lower than before treatment （P＜0.05），and the FGA，BBS，and SS-QOL scores were higher than before treatment （P＜ 0.05），and the reduction of the MAS scores and the increase of the FGA，BBS，and SS-QOL scores of the trial group were significantly superior to those of the conventional group （P＜0.01）.（3） After treatment，the serum GABA and BDNF levels of patients in the two groups were higher than those before treatment （P＜0.05），and the increase in serum GABA and BDNF levels in the trial group was significantly superior to that in the conventional group （P＜0.01）.（4） After treatment，the peak knee flexion and peak hip flexion of patients in the two groups were elevated compared with those before treatment （P＜0.05）， and the trial group’s elevation of peak knee flexion and peak hip flexion was significantly superior to that of the conventional group （P＜0.01）. Conclusion QTD combined with RSWT effectively alleviates spasticity，enhances walking/balance function，mitigates neural injury，and improves quality of life in stroke patients with lower limb spasticity of qi deficiency and blood stasis syndrome during convalescence.

R277.7

国家自然科学基金项目（编号：82302879）；张家口科学技术局科技计划项目（编号：2322138D）