中西医结合治疗重型颅脑损伤急性期与中医证型研究

Clinical Research on the Syndrome Type in TCM of Severe Craniocerebral Trauma in Acute Stage and Combined Treatment of TCM and Western Medicine

目的 探讨重型颅脑损伤急性期的中医证型和中西医结合治疗重型颅脑损伤急性期的机制和疗效。方 法 将重型颅脑损伤急性期患者120例随机分成治疗组和对照组。对照组(59例)采用西医综合治疗,治疗组(61 例)按中医辨证分型论治加西医综合治疗,分析两组证型,比较两组清醒时间、并发症及格拉斯哥预后评分(GOS)。 结果 重型颅脑损伤急性期实证有脑气不通证、瘀停清窍证、痰瘀蒙窍证、痰热蒙窍证、痰瘀蒙窍兼热结腑实证; 虚证有元神外脱证、心脾两虚证、肾精不足证;治疗后治疗组与对照组病死率分别为16．39％和27．12％,治疗组清 醒时间、并发症发生率及GOS均优于对照组,有显著性差异(P<0．01)。结论 重型颅脑损伤急性期中医证型有4 个实证与3个虚证;在西医综合治疗基础上结合中医治疗可提高重型颅脑损伤疗效。

Objective To explore the syndrome type in TCM of severe craniocerebral trauma in acute stage, the mechanism and the clinical curative effect of combined treatment of TCM and westem medicine. Methods The 120 patients are randomly divided into treatment group and control group. The 59 patients in control group are treatmented with westem medicine synthesize method. At the same time, to differentiated and analyzed the syndrome type in TCM with the theories of TCM. The 61 patients in treatment group are treated with combined TCM and western medicine. Then analyses the syndrome type in TCM and comparisons are made between these two groups in wide awake time, complications and GOS. Results It exists Shi-type and Debility type in the TCM syndrome type of the severe craniocerebral trauma in acute stage. Among them, Shitype includes Brain Spirit Impassability, Blood Stasis Stagnate Brain, Phlegm and Stasis Stagnate Brain, Phlegm-hot Stagnate Brain, Phlegm-stasis Stagnate Brain Merge Hot Stagnate Bowel; Debility type includes Vitality of Brain Lose, Vitality of Heart-Spleen Deficiency, Vitality of Kidney Deficiency. The mortality of treatment group and control group was 16.39% and 27.12% （P〈0.01）. The recovery of consciousness in treatment group were statistically shorter than that in control group, and the complication occurrence rate were also statistically lower than control group while increases GOS. Conclusion There are four Shi types and three Debility types in the severe craniocerebral trauma in acute stage. Application combined treatment of TCM and western medicine can significantly reduce motality and improve therapeutic effect.