黄芪注射液加等容血液稀释疗法对老年脑梗死血瘀证患者血液流变学的干预效应(英文)

Interventional effect of astragalus injection plus isometric hemodilution therapy on senile cerebral infarction patients with blood stasis syndrome in hemorrheology

背景:脑梗死多与血瘀证密切相关,血液流变学异常改变常表现为血黏度和红细胞压积增高。等容血液稀释疗法通过放血并移走一定量的红细胞,同时补充等容量的稀释剂,可降低全血黏度。目的:观察补气中药黄芪注射液和等容血液稀释疗法对脑梗死血瘀证患者血液流变学的改善作用。设计:随机对照实验,病例-对照分析。对象:脑梗死组为2002-03/2004-03华中科技大学附属协和医院收治的老年缺血性脑血管病住院患者64例,所有患者年龄>60岁,同时符合血瘀证诊断标准,按随机数字表法分为常规治疗组和中西医治疗组两组各32例。以正常体检的47名年龄相似的健康人为正常对照组。单位:华中科技大学同济医学院附属协和医院。方法:常规治疗组采用脑梗死常规方法治疗,包括扩容、降黏、抗凝、阻滞血小板凝聚、脱水及一般对症支持治疗。中西医治疗组在常规对症治疗基础上加用等容血液稀释和益气中药黄芪注射液治疗:从患者静脉抽取总血量的10%(450～650mL),继之静脉注射等量胶体液,每隔5d治疗1次,连续治疗3次;黄芪注射液50mL加入生理盐水250mL静脉滴注,1次/d,连用3周。主要观察指标:①常规治疗组和中西医治疗组治疗前后血液流变学各指标比较。②脑梗死组和正常对照组血液流变学各指标比较。结果:按意向处理分析,64例患者和47名正常人均进入结果分析。①脑梗死组和正常对照组比较:脑梗死组全血比黏度、红细胞压积和纤维蛋白原高于正常对照组[(3.90±0.73),(3.40±0.28)mPa·s;(46.39±6.03)%,(42.61±2.91)%;(3.25±0.75),(3.08±0.46)g/L,P<0.01,0.05],红细胞变形指数低于正常对照组(0.958±0.006,0.961±0.004,P<0.05)②常规治疗组和中西医治疗组比较:治疗前无差异,治疗后中西医治疗组全血黏度、红细胞压积和纤维蛋白原均低于常规治疗组[(3.90±0.52),(4.21±0.68)mPa·s;(43.80±3.29)%,(48.47±4.50)%;(3.31±0.60),(3.68±0.67)g/L,P<0.01,0.05]。结论:对血瘀证的老年脑梗死患者用等容血液稀释疗法加益气中药黄芪注射液治疗,有较好的降低血黏度、改善血液流变学、减轻症状的作用。

BACKGROUND： Cerebral infarction is commonly associated with blood stasis syndrome. Abnormal alternation of blood rheology is generally manifested as increased blood viscosity and hematocrit （HCT）. In isometric hemodilution, a certain amount of red blood cell （RBC） is shifted by bleeding and simultaneously, isometric diluter is supplemented to reduce whole blood viscosity. OBJECTIVE： To observe the improvement of astragalus injection, the Chinese herb for qi tonification and isometric hermodilution on blood rheology in blood stasis syndrome of cerebral infarction. DESIGN： Randomized controlled experiment and ease-control analysis were designed. SETTING： Union Hospital Affiliated＇to Tongji Medical College, Huazhong University of Science and Technology. PARTICIPANTS： In cerebral infarction group （infarction group）, 64 inpatients of senile isehemic cerebral vascular disease were collected from UnionHospital Affiliated to Huashong University of Science and Technology from March 2002 to March 2004. All of cases were aged over 60 years and were in confurmity with the diagnostic criteria on blood stasis syndrome. According to random number table, routine treatment group （routine group） and the group of integrative therapy of Chinese and western medicine （experimental group） were divided, 32 cases in each one. 47 healthy people of similar age and diagnosed with routine physical exanlination were selected in normal control. METHODS： In routine group, cerebral infarction was treated with routine therapy, including extending capacity, reducing viscosity, resisting coagulation, blocking aggregation of platelct and dehydration and general symptomatic supporting treatment. In experimental group, on basis of routine treatment, isometric hemodilution and astragalus injection, the ChineSe herb for qi tonification were used. 10% of total blood amount （about 450-650 mL） was collected from vein, and colloid solution of same volume was injected intravenously. The treatment was applied once every 5 days, continuously for 3 times. Astragalus injection 50 mL mixed with physical saline 250 mL was intravenous dropped, once per day, continuously for 3 weeks. MAIN OUTCOME MEASURES： （1） Comparison of indexes in blood theology before and after treatment in routine group and experimental group.（2） Comparison of indexes in blood rheology between normal control and infarction group. RESULTS： According to intention management, 64 patients and 47 normal persons all entered result analysis. （1） Comparison between infarction group and normal control： RVB, HCT and PFC （fibrinogen） were higher than normal control [（3.90±0.73）, （3.40±0.28） mPa·s^-1,（46.39±6.03） %. （42.61±2.91）%; （3.25±0.75）, （3.08±0.46） g/L, P〈0.01, 0.05], MTIE （deformity index of RBC） was lower than normal control （0.958±0.006, 0.961±0.004, P 〈 0.05）. （3） Comparison between routine group and experimental group： Difference in some indexes presented before the treatment. After treatment, RVB, HCT and PFC in experimental group were all lower than routine group [（3.90±0.52）, （4.21±0.68） mPa·s; （43.80±3.29）%, （48.47±4.50）%; （3.31±0.60）, （3.68±0.67） g/L, P〈0.01, 0.05]. CONCLUSION： Isometric hemodilution therapy and astragalus injection reduces blood viscosity, improves blood rheology and alleviates clinical symptoms of blood stasis syndrome in senile cerebral infarction.