清热活血法联合脑脊液置换术治疗原发性蛛网膜下腔出血临床观察

Clinical observation on clearing away heat and promoting blood circulation method(清热活血法) combined with cerebrospinal fluid replacement for primary subarachnoid hemorrhage

目的:探讨中西医结合方法治疗原发性蛛网膜下腔出血(SAH)的临床疗效。方法:将60例患者按随机原则分为治疗组(32例)和对照组(28例)。两组均给予脑脊液置换术和西医常规处理,治疗组加用中药清热活血方〔组方:大黄粉6 g(冲服),天麻15 g,钩藤15 g,川牛膝20 g,杭菊花20 g,黄芩15 g,栀子15 g,石菖蒲20g,桃仁15 g,红花6 g,赤芍15 g,丹参15 g〕,每日1剂,治疗15 d,若大便次数超过每日3次,则大黄粉量减半。结果:1个月后,治疗组临床治愈率(62.5%)和总有效率(临床治愈+显著好转,81.3%)明显高于对照组(35.7%和53.6%),两组比较差异均有显著性(P均<0.05)。与对照组相比,治疗组头痛、颈强直持续时间均明显缩短,因头痛剧烈需加用镇痛药次数亦显著减少,两组比较差异均有显著性(P<0.05或P<0.01);治疗组脑梗死、脑积水、应激性溃疡出血、肺部感染发生率也均较对照组明显下降,差异均有显著性(P<0.05或P<0.01);治疗组病死率及再出血率和尿道感染发生率虽均低于对照组,但差异无显著性(P均>0.05)。结论:清热活血法联合脑脊液置换术治疗原发性SAH能明显提高临床治愈率和总有效率,缩短头痛、颈强直持续时间,减少镇痛药应用次数和并发症的发生。

Objective： To observe the curative effect of clearing away heat and promoting blood circulation method （清热活血法） combined with cerebrospinal fluid replacement for treatment of primary subarachnoid hemorrhage （SAH）. Methods： Sixty patients with primary SAH were randomly divided into treatment group （32 cases） and control group （28 cases）. Both groups were treated with cerebrospinal fluid replacement and routine western medicine. Additionally, the treatment group was treated with traditional Chinese medicine （TCM） of clearing away heat and promoting blood circulation prescription [pulvis radici et rhizomae rhei （大黄粉） 6 g taking with water, rhizoma gastrodiae elatae （天麻） 15 g, ramulus uncariae cure uncis （钩藤） 15 g, radix cyathulae officialis （川牛膝） 20 g, flos chrysanthemi Hangzhouensis （杭菊花） 20 g, radix scutellariae （黄芩） 15 g, fructus gardeniae （栀子） 15 g, rhizoma acori tatarinowii （石菖蒲） 20 g, semen persicae （桃仁） 15 g, flos carthami （红花） 6 g,radix paeoniae rubra （赤芍） 15 g, radix et rhizoma salviae miltiorrhizae （丹参） 15 g] once per day for 15 days. Radix et rhizoma rhei was reduced to half of the original dosage when the frequency of stool was more than three times per day. Results： In the treatment group, the clinical cure rate （62.5% vs. 35.7 %） and the total effective rate （81.3% vs. 53.6%） were higher than those in the control group （both P〈0.05）, the time of persistent headache and neck rigidity and the frequency of exerting analgetic extra were lower compared to the control group, the differences being significant （P〈0.05 or P〈 0.01）. The incidences of cerebral infarction, hydrocephalus, stress ulcer hemorrhage and lung infection in the treatment group were all more significantly decreased in the treatment group than those of the control group, and the differences were significant （P〈0.05 or P〈0.01）. The mortality and the incidence of re hemorrhage and urethral infection were lower in the treatment group compared to those in the control group, but the differences were not significant （both P〉0.05）. Conclusion： Clearing away heat and promoting blood circulation method combined with cerebrospinal fluid replacement for primary SAH can increase the clinical cure rate and the total effective rate significantly, shorten the time of persistent headache and neck rigidity, decrease the frequency of exerting analgetic extra and the incidences of developing various complications.