早期使用活血化瘀法治疗对中小量高血压脑出血患者日常生活能力的影响

Clinical study of blood-activating and stasis-resolving therapy (活血化瘀法) for patients with acute hypertensive cerebral hemorrhage small and moderate in amount and its influence on patients′ daily life ability

目的：观察早期使用活血化瘀法治疗中小量高血压脑出血的疗效及安全性。方法：将124例经CT检查确诊的急性期高血压脑出血患者随机分为3组，A组52例，B组34例，C组38例。3组患者均接受西医综合治疗，A组、B组分别于发病24-48h内以及发病1周时给予丹参注射液20ml加质量分数为5％的葡萄糖注射液250ml静脉滴注，每日1次，疗程为28d。于治疗后28d、3个月和6个月对3组患者进行疗效比较，指标包括有效率、脑卒中患者临床神经功能缺损程度评分（NDS）、日常生活能力（ADL）、改良的Barthel指数（MBI）计分、血肿吸收程度及病死率等。结果：A组、B组显效率均较C组明显提高，差异有显著性（P均〈0．05）。A组治疗后28d、3个月和6个月NDS较B组和C组明显改善（P均〈0．05），A组和B组治疗后28d血肿完全吸收率显著高于C组（P均〈0.05），且A组治疗后6个月MBI显著高于B组和C组（P均〈0.05）。B组和C组之间上述各指标接近，差异无显著性（P均〉0.05）。结论：早期使用活血化瘀法治疗中小量高血压脑出血对预后具有良好的作用，能促进颅内血肿吸收，改善患者的远期预后。

Objective： To observe blood- activating and stasis -resolving therapy （活血化瘀法）for patients with acute hypertensive cerebral hemorrhage small and moderate in amount and its influence on patients daily ability. Methods： One hundred and twenty -four cases were randomly divided into 3 groups： A group （n= 52 cases）, B group （n= 34） and C group （n= 38）. Besides conventional therapies, A and B groups were treated additionally with 20 ml of Danshen injection （丹参注射液） in 5% glucose solution 250 ml for intravenous drip （once a day）, 28 days constituting one therapeutic course, the beginning of the injection in A group was 24 - 48 hours after the attack and that of B group, 1 week after the attack. All the cases were evaluated by effective rate, neural defect score （NDS）, ability of daily life （ADL）, modified Barthel index （MBI）, the duration for the absorption of intracranial hematoma, mortality, etc. The therapeutic effects of the 3 groups were compared after the treatment for 28 days, 3 months and 6 months. Results： The total significant effective rates in A group and B group were significantly better than that of C group （all P〈0.05）. After the treatment for 28 days, 3 months and 6 months, in A group, NDS showed statistically significant better improvement than that in B and C groups （all P〈0.05）. After treatment for 28 days, the rates of complete absorption of the hematoma in the A and B groups were significantly higher than that in the C group （all P〈0.05）. After treatment for 6 months, MBI in the A group was markedly higher than that in B and C groups （both P〈0.05）. The above indexes in the B and C groups were close to each other, the difference being not significant （all P〉0.05）. Conclusion： The early use of blood -activating and stasis -resolving therapy is effective for patients with acute hypertensive cerebral hemorrhage small and moderate in amount, it may promote the absorption of the intracranial hematoma, and improve the patients＇ remote prognosis.