中西医结合辨证治疗急性重型颅脑损伤的临床观察

Clinical Observation on Integrated Traditional Chinese and Western Medicine for Acute Severe Traumatic Brain Injury

【目的】通过中西医结合辨证治疗急性重型颅脑损伤的规范化临床实施和观察,证明中西医结合治疗急性重型颅脑损伤患者的疗效,系统评价中医药治疗急性重型颅脑损伤的作用和意义。【方法】采用随机数字表法将60例患者随机分为治疗组(中西医结合辨证治疗组)、对照1组(常规西医治疗加活血祛瘀法组)、对照2组(常规西医治疗组)各20例,治疗1个疗程(3周)后分别对其疗效、神经功能缺损评分变化和并发症情况进行比较。【结果】(1)治疗组显效13例,有效5例,无效2例,总有效率为90.0%;对照1组显效8例,有效4例,无效8例,总有效率为60.0%;对照2组显效9例,有效6例,无效5例,总有效率为75.0%;3组比较,治疗组疗效优于两对照组(P<0.05)。(2)治疗组治疗后的意识刺激、面瘫、语言以及肌力均有改善(与治疗前比较,P<0.05),对照1组的意识刺激、上肢肌力及手肌肌力和对照2组的意识刺激、面瘫、语言及肌力也有改善(与治疗前比较,P<0.05),且治疗组在改善上述神经功能缺损评分方面优于对照1组与对照2组(P<0.05)。(3)并发症情况比较:治疗组的肺部感染和上消化道出血发生率与两个对照组比较,差异有显著性意义(P<0.05)。【结论】中西医结合辨证治疗能降低急性重型颅脑损伤患者致残率,促进脑神经功能恢复,减少并发症的产生。

Objective To investigate the therapeutic effect of integrated traditional Chinese and western medicine for acute severe traumatic brain injury. Methods The patients with acute severe traumatic brain injury were randomized into the treatment group （receiving integrated traditional Chinese and western medicine）, control 1 group （receiving routine western medicine and blood-activating and stasis-removing herbs） and control 2 group （receiving routine western medicine）. The therapeutic effect, neurological impairment score and complications were compared in the three groups after treatment for 3 weeks. Results In the treatment group, 13 patients were markedly effective, 5 effective, 2 ineffective and the total effective rate was 90. 0% ; in control 1 group, 8 patients were markedly effective, 4 effective, 8 ineffective and the total effective rate was 60. 0% ; in control 2 group, 9 patients were markedly effective, 6 effective, 5 ineffective and the total effective rate was 75.0%. The therapeutic effect in the treatment group was superior to that in the two control groups （P 〈 0. 05 ）. The consciousness, facial paralysis, language and muscle strength were improved in the treatment group and in the control 2 group after treatment, so did the consciousness, the upper limb muscle strength and the hand muscle strength in control 1 group （P 〈 0. 05 compared with those before treatment）. The neurological impairment score was much improved in the treatment group as compared with that in the control groups （ P 〈 0.05 ）. The incidences of pulmonary infection and upper digestive tract bleeding in the treatment group differed from those in the control groups （ P 〈 0. 05 ）. Conclusion Integrated traditional Chinese and western medicine has an effect on decreasing disability rate, promoting the recovery of neurological function, and reducing the occurrence of complications.