抵当丸联合西药对脑出血后血肿周围组织血流灌注的影响

Effect of Didang Pill Combined with Western Medicine on Perihematoma Perfusion in Cerebral Hemorrhage Patients

目的探讨脑出血患者血肿周围组织血流的动态变化规律,观察抵当丸对脑出血患者血肿周围组织血流灌注的影响。方法脑出血患者60例,随机分为脑出血Ⅰ组和脑出血Ⅱ组各30例。脑出血Ⅰ组:单纯给予脑出血常规治疗;脑出血Ⅱ组:在常规治疗基础上于发病24h开始服用抵当丸,每日10丸,每次5丸,分早晚2次口服(吞咽困难者予鼻饲)。两组患者疗程均为28天。分别在治疗前及治疗后7天、14天、28天应用CT灌注成像技术测量血肿周围组织的局部脑血流量(rCBF)、局部脑血容量(rCBV)、对比剂平均通过时间(MTT)、对比剂峰值时间(TTP);同时评定患者的神经功能缺损评分(NIHSS)、日常生活能力评分(BI)及中医证候评分。结果脑出血Ⅱ组和脑出血Ⅰ组rCBF、rCBV治疗后7天时最低,随后逐渐升高。MTT与TTP治疗后7天时达高峰,随后逐渐缩短;脑出血Ⅱ组治疗后14天、28天rCBF、rCBV显著高于脑出血Ⅰ组(P<0.05或P<0.01),MTT、TTP显著低于脑出血Ⅰ组(P<0.05或P<0.01)。脑出血Ⅱ组治疗后14天、28天NIH-SS评分和BI评分与同时间脑出血Ⅰ组比较差异有统计学意义(P<0.05或P<0.01)。脑出血Ⅱ组中医证候评分在治疗后14天、28天显著低于脑出血Ⅰ组(P<0.05或P<0.01)。结论脑出血后血肿周围组织存在持续的低灌注状态,这种低灌注状态随时间改变呈现波动性的变化规律。抵当丸能显著改善脑出血后血肿周围组织血流灌注,对神经功能及中医临床证候的改善有促进作用。

Objective To investigate the hemodynamic changes in intracerebral hemorrhage （ICH） patients and observe the effect of Didang Pill （Dead-On Pill） on perihematoma perfusion and prognosis in ICH patients. Methods Sixty ICH patients were randomized into group Ⅰ（conventional treatment） and group Ⅱ （conventional treatment combined with Didang Pill）, with 30 in each. The treatment course lasted for 28 days. The relative cerebralbolood flow （rCBF）, relative cerebralblood volume （rCBV）, mean transit time （MTT）, and time-to-peak （TTP） were detected by computed tomography （CT） perfusion before treatment and on the 7th, 14th and 28th day of treatment. The Institutes of Health Stroke Scale （NIHSS）, Barthel Index （BI） and Chinese medical symptoms were assessed. Results The rCBF and rCBV in both groups were the lowest on the 7th day of treatment and then increased gradually. MTT and TTP reached a peak on the 7th day of treatment and then reduced gradually. The rCBF and rCBV in group Ⅱ were significantly higher than those in group Ⅰ on the 14th and 28th day of treatment （P〈0. 05 or P〈0.01）. The MTT and TTP in group Ⅱ were significantly lower than those in group Ⅰ on the 14th and 28th day of treat- ment （P〈0.05 or P〈0.01）. The NIHSS scores in group Ⅱ were significantly lower than those in group Ⅰon the 14th and 28th day of treatment （P〈0.05 or P〈0.01）. The BI scores in group Ⅱ were significantly higher than those in group Ⅰ on the 28th day of treatment （P〈0.05 or P〈0.01）. The scores of Chinese medical symptoms in group Ⅱ were significantly lower than those in group Ⅰ on the 14th and 28th day of treatment （P〈0.05）. Conclusion There exists persistent hypoperfusion in the perihematoma after ICH. Hypoperfusion is fluctuated with time. Didang Pill could obviously promote the perihematoma perfu- sion after ICH, improve the nerve function and relieve Chinese medical symptoms.