创伤性蛛网膜下腔出血应用芳香开窍药嗅吸剂对患者血液流变学的影响

The effect on the blood rheology after application of aromatic resuscitation in traumatic subarachnoid hemorrhage patients

目的观察由芳香开窍药组成的嗅吸剂微粉经雾化吸入应用治疗创伤所引起的蛛网膜下腔出血后患者血液流变学的影响。方法 20例经颅多普勒检查显示大脑中动脉≥120 cm·s-1颅脑外伤致外伤性蛛网膜下腔出血住院成人患者随机分为治疗组:10人,对照组:10人,全部患者入院后均给予常规治疗,每隔1日行颅多普勒检查脑血流变化。治疗组入院第2天起给予芳香开窍嗅吸剂雾化吸入10天,两组分别于入院后第2天、第11天行全自动血液流变仪检测测定全血黏度高、低切变值,血浆黏度,血沉变化。结果治疗组改善血液流变学指标方面优于对照组,二者比较差异有显著性(P<0.01)。治疗组脑血管痉挛后脑血流速度5天后明显改善,同对照组比较,差异有显著性(P<0.05)。结论经鼻雾化吸入芳香开窍药可以达到缓解颅脑损伤合并蛛网膜下腔出血时脑血管痉挛的效果,并且降低了血液黏度,改善血液的浓黏凝聚状态,促进神经功能的恢复,提高临床疗效。其机制可能是药物除可以通过鼻黏膜及肺部丰富的毛细血管吸收外,还可以直接通过鼻黏膜-脑脊液途径进入脑脊液,突破或绕过血脑屏障,将药物靶向脑部,并且改善血液的浓黏凝聚状态,降低血黏度,促进神经功能的恢复,提高临床疗效。

Objective To observe the effect on the blood rheology after patients suffered from traumatic subarachnoid hemorrhage treated with sniffing agent consisting with aromatic resuscitation medicine powder by atomization inhalation. Methods 20 patients with traumatic subarachnoid hemorrhage whose brain middle artery were more than 120 cm＆#183;s-1 revealed by transcranial Doppler were randomly assigned into 2 groups：10 in treat-ment group and 10 in the control group. They were all admitted with conventional treatment, and cerebral blood flow was detected every day by tran-scranial doppler. The patients in treatment group were treated with aromatic resuscitation by sniffing inhaled agents on the 2nd day after admission and last for 10 days. On the 2nd day and 11th day after admission, blood rheology in high and low shear blood viscosity, plasma viscosity and erythro-cyte sedimentation rate changes were detected by automatic blood rheometer in all of 2 groups. Results The The improvement of blood rheological index in the treatment group was more than that in the control group, there were significant difference （P〈0.01）. In the treatment group,the cerebral blood flow velocity was improved significantly 5 days after admission,compared with the control group, there were significant differences （P〈0.05）. Conclusion Nasal inhalation of aromatic resuscitation medicine can achieve the effect of releasing cerebral vasospasm caused by traumatic sub-arachnoid hemorrhage, reducing the blood viscosity, relieving the blood thick and sticky condensed state, promoting the recovery of neural function, and improving clinical effects. The mechanism may be that the medicine can be absorbed not only through the nasal mucous membranes and pul-monary capillary,but also can be absorbed into cerebrospinal fluid directly through the nasal mucosa-the way,which can break or bypass the blood-brain barrier, and relieve the blood thick and sticky condensed state of the brain, reduce blood viscosity, promote the recovery of neural function, improve clinical efficacy.