醒脑静注射液联合微创穿刺引流术治疗对中等量高血压性基底节区脑出血患者脑水肿、血清AQP4的影响

Effect of Xingnaojing injection combined with minimally invasive percutaneous drainage in treating brain edema and content of serum AQP4 in patients with moderate hypertensive basal ganglia hemorrhage

目的：观察醒脑静注射液联合微创穿刺引流术治疗对中等量高血压性基底节区脑出血患者脑水肿、血清水通道蛋白-4（AQP4）的影响，探讨醒脑静注射液联合微创穿刺引流术对脑出血的治疗机制。方法：选择发病24h内的中等量（25—50mL）高血压性基底节区脑出血患者42例，按患者和家属意愿随机分为观察组22例，对照组20例，采用美国国立卫生研究院脑卒中量表（NIHSS）、头颅CT、双抗体夹心法分别在人院时、治疗1周时和治疗2周时评估和检测2组患者神经功能缺损评分、脑水肿体积、血清AQP4水平。结果：入院时2组患者NIHSS评分、脑水肿体积、血清AQP4水平无明显差异；治疗1周时，观察组NIHSS评分比对照组降低，差异有显著性（P〈0．05），观察组脑水肿体积比入院时减少（P〈0．05），对照组脑水肿体积则比入院时稍增多，对照组患者血清AQP4含量均比人院时升高，但差异无显著性，观察组血清AQP4含量比入院时降低（P〈0．05）；治疗2周时，对照组NIHSS评分比人院时、治疗l周时降低（P〈0．05），与对照组比较，观察组NIHSS评分明显降低（P〈0．01），对照组脑水肿体积比入院时、治疗1周时降低，但观察组比对照组降低更明显，观察组和对照组血清AQP4水平显著降低（P〈0．05），但与对照组比较，观察组血清AQP水平显著降低更为明显（P〈0．01）。治疗2周时，观察组临床疗效比对照组好（P〈0．05）。结论：醒脑静注射液联合微创穿刺引流术治疗明显减少中等量高血压性基底节区脑出血患者的脑水肿，促进神经功能恢复，可做为中等量高血压性基底节区脑出血治疗方案的选择。

Objective： To observe the effect of Xingnaojing Injection combined with minimally invasive percutaneous drainage on brain edema and content of serum aquaporin-4 （AQP4） in patients with moderate hypertensive basal ganglia hemorrhage, and discuss the treatment mechanism of Xingnaojing injection combined with minimally invasive percutaneous drainage for cerebral hemorrhage. Method： Forty-two patients with moderate （25-50 mL） hypertensive basal ganglia hemorrhage （ 〈 24 h） were selected and randomly divided into two groups ： the observation group （ n = 22） and the control group （ n = 20）. The neurological severity score were evaluated by the NIHSS （ national institutes of health stroke scale）, the volume of brain edemas were measured by head CT, the serum levels of AQP4 were determined by ELISA method on admission and 1 and 2 weeks after treatment. Result： On admission, there was no significant difference in the scores of NIHSS, the volume of brain edemas and the level of serum AQP4 between the observation group and the control group. At the end of the first week after the treatment, the score of NIHSS of the observation group were lower than that of the control group, with significant different （ P 〈 0. 05 ） ; the observation group showed reduced volume of brain edemas than that on admission （P 〈 0. 05 ）, whereas the control group the control group showed increased volume of brain edemas than that on admission; the control group displayed increased level of serum AQP4 than that on admission, but without significant difference; the observation group displayed decreased level of serum AQP4 than that on admission （P 〈 0.05 ）. At the end of the second week after the treatment, the control group showed decreased score of NIHSS than that on admission and at the end of the first week after treatment （ P 〈 O. 05 ）. Compared with the control group, the observation group showed a much lower score of NIHSS （ P 〈 0. 01 ） , the control group displayed reduced volume of brain edemas than that on admission and at the end of the first week after treatment, but the obser- vation group was even lower than the control group. Both of observation and control groups displayed significantly reduced level of AQP4 （ P 〈 0. 05）, but the observation group showed a lower AQP4 level than that of the control group （ P 〈 0. 05 ）. Conclusion： The therapy of Xingnaojing injection combined with minimally invasive percutaneous drainage could remarkably reduce brain edema, and promote neural functional recovery, thus could be selected as a therapeutic regimen for patients with moderate hypertensive basal gan- glia hemorrhage.