中西医结合综合救治高血压性中、大量脑出血201例临床研究

Traditional Medicine Combined with Western Medicine for Hypertensive Middle-and Large-Amount Cerebral Hemorrhage:A Report of 201 Cases

【目的】寻求能够提高高血压性中、大量脑出血临床疗效的救治方案。【方法】采用简单随机对照试验方法对 2 0 1例患者进行研究 ,治疗组 10 3例 ,对照组 98例 ;治疗组应用综合救治方案 (包括外科手术治疗、基础治疗和中医药辨证治疗 ) ,对照组应用外科手术治疗和基础治疗 ,西医治疗 ;治疗后 2 8d ,随访 6个月进行疗效评价。【结果】中西医综合救治的治疗组临床疗效较优 (P <0 .0 0 1) ;病死率较低 ,差异有显著性 (P <0 .0 0 1) ;生存病人生活能力状态 (ADL)较好 (P =0 .0 0 2 ,P =0 .0 2 5) ;生存率和累计生存率较高(P <0 .0 1) ;合并症较少 (P =0 .0 0 1,P =0 .0 4 ) ;治疗后 3d、 7d生存病人的神志不清以及阳闭证喉中痰鸣、面赤身热、躁扰不宁等症状改善程度较优 (P <0 .0 1)。显示综合救治方案可提高高血压性中、大量基底节脑出血救治的临床疗效。本研究还显示高血压性中、大量脑出血闭证以阳闭证为主 ,清热、平肝、破瘀、涤痰、通腑、醒神是其基本治法 ;中医药在综合救治方案中的作用可能是降低并发症和并发症致死率。【结论】该方案疗效较为确切 ,值得进一步扩大样本 ,进行多中心合作的验证 。

Objective To find out comprehensive therapeutic protocols for hypertensive middle_and large_amount cerebral hemorrhage. Methods A simple randomized control trial was applied in 201 cases of hypertensive middle_ and large_amount cerebral hemorrhage.The cases were allocated to Group A and Group B.Group A(n=103) was treated with comprehensive treatment including surgical operation,routine treatment and Chinese herbal medicine,Group B (n=98)with surgical operation routine treatment and western medicine.The treatment course last 28 days,and a 6_month follow_up was carried out to evaluate the therapeutic effects. Results The therapeutic effects were better (P< 0.001 ),the mortality was lower(P< 0.001 ),activities of daily life (ADL) was better(P= 0.002 ,P= 0.025 ),survive rate and accumulated survive rate was higher(P< 0.01 ),the complications were less(P= 0.001 ,P= 0.04 ) in Group A than Group B.After 3 days of treatment and 7 days of treatment,the symptoms in Group A with yang_excess syndrome such as rale,unconsciousness,flushed face,fever,and irritability were improved(P< 0.01 ). Conclusion Chinese herbal medicine combined with western medicine can increase the therapeutic effective rate by decreasing incidence and mortality of complications.Yang_excess syndrome is the main type of hypertensive middle_ and large_amount cerebral hemorrhage.Clearing heat and calming the liver,removing blood stasis and phlegm,relaxing the bowels and restoring consciousness are the fundamental therapeutic methods for the cases with yang_excess syndrome.This comprehensive therapy exerts a definite effect,but it is necessary to increase the number of samples and verify by the cooperation of multiple centers.