通腑醒神汤对高血压脑出血微创术后神经功能恢复的影响

Effects of Tongfu Xingshen Decoction on Recovery of Nerve Function After Minimally Invasive Surgery for Hypertensive Cerebral Hemorrhage

目的:观察通腑醒神汤对高血压脑出血微创术后(痰热腑实、风痰闭阻证)神经功能的恢复作用及对白细胞介素-6(IL-6),肿瘤坏死因子-α(TNF-α),基质金属蛋白酶-9(MMP-9)的影响。方法:采用随机按入院前后顺序将96例高血压脑出血术后患者分为对照组和治疗组各48例。在常规治疗的基础上,对照组采用依达拉奉注射液静脉滴注,治疗组在对照组治疗的基础上内服通腑醒神汤内服。两组疗程均为6周。进行格拉斯哥昏迷量表(GCS),神经功能缺损程度评价及其巴塞尔(Barthel)指数评价,检测治疗前后血清IL-6,TNF-α,MMP-9水平。结果:经Ridit分析,治疗组临床疗效优于对照组(P<0.05);治疗后1,2周两组GCS评分均持续升高(P<0.01),治疗组在治疗后1,2周GCS评分均高于对照组(P<0.01);治疗后治疗组Barthel指数评分高于对照组,美国国立卫生研究院卒中量表(NIHSS)评分低于对照组(P<0.01);治疗后治疗组血清IL-6,TNF-α和MMP-9水平均低于对照组(P<0.01)。结论:通腑醒神汤联合依达拉奉静脉滴注对高血压脑出血微创术后(痰热腑实、风痰闭阻证)神经功能的恢复疗效良好,其作用机制可能与其抑制炎症因子反应和MMP-9相关。

Objective： To observe the therapeutic efficacy of Tongfu Xingshen decoction on the recovery of nerve function after minimally invasive surgery for hypertensive cerebral hemorrhage（ phlegm-heat fu organ sthenia and wind phlegm blocking） and observe its influence on the serum level of interieukin-6（ IL-6）,tumor necrosis factor-α（ TNF-α）, and matrix-metalloproteinase-9（ MMP-9）. Method： Ninety-six patients with hypertensive cerebral hemorrhage surgery were randomly divided into control group and treatment group（ 48 cases in each group） by admission sequence. Based on routine therapy,patients of control group received edaravone therapy,ivgtt. Based on the treatment of control group,patients in treatment group were also treated with additional Tongfu Xingshen decoction. Course of treatment was 6 weeks for both groups. The Glasgow coma scales（ GCS）,neurological deficit score,and Barthel index were compared between two groups. Serum IL-6,TNF-α,and MMP-9 levels before and after treatment were detected. Result： The clinical efficacy of treatment group was superior to that in control group by ridit analysis（ P〈0. 05）. After treatment of 1 and 2 weeks,GCS scores of both groups were continuously increased（ P〈0. 01）,and GCS scores in treatment group were significantly higher than those in control group（ P〈0. 01）. After treatment,Barthel Index scores in treatment group were higher than those in control group,and National Institute of Health Stroke Scale（ NIHSS） scores were lower than those in control group（ P〈0. 01）. After treatment,serum levels of IL-6,TNF-α and MMP-9 in treatment group were lower than those in control group（ P〈0. 01）. Conclusion： Tongfu Xingshen decoction combined with intravenous drip of edaravone has good effect on the recovery of nerve function after minimally invasive surgery for hypertensive cerebral hemorrhage（ phlegm-heat fu organ sthenia and wind phlegm blocking）,and its mechanism may be related with inhibiting the inflammatory response and MMP-9.