颅脑损伤后认知功能障碍的机制及其药物治疗进展

Mechanism of Cognitive Dysfunction after Traumatic Brain Injury and Its Development of Drug Therapy

[目的]对颅脑损伤后认知功能障碍的中西医机制及其药物治疗进行综述。[方法]通过对国内外关于颅脑损伤后认知功能障碍的文献进行检索,对西医机制及治疗、中医骨伤科相关病机的认识和中药治疗等方面的研究进行总结。[结果]颅脑损伤后认知功能障碍现代医学机制有脑功能区或脑相关结构损伤,神经递质、因子及其相关受体损伤,其治疗药物有神经递质相关激动剂或抑制剂类、相关因子类,亦有苯哌啶醋酸甲酯、溴隐亭、盐酸多奈哌齐、神经节苷脂等。中医骨伤科则认为该病属"头部内伤"后伴"健忘、痴呆"的病症,为脑髓震动伤及"灵明",使瘀阻清窍,清阳浊阴升降失调而发病,多责之于"痰瘀",亦可见于虚证。中药复方多针对"痰、瘀、虚"病邪及其兼夹之邪论治,中药单体则从肝论治。[结论]颅脑损伤后认知功能障碍机制的研究是中西药物治疗的基础,在西药有效性缺乏大规模随机对照实验与循证医学支持证据之际,中药(复方或单体)的辨证优化运用必将发挥出更大的优势与作用。

[Objective] To summarize the mechanism and its drug therapy Chinese and western medicine in the treatment of cognitive dysfunction after traumatic brain injury（TB1）. [Methods] Based on at home and abroad cognitive dysfunction after TBI of literature retrieval, the research related to the mechanism of disease and drug therapy of western medicine, Chinese medicine orthopedics pathomechanism and its traditional Chinese medicine treatment. [Results]The damage of brain functional area or brain structure related to cognitive dysfunction after TBI in modem medical mechanism, ueurotransmitters, receptors and related factors of injury, a neurotransmitter related factor agonists or inhibitors, the drags, and methylphenidate, bromocriptine, donepezil hydrochloride and ganglioside. Orthopedics and traumatology of Chinese medicine believes that this disease is ＂head injury＂, with amnesia or dementia, cansed by brain vibration damaging ＂Lingming＂ those make blood stasis turbid in orifices, lifting disorders of clear yang and turbid yin, more responsibility is to ＂phlegm and blood stasis, deficiency may be found in. The Chinese herbal compound prescription for phlegm and blood stasis, deficiency of pathogenic factors and pathogenic and clip on the treatment of traditional Chinese medicine. Traditional Chinese medicine monomer treats it from the liver. [Conclusion] The mechanism of cognitive dysfunction after TBI is the basis of drug therapy, effectiveness of the lack of large randomized controlled trials and evidence- based medical evidence in support of the occasion, Chinese traditional medicine（compound or monomer） to optimize the use of differentiation will play a greater role and advantage.