早期应用中医药保护血脑屏障及改善颅脑损伤患者神经功能的作用探讨

Effect of Early Application of Traditional Chinese Medicine on Blood-brain Barrier and Improvement of Neurological Function in Patients with Head Injury

目的观察早期应用中医药治疗保护重型颅脑损伤患者血脑屏障和改善神经功能缺损的作用并探讨其机制。方法将122例重型颅脑损伤瘀停蒙窍证患者随机分为对照组和观察组,各61例,对照组采用常规治疗,观察组在对照组治疗基础上加用活血利水方治疗。两组疗程均为4周。结果治疗后,观察组总有效率65.57%,高于对照组47.54%(P<0.05);治疗后两组脑水肿面积、脑脊液白蛋白及血脑屏障(BBB)指标显著低于治疗前(P<0.05);两组比较,观察组改善优于于对照组(P<0.05);治疗后,两组血浆黏度、全血黏度高切、全血黏度低切、红细胞聚集指数、血小板黏附率均显著低于治疗前(P<0.05),观察组低于对照组(P<0.05);两组美国国立卫生研究院卒中量表(NIHSS)评分低于治疗前,而格拉斯哥昏迷评分(GCS)和Barthel指数高于治疗前(P<0.05);两组比较,观察组优于对照组(P<0.05);两组血清超敏C反应蛋白(hs-CRP),白细胞介素-6(IL-6),白细胞介素-1β(IL-1β)表达水平显著低于治疗前(P<0.05),观察组低于对照组(P<0.05)。结论对重型颅脑损伤瘀停蒙窍证患者早期加用中医药治疗,对保护血脑屏障、减轻脑水肿、改善神经功能缺损和血脑屏障疗效确切,可改善患者血液流变学指标,降低炎症反应。

Objective： To investigate the effect of early application of traditional Chinese medicine（TCM） on blood-brain barrier and neurological deficits in patients with severe traumatic brain injury. Methods： 122 cases of severe traumatic brain injury were randomly divided into the control group and the observation group,61 cases in each group. The control group was treated with conventional treatment,and the observation group was treated with Huoxue Lishui Decoction on the basis of the treatment of the control group. The two groups were treated for 4weeks. Results： After treatment,the total effective rate of the observation group was 65.57%,higher than that of the control group（47.54%）（P 0.05）. The brain edema area,CSF albumin and BBB in the two groups were significantly lower than those before treatment（P 0.05）,and the observation group improved better than the control group（P 0.05）. After treatment,plasma viscosity,whole high viscosity,whole low viscosity,red cell assembling index and PADT were significantly lower than those before treatment（P 0.05）,and the observation group was lower than the control group（P 0.05）. The NIHSS score was lower than before treatment,while the GCS and Barthel index were higher than those before treatment（P 0.05）,and the observation group was better than the control group（P 0.05）. The expression of hs-CRP,IL-6 and IL-1β was significantly lower than that before treatment,and the observation group was lower than the control group（P 0.05）. Conclusion： Early treatment with traditional Chinese medicine on patients with severe traumatic brain injury is effective in protecting blood brain barrier,reducing brain edema,improving nerve function defect and blood brain barrier,and it also can improve the hemorheological indexes and reduce the inflammatory reaction,worthy of clinical application.