熄风解痉汤联合尼莫地平防治动脉瘤性蛛网膜下腔出血后脑血管痉挛的临床研究

Clinical Study on Prevention and Treatment of Cerebral Vasospasm after Aneurysmal Subarachnoid Hemorrhage by Xifeng Jiejing Decoction and Nimodipine

目的观察熄风解痉汤联合尼莫地平防治动脉瘤性蛛网膜下腔出血(aSAH)后迟发性脑血管痉挛(CVS)的临床疗效。方法选取aSAH患者64例,随机分为对照组和试验组,每组32例,对照组在常规治疗基础上给予尼莫地平治疗,试验组在对照组的基础上服用熄风解痉汤治疗,对比分析两组患者入院第1、7、14 d时迟发性CVS和脑梗死的发生率以及大脑中动脉平均血流速度(MBF)、同侧大脑中动脉/颈内动脉颅外段血流速度(LI)指数、美国国立卫生研究院卒中量表(NIHSS)评分,出院时、发病90 d后改良Rankin量表(mRS)评分。结果试验组迟发性CVS和脑梗死的发生率、MBF、LI指数、NIHSS评分在第7、14 d明显低于对照组(P<0.05),mRS评分在出院时、发病90 d后明显低于对照组(P<0.05)。结论熄风解痉汤联合尼莫地平能够有效降低aSAH后迟发性CVS和脑梗死的发生,有效改善神经功能缺失的症状。

Objective To observe the clinical efficacy of Xifeng Jiejing Decoction(XFJJD)combined Nimodipine for treating delayed cerebral vasospasm(CVS)after aneurysmal subarachnoid hemorrhage(aSAH).Methods Sixty-four aSAH patients were randomly assigned to a control group and an experiment group,32 in each group.Patients in the control group took Nimodipine on the basis of conventional treatment.Those in the experiment group additionally took XFJJD.The incidence of delayed CVS and cerebral infarction on the 1 st,7 th,and 14 th day after admission,as well as mean cerebral blood flow velocity(MBF),ipsilateral middle cerebral artery or internal carotid artery extracranial blood flow velocity(Lindegaard,LI)index,National Institute of Health stroke scale(NIHSS)score,and modified Rankine Scale(mRS)score at discharge or at 90 days after onset were compared between the two groups.Results The incidence of delayed CVS and cerebral infarction,MBF,LI index and NIHSS score in the experiment group were significantly lower than those in the control group on the 7 th and 14 th day(P<0.05).The mRS score was significantly lower in the experiment group than in the control group at discharge or at 90 days after onset(P<0.05).Conclusion XFJJD combined Nimodipine effectively reduced the incidence of delayed CVS and cerebral infarction after aSAH,and effectively relieved symptoms of neurological deficit.