推拿针刺联合氢溴酸樟柳碱注射液治疗创伤性蛛网膜下腔出血后脑血管痉挛的临床观察

Observation of clinical efficacy and safety of Tuina and Acupuncture combined with Anisodine Hydrobromide injection for cerebral vasospasm after traumatic subarachnoid hemorrhage

目的探讨推拿针刺联合氢溴酸樟柳碱注射液治疗创伤性蛛网膜下腔出血后脑血管痉挛的有效性和安全性。方法选取2017年1月至2019年3月本院收治的创伤性蛛网膜下腔出血后脑血管痉挛患者108例,随机分为实验组和对照组,每组54例。对照组在常规治疗基础上,加用推拿针刺,连续3周;实验组在对照组治疗基础上,加用氢溴酸樟柳碱注射液,每次2 mg,每天1次,连续3周。比较两组治疗总有效率和不良反应;比较两组患者治疗前及治疗后4、7、10、14、21 d的MCA评分;比较两组患者治疗前及治疗后7、14、21 d的GCS评分;比较两组患者治疗前、治疗后21 d的蒙特利尔认知评估量表(MoCA)评分。结果实验组总有效率为92.59%,高于对照组的79.63%,差异具有统计学意义(P<0.05)。治疗前、治疗后4 d,两组MCA比较差异无统计学意义;治疗后7、10、14、21 d,两组MCA比较差异具有统计学意义(P<0.05)。治疗后7 d,两组GCS评分比较差异无统计学意义;经治疗后14、21 d,实验组GCS评分高于对照组,差异具有统计学意义(P<0.05)。治疗后21 d,两组MoCA评分比较差异无统计学意义,但实验组的评分有高于对照组的趋势。结论推拿针刺联合氢溴酸樟柳碱注射液应用于tSAH后CVS有效,不良反应可耐受,安全性高,是一种有效的临床治疗方法。

Objective To observe the efficacy and safety of tuina and acupuncture combined with hydrobromide anorectic injection in the treatment of cerebral vasospasm after traumatic subarachnoid hemorrhage.Methods 108 patients with cerebral vasospasm after traumatic subarachnoid hemorrhage were randomly divided into study group and control group form January 2017 to March 2019 who were accepted by our hospital,with 54 cases in each group.On the basis of conventional treatment,the control group was treated with tuina and acupuncture for 3 weeks.On the basis of the control group,the study group was treated with hydrobromide anorectic injection,2 mg each time,once a day for 3 weeks.The total effective rate and adverse reactions were compared between the two groups.The MCA scores of the two groups were compared before treatment and 4,7,10,14,and 21 days after treatment.The GCS scores of the two groups were compared before treatment and 7,14,and 21 days after treatment.The Montreal Cognitive Assessment Scale(MoCA)scores were compared between the two groups before treatment and after 21 day of treatment.Results The total effective rate of the study group(92.59%)was higher than that of the control group(79.63%),and the difference was statistically significant(P<0.05).There was no significant difference in MCA between the two groups before treatment and 4 days after treatment.There were differences in MCA between the two groups at 7,10,14,and 21 days after treatment,and the difference was statistically significant(P<0.05).After 7 days of treatment,there was no significant difference in GCS score between two groups.The GCS scores of the experimental group were higher than those of the control group at 14 and 21 days after treatment(P<0.05).After 21 days of treatment,there was no significant difference in the MoCA score between two groups,but the score of the study group was higher than that of the control group.Conclusion Tuina and acupuncture combined with hydrobromide anorectic injection is effective for CVS after tSAH.Adverse reactions can be tolerated and safety is good,it may be an effective method for clinical treatment.