羚角钩藤汤加减联合甘油果糖治疗急性脑出血临床研究

Clinical Study on Modified Lingjiao Gouteng Tang Combined with Glycerin Fructose for Acute Cerebral Hemorrhage

目的:观察羚角钩藤汤加减联合甘油果糖治疗急性脑出血的临床疗效。方法:选取105例急性脑出血患者,按随机数字表法分为研究组、对照A组、对照B组,每组35例。3组均给予低氧流量吸氧、纠正水电解质平衡、预防感染、脑细胞保护等基础治疗,在此基础上对照A组予以甘油果糖治疗,对照B组予以羚角钩藤汤加减治疗,研究组予以羚角钩藤汤加减联合甘油果糖治疗。3组均治疗1个月。比较3组临床疗效及治疗前后美国国立卫生研究院卒中量表(NIHSS)评分、Barthel指数(BI)、脑血肿量、周围水肿量、脑血流动力学指标、血清炎症因子水平及神经细胞因子水平。结果:研究组总有效率为94.29%,高于对照A组、对照B组的71.43%、74.29%(P<0.05)。治疗后,3组NIHSS评分均较治疗前降低(P<0.05),研究组NIHSS评分低于对照A组、对照B组(P<0.05);3组BI评分均较治疗前升高(P<0.05),研究组BI评分高于对照A组、对照B组(P<0.05);3组脑血肿量、周围水肿量均较治疗前减少(P<0.05),研究组脑血肿量、周围水肿量均少于对照A组、对照B组(P<0.05)。治疗后,3组大脑中动脉平均血流速度(Vm)、舒张末期血流速度(Vd)、搏动指数(PI)均较治疗前升高(P<0.05),研究组大脑中动脉Vm、Vd、PI均高于对照A组、对照B组(P<0.05);3组大脑中动脉阻力指数(RI)均较治疗前降低(P<0.05),研究组大脑中动脉RI低于对照A组、对照B组(P<0.05)。治疗后,3组血清白细胞介素-1β(IL-1β)、基质金属蛋白酶-9 (MMP-9)、超敏C-反应蛋白(hs-CRP)、髓鞘碱性蛋白(MBP)、S100B、神经元特异性烯醇化酶(NSE)水平均较治疗前降低(P<0.05),研究组血清IL-1β、MMP-9、hs-CRP、MBP、S100B、NSE水平均低于对照A组、对照B组(P<0.05)。结论:羚角钩藤汤加减联合甘油果糖治疗急性脑出血临床效果显著,可有效促进脑血肿、周围水肿消减,改善脑血流状态,缓解局部炎症反应,保护脑神经细胞,进而促进患者神经及活动功能恢复。

Objective:To observe the clinical effect of modified Lingjiao Gouteng tang combined with glycerin fructose for acute cerebral hemorrhage. Methods:A total of 105 cases of patients with acute cerebral hemorrhage were divided into the study group,the control group A and the control group B according to the random number table method,35 cases in each group. All groups were given basic treatment such as low flow oxygen inhalation,correction of water electrolyte balance,prevention of infection and protection of brain cells;the control group A was additionally treated with glycerin fructose,the control group B was additionally treated with modified Lingjiao Gouteng tang,and the study group was additionally treated with modified Lingjiao Gouteng tang combined with glycerin fructose. All groups were treated for one month. The National Institute of Health Stroke Scale(NIHSS) scores,the Barthel Index(BI),the cerebral hematoma volume,the peripheral edema volume,the cerebral hemodynamic indexes and the levels of inflammatory factors in serum and nerve cell factors before and after treatment and the clinical effect in the three groups were compared. Results:The total effective rate was 94.29% in the study group,higher than those of 71.43% and 74.29% respectively in the control group A and B(P<0.05). After treatment,NIHSS scores in the three groups were decreased when compared with those before treatment(P<0.05),and the score in the study group was lower than those in the control group A and B(P<0.05);the BI scores in the three groups were increased when compared with those before treatment(P<0.05),and the score in the study group was higher than those in the control group A and B(P<0.05);the cerebral hematoma volume and the peripheral edema volume in the three groups were decreased when compared with those before treatment(P<0.05),and the volumes in the study group were fewer than those in the control group A and B(P<0.05). After treatment,the mean velocity(Vm),end-diastolic velocity(Vd) and pulsatility index(PI) in the middle cerebral artery in the three groups were increased when compared with those before treatment(P<0.05),and the Vm,Vd and PI in the middle cerebral artery in the study group were higher than those in the control group A and B(P<0.05);the resistance index(RI) in the middle cerebral artery in the three groups were decreased when compared with those before treatment(P<0.05),and the RI in the middle cerebral artery in the study group were lower than those in the control group A and B(P<0.05). After treatment,the levels of interleukin-1β(IL-1β),matrix metalloproteinase-9(MMP-9), high-sensitivity C-reactive protein(hs-CRP),myelin basic protein(MBP),S100 B and neuron-specific enolase(NSE) in serum in the three groups were decreased when compared with those before treatment(P<0.05),and the levels of IL-1β,MMP-9,hs-CRP,MBP,S100 B and NSE in serum in the study group were lower than those in the control group A and B(P<0.05). Conclusion:Modified Lingjiao Gouteng tang combined with glycerin fructose for acute cerebral hemorrhage has significant clinical effect and can effectively promote the reduction of cerebral hematoma and peripheral edema, improve cerebral blood flow state,relieve local inflammatory reactions,and protect nerve cell factors,so as to promote the recovery of nerve and activity function of patients.