宣白承气汤加味结合西医常规疗法对急性脑梗死昏迷患者促醒作用的影响

Xuanbai-Chengqi Decoction combined with conventional western medicine therapy for coma patients with acute cerebral infarction the influence of arousal

目的探讨宣白承气汤加味结合西医常规疗法对急性脑梗死昏迷患者促醒作用的影响。方法将符合入选标准的2019年3月-2020年1月淮北市中医医院急性脑梗死昏迷患者72例,按随机数字表分为2组,每组36例。对照组采用西医常规疗法治疗,治疗组在对照组基础上结合宣白承气汤加味鼻饲给药。2组均治疗7 d。采用美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale, NIHSS)评估神经功能缺损程度,采用全面无反应性量表(Full Outline of Unresponsiveness Scale, FOUR)评估意识障碍程度,行头颅CT三维重建识别并标记水肿区域,采用双抗夹心ELISA法测定血清高敏C反应蛋白(hs-CRP)、同型半胱氨酸(Hcy )、内皮素-1(ET-1)水平,观察治疗期间的不良反应,评价临床疗效。结果治疗组总有效率为100% (36/36)、对照组为86.1%(35/36) ,2组比较差异有统计学意义(Z=-0.242 ,P=0.015)。治疗组治疗后第3、7天NIHSS评分低于对照组(t值分别为26.567、17.982,P值均<0.001);治疗组治疗后3 d(t=15.235、14.892、18.452、11.232、16.235)、治疗后7 d (t=19.568、16.232、10.356、9.546、11.098)睁眼反应、运动反应、脑干反射、呼吸节律评分及总分均高于对照组(P <0.01)。治疗组治疗后血清hs-CRP、Hcy、ET-1水平及脑水肿CT阈值均低于对照组(t值分别为22.352、17.789、11.908、19.652,P值均<0.001)。2组治疗过程中未见药物不良反应。结论宣白承气汤加味结合西医常规疗法可改善急性脑梗死昏迷患者的神经功能,促进觉醒,作用机制可能与降低hs-CRP、Hcy、ET-1水平,改善微循环、减轻脑水肿有关。

Objective To explore the effect of Xuanbai-Chengqi Decoction combined with conventional western medicine therapy for the coma patients with acute cerebral infarction.Methods A total of 72 patients with acute cerebral infarction in Huaibei Hospital of Traditional Chinese Medicine from March 2019 to January 2020 were randomly divided into two groups with 36 in each group.The control group was treated with conventional western medicine therapy,and the treatment group was given Xuanbai-Chengqi Decoction by nasal feeding on the basis of the control group.Both groups were treated for 7 days.The National Institutes of Health Stroke Scale(NIHSS)was used to evaluate the degree of neurological deficit,and the Full Outline of Unresponsiveness Scale(FOUR)was used to evaluate the degree of consciousness disorder of patients.Three-dimensional reconstruction of head CT was performed to identify and mark the edema area.The levels of serum high-sensitivity C-reactive protein(hs-CRP),homocysteine(Hcy)and vascular endothelin-1(ET-1)were measured by double antibody sandwich enzyme-linked immunosorbent assay.The adverse events during treatment were observed and the clinical effective rate was evaluated.Results The total effective rate was 100%(36/36)in the treatment group and 86.1%(35/36)in the control group,and the difference between the two groups was statistically significant(Z=-0.242,P=0.015).On the 3rd and 7th day after treatment,the NIHSS scores of the treatment group were significantly lower than those in the control group(t values were 26.567 and 17.982,all Ps<0.01).On the 3rd and 7th day after treatment,the eye opening response,motor response,brainstem response,brain stem response and total scores(3 days after treatment,t=15.235,14.892,18.452,11.232,16.235;7 days after treatment,t=19.568,16.232,10.356,9.546,11.098)of the treatment group were significantly lower than those in the control group.The levels of serum hs-CRP,Hcy,ET-1 and CT threshold of brain edema in the treatment group were significantly lower than those in the control group after treatment(t=22.352,17.789,11.908 and 19.652,all Ps<0.01).There were no adverse drug reactions,no abnormal changes in blood routine tests,liver function and electrocardiogram in both groups.Conclusion The Xuanbai-Chengqi Decoction combined with conventional western medicine therapy can improve the neurological function and promote awakening of coma patients with acute cerebral infarction,which may be related to reducing the levels of inflammatory cytokines related to hs-CRP,Hcy and ET-1,improving microcirculation and relieving brain edema.