宁神止痉汤治疗aSAH介入术后脑血管痉挛的机制研究

Study on The Mechanism of Ningshen Zhijing Decoction in Treatment of Cerebral Vasospasm After Intervention of aSAH

目的研究宁神止痉汤治疗aSAH介入术后脑血管痉挛的作用及其机制。方法选择aSAH介入术后患者63例,随机分为两组,其中治疗组33例、对照组30例。两组均给予尼莫地平泵入及常规治疗,治疗组在此基础上加用宁神止痉汤每日一剂,两组均治疗14 d。检测不同时期ET-1、S100-β水平及TCD检查Vm、linde-gard、PI变化,对比颅脑CT新发脑梗死率。结果两组入院时血清ET-1、S100-β水平及TCD检查Vm、linde-gard、PI水平无明显差异(P>0.05),治疗组治疗后ET-1、S100-β水平显著低于对照组同期水平(P<0.05);治疗组Vm、linde-gard、PI水平在第7、14 d显著低于对照组同期水平(P<0.05);治疗组患者新发脑梗死病灶2例(6.1%),对照组新发脑梗死病灶4例(13.3%),治疗组新发脑梗死率显著低于对照组(P<0.05)。结论中药宁神止痉汤联合尼莫地平能够有效减轻aSAH介入术后患者的脑血管痉挛程度,降低新发脑梗死的发生率,其机制可能与降低ET-1及S100-β水平、改善血管内皮功能、预防脑细胞损伤有关。

Objective To study the effect and mechanism of Ningshen Zhijing decoction in the treatment of cerebral vasospasm after intervention of aSAH.Methods 63 patients after aSAH intervention were randomly divided into two groups,including 33 cases in the treatment group and 30 cases in the control group.Both groups were treated with nimodipine pump and routine treatment.On this basis,the treatment group was treated with Ningshen Zhijing decoction once a day.Both groups were treated for 14 days.ET-1 and S100-βin different periods were detected.The changes of Vm,Linde-gard and PI were examined by TCD,and the rate of new cerebral infarction on brain CT was compared.Results Serum level of ET-1,S100-βand Vm,Linde-gard,PI detected by TCD at admission in the two groups had no significant difference(P>0.05).The levels of Vm,Linde-gard and PI in the treatment group were significantly lower than those in the control group after treatment and on the 7th and 14th day(P<0.05).There were 2 cases(6.1%)of new cerebral infarction in the treatment group and 4 cases(13.3%)in the control group.The rate of new cerebral infarction in the treatment group was significantly lower than that in the control group(P<0.05).Conclusion Ningshen Zhijing decoction combined with nimodipine can effectively reduce the degree of cerebral vasospasm and the incidence of new cerebral infarction in patients after aSAH intervention,and its mechanism may be related to the reduction of ET-1 and S100-βLevel,improve vascular endothelial function and prevent brain cell injury.