通腑泻热活血方联合针刺法治疗脑出血后顽固性脑水肿的疗效

Efficacy of Tongfu Xiere Huoxue Decoction combined with acupuncture on intractable cerebral edema after intracerebral hemorrhage

目的探讨通腑泻热活血方联合针刺法治疗脑出血后顽固性脑水肿的疗效。方法选取脑出血后合并顽固性脑水肿患者72例,随机分为对照组与观察组,每组36例。对照组给予常规治疗,观察组在对照组治疗的基础上给予通腑泻热活血方联合针刺治疗。分别于治疗前及治疗后3、7、14 d检测2组的颅内压(intracranial pressure,ICP),于治疗前及治疗后7、14 d测量脑水肿体积并评估美国国立卫生院神经功能缺损评分(the National Institutes of Health Neurological Impairment Score,NIHSS)、中医证候(traditional Chinese medicine,TCM)评分,检测血清白细胞介素-1β(interleukin-1β,IL-1β)、白细胞介素-6(interleukin-6,IL-6)、细胞间黏附分子-1(intercellular adhesion molecule-1,ICAM-1)、基质金属蛋白酶-9(matrix metalloproteinase-9,MMP-9)、一氧化氮(nitric oxide,NO)、内皮素-1(endothelin-1,ET-1)、水通道蛋白4(aquaporin 4,AQP4)、S100蛋白(S100 protein,S100β)以及神经元特异性烯醇化酶(neuron-specific enolase,NSE)和脑源性神经营养因子(brain-derived neurotrophic factor,BDNF)水平。结果治疗3、7、14 d后,2组的ICP均明显降低(P<0.05),且治疗3、7 d后观察组的ICP明显低于对照组(P<0.05);治疗7、14 d后,2组的相对脑水肿体积、绝对脑水肿体积、NIHSS评分及TCM评分均显著降低,且观察组低于对照组(P<0.05)。治疗后,2组的血清IL-1β、IL-6、ICAM-1、MMP-9、ET-1、AQP4、S100β及NSE均降低,NO和BDNF均升高,且观察组的改善幅度优于对照组(P<0.05)。结论通腑泻热活血方联合针刺治疗脑出血后顽固性脑水肿可促进水肿消退,提高临床疗效,促进神经重塑,其机制与抑制神经炎症、保护血管内皮细胞及调节神经损伤相关因子的表达等有关。

Objective To investigate the efficacy of Tongfu Xiere Huoxue Decoction combined with acupuncture on refractory cerebral edema after intracerebral hemorrhage(ICH).Methods A total of 72 patients with intractable cerebral edema after ICH were selected and randomly divided into control group and observation group,with 36 cases in each.The control group was given conventional treatment,while the observation group was given Tongfu Xiere Huoxue Decoction combined with acupuncture on this basis.The intracranial pressure(ICP)before treatment,and 3,7 and 14 days after treatment was detected,the cerebral edema volume before treatment,7 and 14 days after treatment was measured,the National Institutes of Health Neurological Impairment Score(NIHSS)and traditional Chinese medicine(TCM)score was evaluated,the serum interleukin-1β(IL-1β),interleukin-6(IL-6),intercellular adhesion molecule-1(ICAM-1),matrix metalloproteinase-9(MMP-9),nitric oxide,endothelin-1(ET-1),aquaporin 4(AQP4),S100 protein(S100β),neuron-specific enolase(NSE)and brain-derived neurotrophic factor(BDNF)levels before and after treatment were detected.Results After 3,7 and 14 days treatment,the ICP of the 2 groups were significantly reduced(P<0.05),and the ICP of the observation group was significantly lower than that of the control group after 3 and 7 days treatment(P<0.05);after 7 and 14 days treatment,the relative brain edema volume,absolute brain edema volume,NIHSS score and TCM score in the 2 groups were significantly reduced,and the observation group were lower than the control group(P<0.05).After treatment,the serum IL-1β,IL-6,ICAM-1,MMP-9,ET-1,AQP4,S100β,and NSE of the 2 groups were decreased,the NO and BDNF were increased,and the improvement of the observation group were better than the control group(P<0.05).Conclusion Tongfu Xiere Huoxue Decoction combined with acupuncture treatment for refractory cerebral edema after ICH can promote the resolution of edema,improve clinical efficacy,and promote nerve remodeling.The mechanism maybe related to inhibiting neuroinflammation,protecting vascular endothelial cells and regulating the expression of nerve injury-related factors.