化瘀解痉方联合尼莫地平治疗动脉瘤性蛛网膜下腔出血后脑血管痉挛患者的疗效及对其血管内皮功能的影响

Efficacy of Huayu Jiejing Formula Combined with Nimodipine in Treatment of Cer-ebral Vasospasm after Aneurysmal Subarachnoid Hlemorrhage and Effect on Vascu-lar Endothelial Function

目的探讨化瘀解痉方联合尼莫地平治疗动脉瘤性蛛网膜下腔出血(Subarachnoid hemorrhage,SAH)后脑血管痉挛患者的疗效及对其血管内皮功能的影响。方法选取2022年1月-2023年1月期间保定市第一中心医院收治的SAH后脑血管痉挛患者90例,按随机数字表法分为对照组和观察组,每组各45例。对照组给予尼莫地平治疗,观察组在对照组基础上联合化瘀解痉方治疗,均连续治疗15 d。观察两组患者治疗前后神经功能缺损评分(National institute of health stroke scale,NIHSS)、Hunt-Hess分级评分、意识障碍程度评分(Glasgow coma scale,GCS)、血管内皮功能指标[内皮素-1(Endothelin-1,ET-1)、血管内皮生长因子(Vascular endothelial growth factor,VEGF)]、脑血流指标[大脑中动脉平均流速(Mean flow velocity of middle cerebral artery,MCA-Vm)、颈内动脉颅外段平均流速(Mean extracranial velocity of internal carotid artery,VICA-Vm)、脑血管痉挛(Cerebral vasospasm,CAS)指数]改善情况,临床总有效率及不良反应情况。结果治疗后两组患者NIHSS、Hunt-Hess评分均较治疗前降低,GCS评分均较治疗前升高,差异有统计学意义(P<0.05);且观察组NIHSS、Hunt-Hess评分均明显低于对照组,GCS评分明显高于对照组,差异有统计学意义(P<0.05)。治疗后两组患者ET-1、VEGF水平均较治疗前降低,差异有统计学意义(P<0.05);且观察组ET-1、VEGF水平均明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者MCA-Vm、VICA-Vm及CAS指数均较治疗前降低,差异有统计学意义(P<0.05);且观察组MCA-Vm、VICA-Vm及CAS指数均明显低于对照组,差异有统计学意义(P<0.05)。治疗后观察组临床总有效率91.11%(41/45)明显高于对照组73.33%(33/45),差异有统计学意义(P<0.05)。治疗期间,两组患者均未发生不良反应,也未出现死亡病例。结论化瘀解痉方联合尼莫地平能够改善SAH后脑血管痉挛患者的血管内皮功能,增加脑血流灌注,减轻神经功能损伤,控制病情发展,疗效显著,安全性高。

Objective To investigate the efficacy of Huayu Jiejing Formula combined with nimodipine in treating cerebral vasospasm(CAS)in patients with aneurysmal subarachnoid hemorrhage(SAH)and its impact on vascular endothelial function.Methods Ninety patients with CAS after SAH admitted to the Bao Ding No.1 Central Hospital from January 2022 to January 2023 were selected and randomly divided into a control group and an observation group,with 45 patients in each group.The control group was treated with nimodipine,while the observation group received Huayu Jiejing Formula combined with nimodipine.Both groups were treated continuously for 15 days.The following parameters in both groups were observed before and after treatment:neurological function deficit score(National Institute of Health Stroke Scale,NIHSS),Hunt-Hess grade,degree of consciousness impairment(Glasgow Coma Scale,GCS),vascular endothelial function indicators[endothelin-1(ET-1),vascular endothelial growth factor(VEGF)],cerebral blood flow indicators[mean flow velocity of the middle cerebral artery(MCA-Vm),mean extracranial velocity of the internal carotid artery(VICA-Vm),and CAS index],overall clinical efficacy,and adverse reactions.Results After treatment,both groups showed significantly lower NIHSS and Hunt-Hess scores and higher GCS scores than those before treatment(P<0.05).The observation group had significantly lower NIHSS and Hunt-Hess scores and higher GCS scores than the control group(P<0.05).Levels of ET-1 and VEGF were significantly reduced in both groups after treatment(P<0.05),with the observation group showing lower levels than the control group(P<0.05).MCA-Vm,VICA-Vm,and CAS index also decreased significantly in both groups after treatment(P<0.05),with the observation group showing more significant reductions than the control group(P<0.05).The overall clinical efficacy in the observation group was 91.11%(41/45),significantly higher than 73.33%(33/45)in the control group(P<0.05).No adverse reactions or deaths occurred during treatment in either group.Conclusion Huayu Jiejing Formula combined with nimodipine can improve vascular endothelial function,increase cerebral blood perfusion,reduce neurological damage,control disease progression,and is significantly effective and safe in treating CAS after SAH.