活血通窍汤辅助治疗对动脉瘤性蛛网膜下腔出血并发脑血管痉挛临床疗效及对血清基质金属蛋白酶-9同型半胱氨酸和可溶性细胞间黏附分子-1水平的影响

Clinical efficacy of Huoxue Tongqiao Decoction as adjuvant therapy for SAH complicated with CVS patients and its effects on serum MMP-9,Hcy,and sICAM-1 levels

目的分析活血通窍汤辅助治疗对动脉瘤性蛛网膜下腔出血(SAH)并发脑血管痉挛(CVS)挛患者临床疗效及对血清基质金属蛋白酶(MMP)-9、同型半胱氨酸(Hcy)和人可溶性细胞间黏附分子-1(sICAM-1)的影响。方法选择浙江省义乌市中心医院2021年4月至2022年4月收治的SAH并发CVS患者78例,运用随机数字表法分为对照组(39例)与治疗组(39例)。对照组给予盐酸法舒地尔注射液治疗,治疗组在对照组基础上服用活血通络汤。2组均治疗2周。比较2组治疗疗效,治疗前后中医证候积分、血流动力学、神经功能和认知功能、MMP-9、Hcy和sICAM-1水平变化。结果治疗组总有效率高于对照组(P<0.05)。2组治疗后患者头痛、恶心呕吐和颈项抵抗积分较治疗前降低(P<0.05),治疗组低于对照组(P<0.05)。2组治疗后颈内动脉颅外段平均注速(VICA-Vm)和大脑中动脉平均注速(MCA-Vm)较治疗前降低(P<0.05),治疗组治疗后低于对照组(P<0.05)。2组治疗后mRS评分较治疗前降低,MoCA评分较治疗前升高(P<0.05);治疗组治疗后改良Rankin量表(mRS)评分低于对照组,蒙特利尔认知评估量表(MoCA)评分高于对照组(P<0.05)。2组治疗后MMP-9、Hcy和sICAM-1水平较治疗前降低(P<0.05);治疗组治疗后MMP-9、Hcy和sICAM-1水平低于对照组(P<0.05)。结论活血通窍汤辅助治疗SAH并发CVS患者疗效良好,患者血流动力学改善,神经功能改善,可降低MMP-9、Hcy和sICAM-1水平。

Objective To explore the clinical efficacy of Huoxue Tongqiao Decoction in the treatment of aneurysmal subarachnoid hemorrhage(SAH)complicated with cerebral vasospasm(CVS)contracture,and the ef-fect on the serum levels of MMP-9,Hcy and sICAM-1.Methods A total of 78 patients with SAH complicated by CVS admitted to Yiwu Central Hospital in Zhejiang Province from April 2021 to April 2022 were divided into a control group(n=39)and a treatment group(n=39)using a random number table method.The control group was treated with fasudil hydrochloride injection,while the treatment group was administered with Huoxue Tongqiao Decoction on the basis of the treatment received by the control group.Both groups were treated for 2 weeks.The therapeutic effects,changes in traditional Chinese medicine(TCM)syndrome scores,hemodynamics,neurological and cognitive functions,as well as levels of MMP-9,Hcy,and sICAM-1 before and after treatment were compared between the two groups.Results The total effective rate in the treatment group was higher than that in the con-trol group(P<0.05).After treatment,the scores for headache,nausea,vomiting,and neck resistance decreased in both groups compared with those before treatment(P<0.05),and the scores in the treatment group were lower than those in the control group(P<0.05).After treatment,VICA-Vm and MCA-Vm decreased in both groups compared with those before treatment(P<0.05),and the values in the treatment group were lower than those in the control group after treatment(P<0.05).After treatment,the mRS scores decreased and the MoCA scores increased in both groups compared with those before treatment(P<0.05).The mRS scores in the treatment group were lower than those in the control group,while the MoCA scores were higher(P<0.05).After treatment,the levels of MMP-9,Hcy,and sICAM-1 decreased in both groups compared with those before treatment(P<0.05).The levels of MMP-9,Hcy,and sICAM-1 in the treatment group were lower than those in the control group after treatment(P<0.05).Conclusion The adjuvant treatment of SAH complicated with CVS patients with Huoxue Tongqiao Decoction had good effects.The hemodynamics and neurological function of the patients were improved,and the levels of MMP-9,Hcy and sICAM-1 were reduced.