芪参还五胶囊配合立体定向引流术治疗出血性中风的疗效及对脑血流动力学、氧化-抗氧化失衡的影响
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摘要
目的观察芪参还五胶囊配合立体定向引流术治疗出血性中风的疗效及对脑血流动力学、氧化-抗氧化失衡的影响。方法将91例出血性中风患者随机分为观察组(46例)和对照组(45例),对照组给予立体定向引流术治疗,观察组在对照组的基础上给予芪参还五胶囊治疗,疗程均为8周。观察2组中医症状积分、神经功能、影像学和血清学指标改善情况;检测脑血流动力学、氧化-抗氧化失衡恢复情况,并比较2组临床预后。结果治疗后2组中医证候积分均显著降低(P均<0. 05),观察组积分均明显低于对照组(P均<0. 05);治疗后2组NIHSS评分、头颅CT检查指标(颅内血肿量、血肿周围水肿体积、脑中线移位)均有显著改善(P均<0. 05),观察组改善情况均显著优于对照组(P均<0. 05); 2组治疗后大脑中动脉和大脑前动脉收缩期峰值速度(Vs)、舒张期峰值速度(Vd)、平均血流速度(Vm)、血管阻力指数(RI)均显著改善(P均<0. 05),观察组以上指标改善情况均显著优于对照组(P均<0. 05); 2组治疗后血清髓过氧化物酶(MOP)、脂质过氧化物(LPO)、超氧化物歧化酶(SOD)、丙二醛(MAD)均显著改善(P均<0. 05),观察组以上指标改善情况均显著优于对照组(P均<0. 05)。观察组术后6个月随访时的GOS评分、BI评分分级和分值均显著优于对照组(P均<0. 05)。结论芪参还五胶囊配合立体定向引流术能够减轻出血性中风患者神经功能损伤,改善临床预后和日常活动能力,机制可能与其调节脑血流动力学,促进氧化-抗氧化平衡有关。
Objective It is to observe the curative effect of Qishen Huanwu capsule combined with stereotactic drainage on hemorrhagic stroke and its influence on cerebral hemodynamics and oxidation-antioxidation imbalance. Methods 91 patients with hemorrhagic stroke were randomly divided into observation group( 46 cases) and control group( 45 cases). The control group was treated with stereotactic drainage. The observation group was treated with Qishen Huanwu capsule on the basis of the control group. Both courses of treatment were 8 weeks. The improvement of TCM symptom scores,neurological function,imaging and serological indicators in the two groups was observed; the recovery of cerebral hemodynamics and oxidation-antioxidation imbalance was detected,and the clinical prognosis of the two groups was compared. Results The scores of TCM syndromes after treatment were significantly lower than those before treatment in the two groups,and the scores in the observation group were higher than those in the control group( P < 0. 05). After treatment,NIHSS score,cerebral CT scan indexes( intracranial hematoma volume,edema volume around the hematoma,midline shift),the parameters Vs,Vd,Vm and RI of MCA and ACA in the two groups were significantly improved( P < 0. 05),the improvements of above indexes of the observation group were better than those of the control group( P < 0. 05). The serum LOP,MOP,SOD and MAD were significantly improved after treatment in the two groups( P < 0. 05),the improvements of above indexes of the observation group were better than those of the control group( P < 0. 05). The GOS score,BI score and classification of the observation group were better than those of the control group at 6 months follow-up( P < 0. 05). Conclusion Qishen Huanwu capsule combined with stereotactic drainage can alleviate the neurological damage,improve clinical prognosis and daily activity in patients with hemorrhagic stroke,,and its mechanism may be related to its regulation of cerebral hemodynamics and antioxidative-oxidative balance.
Objective It is to observe the curative effect of Qishen Huanwu capsule combined with stereotactic drainage on hemorrhagic stroke and its influence on cerebral hemodynamics and oxidation-antioxidation imbalance. Methods 91 patients with hemorrhagic stroke were randomly divided into observation group( 46 cases) and control group( 45 cases). The control group was treated with stereotactic drainage. The observation group was treated with Qishen Huanwu capsule on the basis of the control group. Both courses of treatment were 8 weeks. The improvement of TCM symptom scores,neurological function,imaging and serological indicators in the two groups was observed; the recovery of cerebral hemodynamics and oxidation-antioxidation imbalance was detected,and the clinical prognosis of the two groups was compared. Results The scores of TCM syndromes after treatment were significantly lower than those before treatment in the two groups,and the scores in the observation group were higher than those in the control group( P < 0. 05). After treatment,NIHSS score,cerebral CT scan indexes( intracranial hematoma volume,edema volume around the hematoma,midline shift),the parameters Vs,Vd,Vm and RI of MCA and ACA in the two groups were significantly improved( P < 0. 05),the improvements of above indexes of the observation group were better than those of the control group( P < 0. 05). The serum LOP,MOP,SOD and MAD were significantly improved after treatment in the two groups( P < 0. 05),the improvements of above indexes of the observation group were better than those of the control group( P < 0. 05). The GOS score,BI score and classification of the observation group were better than those of the control group at 6 months follow-up( P < 0. 05). Conclusion Qishen Huanwu capsule combined with stereotactic drainage can alleviate the neurological damage,improve clinical prognosis and daily activity in patients with hemorrhagic stroke,,and its mechanism may be related to its regulation of cerebral hemodynamics and antioxidative-oxidative balance.
引文
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[19]张科,郑玲.自拟桃仁川芎汤联合西医治疗脑出血后遗症疗效及对运动功能、生活能力的影响[J].现代中西医结合杂志,2017,26(28):3129-3131
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[21]吴俊杰,汪宏锦,杨帅,等.冰片对梓醇及葛根素透过局灶性脑缺血模型大鼠血脑屏障作用的研究[J].中国中药杂志,2016,41(21):3988-3995
[2]江耿思,陈桂增,黄任娥,等. CT引导立体定向脑内血肿穿刺碎吸合并尿激酶冲洗引流治疗原发性脑出血[J].现代医用影像学,2017,26(2):374-376
[3]高利.高血压性脑出血急性期中西医结合诊疗专家共识[J].中国全科医学,2016,19(30):3641-3648
[4]中华医学会神经病学分会.中国脑出血诊治指南(2014)[J].中华神经科杂志,2015,48(6):435-444
[5]国家中医药管理局.中医病证诊断疗效标准[S].南京:南京大学出版社,1994:118-119
[6]国家中医药管理局.中药新药临床研究指导原则(试行)[S].北京:中国医药科技出版社,2002:203-204
[7]官君达,万霞,胡立胜.中医症状量化及其疗效评定方法探讨[J].中国中西医结合杂志,2002,22(6):431
[8]濮璟楠,师蔚.脑出血后脑水肿管理专家共识[J].中华医学信息导报,2017,25(8):1-6
[9]中华健康管理学杂志编辑委员会.脑血管健康管理与脑卒中早期预防专家共识[J].中华健康管理学杂志,2017(5):397-407
[10]沈健,杨华.不同手术时机小骨窗显微手术治疗高血压脑出血与日常生活活动能力量表、格拉斯哥预后评分的相关性[J].中国老年学杂志,2017,37(2):354-355
[11]雷秀虹,康玉玲.某市社区人群脑卒中患病率及危险因素流行病学调查分析[J].解放军预防医学杂志,2017,35(10):1209-1211
[12]孙永梅,王雨童,蒋令修,等.甘露醇联合尼莫地平对高血压脑出血患者脑血流动力学参数的影响[J/CD].临床医药文献电子杂志,2016,3(15):3031-3031
[13]刘勇.经颅多普勒超声观察甘露醇对脑出血患者脑血流的影响[J].中国实用神经疾病杂志,2016,19(9):80-81
[14]柯国秀,王国军,王建生,等.早期继续出血的自发性脑出血患者不同时间点氧化应激及炎性介质水平的变化[J].卒中与神经疾病,2017,24(4):306-309
[15]李晓峰.脑出血后继发性脑损伤机制研究进展[J].内科,2015,10(3):383-385
[16]王春华,许丽,陈祥,等.依达拉奉联合尼莫地平对脑出血患者氧化应激以及神经功能的影响[J].广西医科大学学报,2018(2):209-212
[17]王轶,陈宏朝,张宗杰,等.脑出血立体定向穿刺与内科保守治疗的临床比较分析[J].中华神经外科疾病研究杂志,2016,15(5):424-426
[18]谢靖,高惠春,郑玺.黄芪甲苷对急性脑出血大鼠神经功能的影响[J].中国病理生理杂志,2016,32(10):1905-1908
[19]张科,郑玲.自拟桃仁川芎汤联合西医治疗脑出血后遗症疗效及对运动功能、生活能力的影响[J].现代中西医结合杂志,2017,26(28):3129-3131
[20]袁梦果.基于脑肠互动研究大黄治疗大鼠脑出血的抗炎机制[D].南京:南京中医药大学,2017
[21]吴俊杰,汪宏锦,杨帅,等.冰片对梓醇及葛根素透过局灶性脑缺血模型大鼠血脑屏障作用的研究[J].中国中药杂志,2016,41(21):3988-3995