芳香开窍法对急性期脑梗死患者神经元的保护作用

背景:中医认为中风病急性期治疗当以熄风、化痰、祛瘀、清热为主,并应重在开窍。目的:观察中医芳香辟秽、化痰开窍法对急性缺血性脑卒中患者神经元的保护作用。设计:对比观察。单位:北京大学医学部附属人民医院中医科。对象:选择2000-07/2001-08北京大学医学部附属人民医院急诊及中医科确诊为脑梗死且发病时间不超过72h的住院患者67例,随机分配奇数为治疗组,偶数为对照组。治疗组33例,男19例,女14例。对照组34例,男22例,女12例。方法:①病例选择标准参照脑梗死诊断标准及脑CT结果。②中医分型:治疗组痰热内闭型13例,痰浊内盛型9例,瘀血内阻型7例,气虚血瘀型4例。对照组痰热内闭型12例,痰浊内盛型13例,瘀血内阻型8例,气虚血瘀型1例。中医辩证标准及积分标准均参照国家中医药管理局脑病急症科研组颁布的《中风病辩证标准》。③治疗组使用醒脑静注射液,对照组使用丹参注射液。治疗2周前后进行血浆内皮素,肿瘤坏死因子,一氧化氮水平测定,并进行对比观察。主要观察指标:治疗前及治疗2周后空腹抽血检验血浆内皮素、肿瘤坏死因子、一氧化氮浓度及肝、肾功能。结果:脑梗死患者67例均进入结果分析。①治疗组治疗后痰热内闭证和痰浊内盛证辩证积分以及神经功能缺损评分均比治疗前有非常显著的降低[(17.94±5.22),(25.66±6.39);(17.12±4.98),(23.89±5.31),P<0.01],与对照组治疗后比较差异有显著性[(17.94±5.22),(22.37±5.24);(17.12±4.98),(23.49±4.96),P<0.05],说明醒脑静对此两证型疗效及神经功能的改善均优于丹参组。②治疗组血浆内皮素、肿瘤坏死因子、一氧化氮浓度治疗后较治疗前有显著降低。以肿瘤坏死因子下降的程度更为显著。结论:中医芳香辟秽、化痰开窍法治疗急性缺血性脑卒中患者,是通过多种途径起到神经元保护作用的.这为今后研究中医药防治缺血再灌注诱导的脑神经细胞凋亡提供了思路。

Protective effect of aromatic induced resuscitation therapy on the neurons of patients with acute cerebral infarction

BACKGROUND: Traditional Chinese medicine (TCM) believes that the treatment for stroke at exacerbation should emphasize on reducing fever,calming the wind, resolving phlegm and removing blood stasis, and should pay more attention to inducing resuscitation.OBJECTIVE: To observe the protective effect on neurons by the TCM methods for dissolving the turbid with aromatics and eliminating the phlegm for resuscitation in patients with acute ischemic stroke.DESIGN: A comparative observation.SETTING: Department of Traditional Chinese Medicine, People's Hospital affiliated to Peking University Health Science Center.PARTICIPANTS: Sixty-seven inpatients diagnosed to have cerebral infarction within 72 hours after the attack were selected from the Emergency Department and Department of Traditional Chinese Medicine, Peking University Health Science Center between July 2000 and August 2001. They were randomly divided into treatment group (odd number, n=33, 19 males and 14 females) and control group (even number, n=34, 22 males and 12 females).METHODS: ①The patients were selected according to the diagnostic standard about cerebral infarction and the results of cerebral CT. ② TCM typing: In the treatment group, there were 13 cases of internal block due to phlegm and heat, 9 of internal excess due to stagnation of phlegm, 7 of internal block due to blood stasis and 4 of deficiency of qi due to blood stasis. In the control gToup, there were 12 cases of internal block due to phlegm and heat, 13 of internal excess due to stagnation of phlegm, 8 of internal block due to blood stasis and 1 of deficiency of qi due to blood stasis. The standards for TCM syndrome differentiation and integral referred to the Standards for the Differentiation of Stroke Syndrome set by the scientific research group of State Administration of Traditional Chinese Medicine of China. ③ Patients in the treatment group and control group were treated with Xingnaojing injection and Danshen injection respectively.The levels of endothelin, tumor necrosis factor (TNF-α) and nitric oxide in plasma were detected before treatment and at 2 weeks after treatment, and the results were compared.MAIN OUTCOME MEASURES: The levels of endothelin, tumor necrosis factor (TNF-α) and nitric oxide in plasma, the liver and renal functions were detected before treatment and at 2 weeks after treatment.RESULTS: All the 67 patients with cerebral infarction were involved in the analysis of results. ①The integrals of syndromes of internal block due to phlegm and heat and internal excess due to stagnation of phlegm and the neurologic deficit score in the treatment group after treatment were very significantly decreasedas compared with those before treatment[(17.94±5.22), (25.66±6.39); (17.12±4.98), (23.89±5.31) ,P ＜ 0.01], also significantly different from those in the control group after treatment[(17.94 ±5.22), (22.37 ±5.24); ( 17.12 ±4.98 ), (23.49 ±4.96),P ＜ 0.05],suggesting that the effects of Xingnaojing on the two syndromes and nerve function were better than those of Danshen. ② The concentrations of endothelin, TNF-α and nitric oxide in the treatment group after treatment were markedly decreased as compared with those before treatment, and TNF-α decreased more significantly.CONCLUSION: TCM methods for dissolving the turbid with aromatics and eliminating the phlegm for resuscitation in treating patients with acute ischemic stroke has various protections on the neurons of patients with ischemic stroke, which has provided new thoughts for TCM in preventing and treating the neural apoptosis induced by ischemia/reperfusion in the future.