高血压脑出血微创穿刺引流术后采用中医分阶段治疗方案的疗效评估

目的:探讨高血压脑出血微创穿刺引流术后应用中医分阶段治疗方案的疗效。方法:收集具有手术指征的高血压脑出血患者作为研究对象,均行微创穿刺引流术,术后格拉斯哥昏迷指数(GCS)评分≥9分、生命体征平稳,共纳入84例,按随机数字表法将其分为两组各42例,对照组术后采用西医常规治疗,疗程4周;治疗组在对照组基础上于术后当天加用中医分阶段疗法,第一阶段(发病1~3 d)采用羚羊角汤加减,第二阶段(发病4~28 d)采用补阳还五汤加减结合病灶对侧头电针治疗。随访3个月。分别采用美国国立卫生研究院卒中量表(NIHSS)评分、GCS、Barthel指数评分评估两组患者治疗前后及随访3个月的神经功能缺损程度、昏迷程度、日常生活活动能力情况,采用中医证候评分评定中医证候疗效,记录并比较两组治疗前后脑血肿量及术后患者清醒时间。结果:治疗后中医证候疗效中基本恢复率、显著进步率、总有效率治疗组分别为52.38%(22/42)、23.81%(10/42)、90.48%(38/42),对照组分别为33.33%(14/42)、14.29%(6/42)、83.33%(35/42),两组比较,差异均有统计学意义(P<0.05);治疗后两组GCS评分高于治疗前,NIHSS评分、脑血肿量均低于治疗前,且治疗组患者改善优于对照组,治疗组患者术后清醒时间短于对照组,差异均有统计学意义(P<0.05);治疗结束3个月后随访,治疗组患者Barthel指数评分高于对照组,差异有统计学意义(P<0.05)。结论:在微创穿刺引流术后应用中医分阶段治疗高血压脑出血可明显改善患者临床症状,减少脑血肿量,加速觉醒,促进神经功能恢复及日常生活能力的提高。

Evaluation of Curative Effect of Traditional Chinese Medicine Phased Treatment Scheme on Patients after Minimally Invasive Puncture and Drainage of Hypertensive Intracerebral Hemorrhage

Objective: To explore the curative effect of TCM phased treatment scheme on patients after minimally invasive puncture and drainage for hypertensive cerebral hemorrhage. Methods: Patients of hypertensive intracerebral hemorrhage with surgical indications were collected and treated with minimally invasive puncture and drainage. The patients were with Glasgow Coma Index(GCS) score ≥9 and stable vital signs. A total of 84 cases were included and divided into two groups according to random number table, 42 cases in each group.The control group was treated with conventional western medicine after operation for 4 weeks. On the basis of the control group, the treatment group was treated with TCM phased treatment scheme on the day after operation.In the first stage(within 1-3 days of onset), the modified Lingyangjiao decoction (羚羊角汤加减) was used, and in the second stage(within 4-28 days of onset), modified Buyang Huanwu decoction(补阳还五汤加减) combined with electroacupuncture on the opposite side of the lesion was used. Patients were followed-up for three months.The National Institutes of Health Stroke Scale(NIHSS), Glasgow Coma Index(GCS) and Barthel Index were used to evaluate the neurological deficit, coma and activities of daily living before and after treatment and three months follow-up. The TCM syndrome curative effect was evaluated according to TCM syndrome score;The amount of cerebral hematoma and the awake time of postoperative patients were recorded and compared between the two groups. Results: After treatment, the basic recovery rate, significant improvement rate and total effective rate were respectively 52.38%(22/42), 23.81%(10/42) and 90.48%(38/42) in the treatment group, and respectively33.33%(14/42), 14.29%(6/42) and 83.33%(35/42) in the control group. There was significant differences on effi cacy between the two groups(P <0.05). After treatment, GCS scores increased and NIHSS scores and brain hematoma volume decreased in the two groups. The treatment group showed higher GCS scores while lower NIHSS scores and brain hematoma volume than the control group, and the postoperative waking time of the treatment group was shorter than that of the control group, with statistical differences(P <0.05). After three months’ follow-up, the treatment group showed higher Barthel index score than the control group, and the difference was statistically significant(P <0.05). Conclusion: TCM phased treatment scheme after minimally invasive puncture and drainage can obviously improve the clinical symptoms of patients, reduce the amount of cerebral hematoma, accelerate awakening, promote the recovery of neurological function and improve the ability of daily living.