活血涤痰汤对高血压脑出血神经功能恢复的影响

目的:观察活血涤痰汤对高血压脑出血(HICH)神经功能恢复影响及作用机制。方法:将94例HICH患者采用随机按数字表法分为对照组和观察组各47例。对照组采用手术治疗、脱水降颅压、控制血压、防治感染、营养神经、对症支持等西医综合治疗措施。观察组在对照组治疗的基础上加用活血涤痰汤,1剂/d,水煎服。两组疗程均为14 d。分别于治疗前、治疗后7,14 d进行美国国立卫生院神经功能缺损(NIHSS)评分和脑水肿情况;检测治疗前后补体C3,C4,超敏C-反应蛋白(hs-CRP),神经肽Y(NPY)和血浆神经元特异性烯醇化酶(NSE)水平。结果:经Ridit分析,治疗后观察组临床疗效优于对照组(P<0.05);治疗后观察组NPY,NSE和hs-CRP水平低于对照组(P<0.01);治疗后对照组C3和C4水平较治疗前升高(P<0.01),观察组变化不明显,治疗后观察组C3和C4水平低于对照组(P<0.01)。观察组在治疗后7,14 d NIHSS评分均低于对照组(P<0.01);治疗后7 d对照组脑水肿体积较治疗前增多(P<0.01),治疗后14 d对照组脑水肿体积较治疗前及治疗后7 d均显著下降(P<0.01);观察组在治疗后第7,14天脑水肿体积均持续下降(P<0.01),并低于同期对照组脑水肿体积(P<0.01)。结论:在西医常规综合疗法的基础上,活血涤痰汤能减轻脑水肿,促进神经功能的恢复,其作用机制可能与降低血管阻力,减轻炎症反应及补体系统对神经细胞损伤有关。

Influence of Huoxue Ditan Decoction on Recovery of Blood Neural Function in Patients with Hypertensive Cerebral Hemorrhage Disease

Objective: To observe the influence of Huoxue Ditan decoction on the recovery of neural function and to investigate its mechanism of action in treating hypertensive cerebral hemorrhage disease (HICH). Method: Ninety-four patients with HICH were randomly divided into the control group (47 cases) and the observation group (47 cases) by a random number table. Patients in the control group received Western medicine comprehensive treatment including surgical treatment, dehydration of intracranial pressure, blood pressure control, prevent infection, nerve nutrition and expectant support. Based on the treatment of the control group, patients in the observation group added one does Huoxue Ditan decoction once daily. All patients received 14 days of treatment. The national institutes of health USA nerve function defect (NIHSS) scores and cerebral edema were evaluated before treatment, at day 7,14.Levels of complement C3, C4, hypersensitive c-reactive protein (hs-CRP), neuropeptide Y (NPY) and serum neuron specific enolization enzyme (NSE) were tested. Result: The clinical curative effect of the observation group was superior to that in the control group (P<0.05). Levels of NPY, NSE and hs-CRP in the observation group were less than those of control group (P<0.01). Compared with before, levels of C3, C4 increased in the control group after treatment (P<0.01). However, changes in the observation group were not obvious. Levels in C3, C4 in the observation group were lower than those in the control group (P<0.01). NIHSS score in the observation group was lower than that in the control group at day 7, 14 (P<0.01). Cerebral edema volume in the observation group decreased compared with the data before and seven days after treatment (P<0.01). Ccompared with before and day 7, volume of cerebral edema at day 14 in the observation group went down (P<0.01). Edema volume at day 7, 14 in the observation group decreased persistently (P<0.01), and they were lower than those in control group (P<0.01). Conclusion: Based on the conventional Western medicine comprehensive therapy, Huoxue Ditan decoction could receive edema and improve the recovery of neurological function. Its mechanism of action may be related to reducing the vascular resistance, the inflammatory response and the nerve injury caused by the complement system.