醒脑通络汤对风痰阻络型高血压脑出血患者微创血肿清除术后脑水肿体积、神经功能及生活质量的影响

背景微创血肿清除术虽能迅速解除脑组织血肿压迫情况,但该操作可能对神经组织造成损伤,故减轻神经损伤对提高微创血肿清除术治疗效果具有重要意义。目的探讨醒脑通络汤对风痰阻络型高血压脑出血患者微创血肿清除术后脑水肿体积、神经功能及生活质量的影响。方法选取2018年1月-2020年1月重庆市开州区中医院收治的87例风痰阻络型高血压脑出血患者为研究对象,采用随机数字表法分为对照组(n=43)和观察组(n=44)。对照组患者采用微创血肿清除术及常规药物治疗,观察组患者在对照组治疗基础上加用醒脑通络汤。比较两组患者治疗前及治疗2、4周脑水肿体积,治疗前及治疗4周神经损伤指标包括神经元特异性烯醇化酶(NSE)、髓鞘碱性蛋白(MBP)、S100B蛋白、胶质纤维酸性蛋白(GFAP)]、免疫-炎性反应指标包括高迁移率族蛋白1(HMGB-1)、粒细胞巨噬细胞集落刺激因子(GM-CSF)]、N末端脑钠肽前体(NT-proBNP)水平、美国国立卫生研究院卒中量表(NIHSS)评分及Barthel指数(BI)评分;比较两组患者临床疗效,并观察两组患者术后并发症发生情况及治疗期间不良反应发生情况。结果本组患者治疗期间脱落3例,无剔除病例,对照组和观察组最终均纳入42例患者。观察组患者治疗2、4周脑水肿体积小于对照组(P <0.05);治疗2、4周两组患者脑水肿体积分别小于本组治疗前(P <0.05)。观察组患者治疗4周血清NSE、MBP、S100B蛋白、GFAP水平低于对照组(P <0.05);治疗4周两组患者血清NSE、MBP、S100B蛋白、GFAP水平分别低于本组治疗前(P <0.05)。观察组患者治疗4周血清HMGB-1、GM-CSF、NT-proBNP水平低于对照组(P <0.05);两组患者治疗4周血清HMGB-1、GM-CSF、NT-proBNP水平分别低于本组治疗前(P <0.05)。观察组患者治疗4周NIHSS评分低于对照组,BI评分高于对照组(P <0.05);两组患者治疗4周NIHSS评分分别低于本组治疗前,BI评分分别高于本组治疗前(P <0.05)。观察组患者临床疗效优于对照组(P <0.05)。观察组患者术后并发症发生率为4.8%(2/42),低于对照组的19.1%(8/42)(P <0.05)。治疗期间两组患者均未出现药物相关不良反应,治疗前后血常规、心电图、肝肾功能等检查均无明显异常。结论醒脑通络汤能有效减轻风痰阻络型高血压脑出血患者微创血肿清除术后脑水肿体积、神经功能损伤程度,提高患者生活质量,且安全性较高。

Impact of Xingnao Tongluo Decoction on Brain Edema Volume,Neurological Function and Quality of Life after Minimally Invasive Hematoma Removal of Hypertensive Intracerebral Hemorrhage Patients with Wind-phlegm Blocking Collateral

Background Although minimally invasive hematoma removal can quickly relieve the compression of hematoma in brain tissue,but it may cause damage to nerve tissue.Therefore,reducing nerve injury is of great significance to improve the therapeutic effect of minimally invasive hematoma removal.Objective To explore the impact of Xingnao Tongluo decoction on brain edema volume,neurological function and quality of life after minimally invasive hematoma removal of hypertensive intracerebral hemorrhage patients with wind-phlegm blocking collateral.Methods A total of 87 hypertensive intracerebral hemorrhage patients with wind-phlegm blocking collateral treated in Chongqing Kaizhou TCM Hospital from January 2018 to January 2020 were selected as the research objects,and they were randomly divided into control group(n=43)and observation group(n=44).The patients in the control group were treated with minimally invasive hematoma removal and conventional drugs,while the patients in the observation group were treated with Xingnao Tongluo decoction on the basis of control group.The brain edema volume before treatment and 2,4 weeks after treatment,nerve injury indexesneuron-specific enolase(NSE),including myelin basic protein(MBP),S100 B protein,glial fibrillary acidic protein(GFAP)],immune inflammatory reaction indexesincluding high mobility group box-1 protein(HMGB-1)and granulocyte macrophage colony-stimulating factor(GM-CSF)],N terminal pro-brain natriuretic peptide(NT-proBNP)level,National Institutes of Health Stroke Scale(NIHSS)score and Barthel Index(BI)score before treatment and 4 weeks after treatment were compared between the two groups.The clinical efficacy were compared between the two groups,and the incidence of postoperative complications and adverse reactions during treatment of the two groups were observed.Results In this group,3 patients dropped out during the treatment,and no patients were excluded.42 patients were included in the control group and the observation group,respectively.The brain edema volume in the observation group was smaller than that in the control group at 2 and 4 weeks after treatment(P<0.05);the brain edema volume in the two groups at 2 and 4 weeks after treatment was smaller than that before treatment,respectively(P<0.05).The serum levels of NSE,MBP,S100 B protein and GFAP in the observation group at 4 weeks after treatment were lower than those in the control group(P<0.05);the serum levels of NSE,MBP,S100 B protein and GFAP in the two groups at 4 weeks after treatment were lower than those before treatment,respectively(P<0.05).The serum levels of HMGB-1,GM-CSF and NT-proBNP in the observation group at 4 weeks after treatment were lower than those in the control group(P<0.05);the serum levels of HMGB-1,GM-CSF and NT-proBNP in the two groups at 4 weeks after treatment were lower than those before treatment,respectively(P<0.05).The NIHSS score in the observation group at 4 weeks after treatment was lower than that in the control group,and the BI score was higher than that in the control group(P<0.05);the NIHSS score of the two groups at 4 weeks after treatment was lower than that before treatment,and the BI score was higher than that before treatment,respectively(P<0.05).The clinical effect of the observation group was better than that of the control group(P<0.05).The incidence of postoperative complications in the observation group was 4.8%(2/42),which was lower than 19.1%(8/42)in the control group(P<0.05).During the treatment,there were no drugrelated adverse reactions in the two groups,and there were no obvious abnormalities in blood routine,electrocardiogram,liver and kidney function before and after treatment.Conclusions Xingnao Tongluo decoction can effectively reduce the brain edema volume and the degree of nerve function damage of hypertensive intracerebral hemorrhage patients with wind-phlegm blocking collateral,improve the quality of life of patients,and has high safety.