中西医结合综合救治高血压性中、大量脑出血201例临床研究

目的 寻求能够提高血压性中、大量脑出血临床疗效的救治方案。方法 采用简单随机对照试验方法对201例患者进行研究，治疗组103例，对照组98例；治疗组应用综合救治方案（包括外科手术治疗、基础治疗和中医药辩证治疗），对照组应用外科手术治疗和基础治疗，西医治疗；治疗后28d，随访6个月进行疗效评价。结果 中西医综合救治的治疗组临床疗效较优（P＜0．001）；病死率较低，差异有显著性（P＜0．001）；生存病人生活能力状态（ADL）较好（P＝0．002，P＝0．025）；生存率和累计生存率较高（P＜0．01）；合并症较少（P＝0．001，P＝0．04）；治疗后3d、7d生存病人的神志不清以及阳闭证喉中痰鸣、面赤身热、躁扰不宁等症状改善程度较优（P＜0．01）。显示综合救治方案可提高高血压性中、大量基底节脑出血救治的临床疗效。本研究还显示高血压性中、大量脑出血闭证阳闭证为主，清热、平肝、破瘀、涤痰、通腑、醒神是其基本治法；中医药在综合救治方案中的作用可能是降低并发症和并发症致死率。结果 该方案疗效较为确切，值得进一步扩大样本，进行多中心合作的验证，以推广应用。

Traditional Medicine Combined with Western Medicine for HypertensiveMiddle- and Large-Amount Cerebral Hemorrhage:A Report of 201 Cases

Objective To find out comprehensive therapeutic protocols for hypertensive middle_and large_amount cerebral hemorrhage. Methods A simple randomized control trial was applied in 201 cases of hypertensive middle_ and large_amount cerebral hemorrhage.The cases were allocated to Group A and Group B.Group A(n=103) was treated with comprehensive treatment including surgical operation,routine treatment and Chinese herbal medicine,Group B (n=98)with surgical operation routine treatment and western medicine.The treatment course last 28 days,and a 6_month follow_up was carried out to evaluate the therapeutic effects. Results The therapeutic effects were better (P< 0.001 ),the mortality was lower(P< 0.001 ),activities of daily life (ADL) was better(P= 0.002 ,P= 0.025 ),survive rate and accumulated survive rate was higher(P< 0.01 ),the complications were less(P= 0.001 ,P= 0.04 ) in Group A than Group B.After 3 days of treatment and 7 days of treatment,the symptoms in Group A with yang_excess syndrome such as rale,unconsciousness,flushed face,fever,and irritability were improved(P< 0.01 ). Conclusion Chinese herbal medicine combined with western medicine can increase the therapeutic effective rate by decreasing incidence and mortality of complications.Yang_excess syndrome is the main type of hypertensive middle_ and large_amount cerebral hemorrhage.Clearing heat and calming the liver,removing blood stasis and phlegm,relaxing the bowels and restoring consciousness are the fundamental therapeutic methods for the cases with yang_excess syndrome.This comprehensive therapy exerts a definite effect,but it is necessary to increase the number of samples and verify by the cooperation of multiple centers.