醒脑静对动脉瘤性蛛网膜下腔出血的疗效分析_李

发布时间：2021-06-07

辽宁中医药大学学报

第11卷第12期 2009 年 12 月

辽宁中医药大学学报

JOURNAL OF LIAONING UNIVERSITY OF TCM

Dec . ，2009

醒脑静对动脉瘤性蛛网膜下腔出血的疗效分析

李奇峰，郎铁成，姜晓东

（上海中医药大学附属岳阳中西医结合医院，上海 200437）

摘要：目的：研究醒脑静在治疗蛛网膜下腔出血（包括脑血管痉挛）在介入治疗恢复期中所起的作用，探讨醒

脑静治疗SAH的机理，从中医学角度加深对SAH的理解，研究分析醒脑静对SAH的影响及可能影响途径；考察两种疗法（纯西医和加中成药醒脑静注射液）治疗SAH的临床有效性、安全性、适应症、禁忌症等，进行临床疗效的验证和评价；为治疗方法选择、进一步研究其影响机理奠定基础。方法：将40例蛛网膜下腔出血患者在确诊为动脉瘤破裂出血后立即行动脉瘤栓塞术,术后随机分为两组，两组均给予腰穿、止血、营养神经及对症支持治疗,治疗组在上述方法的基础上加用醒脑静注射液。症状性血管痉挛通过临床表现、TCD、DSA等检查判断，比较不同时期的TCD检查结果判断脑血流的变化及治疗前后患者Hunt-Hess分级及疼痛强度分级的变化。结果：40例患者TCD检查，血管痉挛符合率达100％，醒脑静组第5天、第10天脑血管痉挛缓解程度较对照组明显，两组之间有显著差异（P<0.05）, 40例患者治疗前后Hunt-Hess分级及疼痛强度分级比较治疗组较对照组下降明显，并且具有统计学意义（P<0.05）。结论：醒脑静有助于缓解SAH后脑血管痉挛的程度，改善患者的预后。TCD结合其他方法有助于脑血管痉挛的诊断与疗效分析。

关键词：醒脑静注射液；颅内动脉瘤；蛛网膜下腔出血；脑血管痉挛；TCD；介入

(2009) 12- 中图分类号：R743.35 文献标识码：B 文章编号：1673-842X 0097- 03Effect of Xingnaojing on Cerebral Vasospasm Following Aneurysmal Subarachnoid Hemorrhage

LI Qi-feng, LANG Tie-cheng, JIANG Xiao-dong

（Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated

to Shanghai University of Chinese Medicine, Shanghai 200437, China）Objective：To investigate the effects of Xingnaojing on aneurysmal subarachnoid hemorrhage Abstract：

SAH（including cerebral vasospasm）after intervention, and further explore the mechanism on aneurysmal subarachnoid hemorrhage and deepen the apprehension on aneurysmal subarachnoid hemorrhage from traditional Chinese medical science, and study the influence pathway of Xingnaojing on SAH, diagnosis cerebral vasospasm, and investigate the two treatment(medicine and Xingnaojing group) on validity and safety and indication and contraindication, and carry on authentication and evaluation on clinic therapeutic effects, to establish the foundation on selecting methods and studying mechanism. Methods: Forty patients presented with aneurysmal SAH were randomly divided into two groups. All the patients received triple-H therapy and conventional therapy. and treating group received Xingnaojing injection. The symptomatic vasospasm was determined by clinical manifestation, TCD, DSA. The changes of regional cerebral blood flow at different stage was observed by TCD ,The change of Hunt-Hess grading and pain strength grading was observed by clinical observation. Results: Forty patients developed symptomatic vasospasm by TCD. And the relieving degree of vasospasm in treating group in the 5 day and the 10 day was greater than the control group and had significant deviation（P<0.05）. The comparison both the Hunt-Hess grading and the pain strength grading had statistical significance（P<0.05）. Conclusions: Xingnaojing conduced to relieve the degree of cerebral vasospasm and improve patient's prognosis. It is indicated that TCD combined with other methods could play an important role in the diagnosis of cerebral vasospasm.

Xingnaojing injection; intracranial aneurysm; aneurysmal subarachnoid hemorrhage; Key words：

cerebral vasospasm; TCD ; intervention

蛛网膜下腔出血（aneurysmal subarachnoid hemorrhage, aSAH）死亡率高，出血后期易出现脑血管痉挛，严重影响患者的预后。本院采用醒脑静注射液治疗蛛网膜下腔出血40例，效果明显，现报道如下。

1　临床材料

在33~79岁之间，平均年龄（54.60±14.67）岁，上述两组资料，经统计学处理，无显著性差异。见表1。

表1 临床资料统计

组别性别年龄（岁）

男女

治疗组 9* 11* 55.4±13.66*对照组 10* 10* 54.6±14.07*注：与对照组比较，*P>0.05。2　方　法

收集2004年6月—2005年3月入院的颅内动脉瘤破裂导致蛛网膜下腔出血的病例40例，诊断标准：1989年中华医学会第二届全国脑血管病学术会议第三次修订的《各类脑血管病的诊断要点》中“蛛

[1]

随机分为醒脑静治疗网膜下腔出血”的诊断标准，