[关键词]
[摘要]
目的 探究苏合香丸联合尼莫地平治疗蛛网膜下腔出血后脑血管痉挛的临床疗效。方法 选取2018年5月—2021年5月南阳市南石医院收治的110例蛛网膜下腔出血后脑血管痉挛患者,所有患者随机分为对照组(55例)和治疗组(55例)。对照组静脉滴注尼莫地平注射液,注入5%葡萄糖溶液500 mL中,初始速度为0.5 mg/h,若血压无大幅下降可在2 h后改为1 mg/h,不间断给药,治疗2周。再口服尼莫地平片,60 mg/次,4次/d,治疗1周。治疗组在对照组的基础上口服苏合香丸,每天早晚各1粒,连续治疗3周。观察两组的临床疗效,比较两组患者神经功能,大脑前、中、后动脉平均血流速度,炎性因子和血管内皮功能因子水平。结果 治疗后,治疗组总有效率为90.91%,对照组总有效率为74.55%,组间比较具有明显差异(P<0.05)。治疗后,两组美国国立卫生研究院卒中量表(NIHSS)评分均明显降低(P<0.05),且与对照组比较,治疗组NIHSS评分明显降低(P<0.05)。治疗后,两组大脑前、中、后动脉平均血流速度均明显降低(P<0.05),且治疗组大脑前、中、后动脉平均血流速度明显高于对照组(P<0.05)。治疗后,两组血清超敏C反应蛋白(hs-CRP)、白细胞介素-8(IL-8)、肿瘤坏死因子(TNF-α)水平均明显降低(P<0.05),且与对照组相比,治疗组血清hs-CRP、IL-8、TNF-α水平明显降低(P<0.05)。治疗后,两组血清内皮素-1(ET-1)、血管内皮生长因子(VEGF)水平均明显降低,血清降钙素基因相关肽(CGRP)水平明显升高(P<0.05),且与对照组比较,治疗组血清ET-1、VEGF水平明显降低,血清CGRP水平明显升高(P<0.05)。结论 苏合香丸联合尼莫地平治疗蛛网膜下腔出血后脑血管痉挛具有较好的临床疗效,可有效提高神经功能,改善脑血流速度和血管内皮功能,减轻炎症反应,安全性较好。
[Key word]
[Abstract]
Objective To explore the clinical effect of Suhexiang Pills combined with nimodipine in treatment of cerebral vasospasm after subarachnoid hemorrhage.Methods Patients (110 cases) with cerebral vasospasm after subarachnoid hemorrhage in Nanshi Hospital of Nanyang from May 2018 to May 2021 were randomly divided into the control group (55 cases) and the treatment groups (55 cases). Patients in the control group were iv administered with Nimodipine Injection, dissolved with 5% glucose solution 500 mL. The initial rate was 0.5 mg/h, and if there was no significant decrease in blood pressure, it could be changed to 1 mg/h after 2 h, and the drug was administered continuously for 2 weeks. After that, patients in the control group were po administered with Nimodipine Tablets, 60 mg/time, four times daily, treated for 1 week. Patients in the treatment group were po administered with Suhexiang Pills on the basis of the control group, one capsule every morning and evening, treated for 3 weeks. After treatment, the clinical efficacies were evaluated, and the neurological function, the average blood flow velocity of anterior, middle, and posterior cerebral arteries, and the levels of inflammatory factors and vascular endothelial function factors in two groups were compared.Results After treatment, the total effective rate of the treatment group was 90.91%, that of the control group was 74.55%, and there was a significant difference between two groups (P < 0.05). After treatment, the NIHSS score of two groups were significantly decreased (P < 0.05), and compared with the control group, the NIHSS score of the treatment group was significantly lower (P < 0.05). After treatment, the average blood flow velocity of anterior, middle, and posterior cerebral arteries in two groups were significantly decreased (P < 0.05), and the average blood flow velocity of anterior, middle, and posterior cerebral arteries in the treatment group was significantly higher than those in the control group (P < 0.05). After treatment, the serum levels of hs-CRP, IL-8, and TNF-α in the two groups were significantly decreased (P < 0.05), and the serum levels of hs-CRP, IL-8, and TNF-α in the treatment group were significantly lower than those in the control group (P < 0.05). After treatment, the serum levels of ET-1 and VEGF in two groups were significantly decreased, but the serum level of CGRP in two groups were significantly increased (P < 0.05). Compared with the control group, the serum levels of ET-1 and VEGF were significantly lower, but the serum level of CGRP in the treatment group was significantly higher (P < 0.05).Conclusion Suhexiang Pills combined with nimodipine has clinical curative effect in treatment of cerebral vasospasm after subarachnoid hemorrhage, can effectively improve neurological function, cerebral blood flow velocity, and vascular endothelial function, and reduce inflammatory reaction, with good safety.
[中图分类号]
R971
[基金项目]
河南省高等学校重点科研项目(20A310011)