中西医结合方案防治动脉瘤性蛛网膜下腔出血围手术期迟发性脑血管痉挛的临床观察  

Clinical Observation on the Prevention and Treatment of Perioperative Delayed Cerebrovasospasm in Patients with Aneurysmal Subarachnoid Hemorrhage by the Comprehensive Protocol of Integrative Medicine

作　　者：李贵福[1] 马朝晖[1] 罗望池[1] 钟经馨[1] 郭建文[1] 李铁林[1] 黄燕[1] 

机构地区：[1]广东省中医院脑病三科,广州510120

出　　处：《中国中西医结合杂志》2012年第10期1345-1349,共5页Chinese Journal of Integrated Traditional and Western Medicine

基　　金：国家中医药管理局中医药科学技术专项(No.06-07LP31);广东省中医药管理局资助项目(No.2008322)

摘　　要：目的探讨中西医结合方案防治动脉瘤性蛛网膜下腔出血(aneurysmal subarachnoid hemorrhage,aSAH)围手术期迟发性脑血管痉挛(delayed cerebrovasospasm,DCVS)的有效性及安全性。方法采用前瞻性随机对照试验设计,63例aSAH住院患者分为试验组31例(介入治疗24例,开颅7例)和对照组32例(介入治疗26例,开颅6例)。两组均给予基础治疗及尼莫地平治疗,试验组加服中药脑脉解痉汤1号和2号治疗。比较两组患者入院第180天DCVS、再出血、脑积水发生率及病死率;入院第1、3、7、14天大脑中动脉平均血流速度(Vm)、脉冲指数(PI)、脑血管痉挛指数(linde-gard指数);入院第1、14、180天中医证候评分、美国国立卫生所卒中量表(NIHSS)及修正的Rankin量表评分。结果试验组DCVS发生率及再出血发生率明显低于对照组(分别为29.0%vs53.1%,3.2%vs6.2%),差异均有统计学意义(P<0.05)。两组病死率(6.4%vs9.4%)及脑积水发生率(29.0%vs25.0%)比较,差异均无统计学意义(P>0.05)。试验组入院第7天Vm、PI和linde-gard指数以及第14天Vm和linde-gard指数均明显低于对照组(P<0.05)。试验组入院第14、180天时中医证候评分及NIHSS评分均低于对照组,差异有统计学意义(P<0.05)。结论中西医结合治疗能够降低aSAH患者DCVS的发生率、中医证候评分以及NIHSS评分,改善临床症状。Objective To investigate the efficacy and safety of the comprehensive protocol of integrative medicine in preventing and treating perioperative delayed cerebrovasospasm （DCVS） in patients with aneurysmal subarachnoid hemorrhage （, aSAH）. Methods Using a prospective randomized controlled trial design, 63 aSAH inpatients were assigned to the treatment group （31 cases, 24 treated by intervention treatment and 7 by craniot- omy） and the control group （32 cases, 26 treated by intervention treatment and 6 by craniotomy）. All patients were treated with basic therapy and nimodipine. Those in the treatment group additionally took Naomai Jiejing De- coction No. 1 and No. 2. The incidence and the mortality of DCVS, re-bleeding, hydrocephalus were compared on the 180th day. The middle cerebral artery mean flow velocity （Vm）, PI value, linde-gard index on day 1,3, 7, and 14 were compared. The Chinese medicine syndrome score, NIHSS, and revised Rankin questionnaire on day 1, 14, and 180 were compared. Results The DCVS occurred in 9 cases （29.0%） of the treatment group and 17 patients （53. 1%） of the control group, showing statistical difference （P 〈0.05）. The occurrence of re- hemorrhage was obviously lower in the treatment than in the control group （3.2% vs 6.2% ）, showing statistical difference （ P 〈0.05）. There was no statistical difference in the mortality （6.4% vs 9.4%） or the occurrence of hydrocephalus （29.0% vs 25.0%, P 〉0.05）. The Vm, PI, and linde-gard index on day 7, the Vm and linde- gard index on day 14 were obviously lower in the treatment group than in the control group （P〈0. 05）. The Chi- nese medicine syndrome score and NIHSS on day 14 and 180 were lower in the treatment group than in the con-trol group, showing statistical difference （P 〈 0.05）. Conclusion The comprehensive protocol of integrative medicine could reduce the incidence of aSAH patients＇ DCVS, the Chinese medicine syndrome score and NIH-SS, and improve their clinical symptoms.

关 键 词：中西医结合 蛛网膜下腔出血 脑血管痉挛 颅内动脉瘤 围手术期 

分 类 号：R743.3[医药卫生—神经病学与精神病学]