芳香开窍药嗅吸剂联合尼莫地平对创伤性蛛网膜下腔出血后脑血管痉挛的影响  

Effect of Sniffing Agents of Resuscitative Aromatic Herbs with Nimodipine on Cerebral Vasospasm in Patients with Traumatic Subarachnoid Hemorrhage

作　　者：姜涛[1] 周杰[2] 周水晶[1] 黄李法[1] 崔建军[1] 叶强[1] 

机构地区：[1]浙江省中医院 [2]中国中医科学院望京医院

出　　处：《中医杂志》2015年第6期492-495,共4页Journal of Traditional Chinese Medicine

基　　金：浙江省中医药科技计划项目(2010ZA030)

摘　　要：目的观察芳香开窍药嗅吸剂联合尼莫地平治疗创伤性蛛网膜下腔出血（t SAH）后脑血管痉挛（CVS）的临床疗效。方法 60例t SAH患者随机分为对照组、嗅吸剂组、尼莫地平组、联合治疗组,每组15例。对照组给予止血、脱水、支持及对症处理等常规治疗。在对照组常规治疗基础上,嗅吸剂组加用芳香开窍嗅吸剂嗅吸每次5~10 min,每日3~5次;尼莫地平组加用尼莫地平每日10 mg持续静脉微量泵入;联合治疗组联合应用芳香开窍药嗅吸剂和尼莫地平。各组均治疗10天。入院时及入院后第3、5、7、9、11天行经经颅多普勒检查,观察患者大脑中动脉平均流速,并于3个月后评价患者脑外伤综合征阳性体征情况。结果 5天后嗅吸剂组、尼莫地平组及联合治疗组脑血流速度均较对照组明显改善（P〈0.05）,且联合治疗组优于嗅吸剂组及尼莫地平组（P〈0.05）,尼莫地平组与嗅吸剂组比较,差异无统计学意义（P〉0.05）。与对照组比较,嗅吸剂组及联合治疗组脑外伤综合征阳性体征患者显著减少（P〈0.05）,且联合治疗组优于嗅吸剂组（P〈0.05）。结论芳香开窍药嗅吸剂联合尼莫地平不仅能减轻t SAH后CVS的严重程度,且能明显改善患者的预后。Objective To observe the clinical efficacy of sniffing agents of resuscitative aromatic herbs combined with nimodipine in treating cerebral vasospasm（ CVS） in patients with traumatic subarachnoid hemorrhage（ t SAH）.Methods Totally 60 t SAH patients were randomly divided into control group,sniffing agent group,nimodipine group,and combined treatment group,with 15 cases in each. Each group was given hemostasis,dehydration,and symptomatic and supportive treatments. Meanwhile,the sniffing agent group was added with sniffing agents of resuscitative aromatic herbs for 3- 5 min each time,3- 5 times per day; the nimodipine group was added with 10 mg of nimodipine through continuous intravenous pump daily; and the combined treatment group was added with both the the sniffing agents and nimodipine together. The course lasted for 10 days. At the time of admission and on day 3,5,7,9 and 11 after admission,the examination of transcranial Doppler ultrasound was conducted to observe the average flow velocity of the middle cerebral artery,and in month 3,the positive signs of postcerebrotraumatic syndrome were detected. Results Compared with the control group,the cerebral blood flow velocity in the sniffing agent group,nimodipine group and combined treatment group on day 5 was significantly improved（ P〈0. 05）. The combined treatment group had the best results in blood flow velocity improvement among the groups（ P〈0. 05）,while there was no significant difference in the improvements between the sniffing agent group and nimodipine group had（ P〉0. 05）. Compared with the control group,there were much less patients with positive signs in the sniffing agent group and combined treatment group（ P〈0. 05）,especially in the combined treatment group（ P〈0. 05）. Conclusion The sniffing agents of resuscitative aromatic herbs combined with nimodipine could not only reduce the severity of CVS in t SAH patients,but improve their prognosis.

关 键 词：创伤性蛛网膜下腔出血 脑血管痉挛 芳香开窍药 经鼻腔给药 尼莫地平 

分 类 号：R743.35[医药卫生—神经病学与精神病学]