通窍活血汤联合依达拉奉和高压氧治疗一氧化碳中毒后迟发性脑病的研究  

A study of Tongqiao Huoxue decoction combined with edaravone and hyperbaric oxygen for treatment of delayed encephalopathy after carbon monoxide poisoning

作　　者：孙锡波[1] 陈传磊[1] 潘海英[1] 赵成花[1] 李真[1] 刘明德[2] 牛建一[1] 李炳选[1] 

机构地区：[1]潍坊医学院附属益都中心医院神经内科,山东青州262500 [2]潍坊医学院附属益都中心医院中医科,山东青州262500

出　　处：《中国中西医结合急救杂志》2015年第2期170-172,共3页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：山东省潍坊市中医药科研项目（2013035）

摘　　要：目的：探讨通窍活血汤联合依达拉奉和高压氧治疗一氧化碳（CO）中毒后迟发性脑病（DEACMP）的临床疗效。方法采用前瞻性研究方法，选择2012年1月至2014年1月潍坊医学院附属益都中心医院收治的46例DEACMP患者，按照简单随机法分为观察组和对照组，每组23例。观察组在高压氧、胞二磷胆碱等常规治疗基础上加用自拟通窍活血汤加减治疗（方药组成：赤芍15 g，川芎15 g，桃仁15 g，红花15 g，生姜3片，大枣2个，麝香0.5 g，老葱1棵；每日1剂，水煎服或鼻饲），疗程1个月；同时给予依达拉奉每次30 mg，每日2次静脉滴注（静滴），连用14 d。对照组给予高压氧等常规治疗，疗程30 d。治疗30 d后观察临床疗效和不良反应发生情况，应用长谷川智能量表（HDS）检测患者智能水平的改变，应用肌电图/诱发电位仪检测治疗前后时间相关电位P300潜伏期的变化。结果观察组总有效率明显高于对照组〔91.3%（21/23）比65.2%（15/23）， P＜0.01〕。观察组出现肌酐升高1例，丙氨酸转氨酶（ALT）轻度升高1例，治疗结束后均恢复正常；对照组未见不良反应发生。两组治疗后30d HDS评分均较治疗前明显升高〔对照组（分）：13.4±2.8比6.8±2.3；观察组（分）：20.8±3.4比6.6±2.5，均P＜0.05〕，P300潜伏期均较治疗前明显降低〔对照组（ms）：355.7±25.7比385.5±27.8；观察组（ms）：337.3±24.6比386.8±25.4，均P＜0.05〕，且以观察组的变化更显著〔HDS评分（分）：20.8±3.4比13.4±2.8，P300潜伏期（ms）：337.3±24.6比355.7±25.7，均P＜0.05〕。结论通窍活血汤联合依达拉奉、高压氧治疗DEACMP疗效好，值得临床推广。Objective To study the clinical curative effect of Tongqiao Huoxue decoction combined with edaravone and hyperbaric oxygen for treatment of delayed encephalopathy after carbon monoxide poisoning （DEACMP）. Methods A prospective study was conducted. Forty-six patients with DEACMP admitted into Yidu Central Hospital of Weifang Medical College from January 2012 to January 2014 were randomly divided into observation group （23 cases） and control group （23 cases）. The basic treatments of two groups were identical. Based on the basic treatments including hyperbaric oxygen and citicoline sodium injection etc, the observation group was treated with our-self made Tongqiao Huoxue decoction which could be modified in accord to the individual differentiation of syndromes in traditional Chinese medicine （the composition of decoction included Paeoniae Radix Rubra 15 g, Chuanxiong Rhizoma 15 g, Persicae Semen 15 g, Carthami Flos 15 g, Zingiberis Rhizoma Recens 3 pieces, Jujubae Fructus 2 pieces, Moschus 0.5 g, Allium Fistulosum 1 segment）. The decoction was administered orally or by nasogastric gavage, one dosage everyday for 1 month, and in the mean time, edaravone intravenously drip 30 mg was given to the observation group twice a day for 14 days. The control group was given hyperbaric oxygen and other conventional treatment for 30 days. The clinical therapeutic effect and adverse reaction were observed after treatment for 30 days. The changes of intelligent level were detected by Hasegawa dementia scale （HDS）, and the changes of latency of P300 were measured by electromyologram/evoked potential instrument in two groups before and after treatment. Results The total effective rate in observation group was significantly higher than that in control group [91.3% （21/23） vs. 65.2% （15/23）, P 〈 0.01]. Elevation of creatinine occurred in 1 case, moderate increase in alanine aminotransferase （ALT） appeared in 1 case, and both of them were reduced to normal after treatment in observation group; no adver

关 键 词：通窍活血汤 依达拉奉 高压氧 一氧化碳中毒后迟发性脑病 

分 类 号：R749.63[医药卫生—神经病学与精神病学]