麝香四黄汤联合正中神经电刺激促醒痰热血瘀型脑外伤后昏迷患者的临床观察  

Clinical Observation of Shexiang Sihuang Decoction Combined with Median Nerve Electrical Stimulation to Regain Consciousness in Patients with Coma Caused by TBI of Phlegm-Heat and Blood Stasis

作　　者：胡逸君 张伦忠[2] 周虹[2] 张焕新 隋云龙 张臻 HU Yijun;ZHANG Lunzhong;ZHOU Hong;ZHANG Huanxin;SUI Yunlong;ZHANG Zhen(First School of Clinical Medicine,Shandong University of Traditional Chinese Medicine,Jinan 250014,China;Weifang Hospital of Traditional Chinese Medicine,Weifang 261041,China)

机构地区：[1]山东中医药大学第一临床医学院,山东济南250014 [2]潍坊市中医院,山东潍坊261041

出　　处：《中医药学报》2022年第11期73-77,共5页Acta Chinese Medicine and Pharmacology

基　　金：山东省中医药科技项目(2020M143)。

摘　　要：目的:观察麝香四黄汤联合正中神经电刺激对于痰热血瘀型脑外伤后昏迷患者的促醒作用。方法:将潍坊市中医院脑病康复科2021年1月—2021年10月收治的60例辨证为痰热血瘀型的脑外伤昏迷患者采用随机数字表法分为两组,对照组和治疗组,每组30例。对照组患者使用常规促醒方法(多感官刺激,高压氧、运动康复、脑保护剂)加用2次/d正中神经电刺激治疗,治疗组患者采用常规促醒加用1剂/d麝香四黄汤,分2次鼻饲,并且加用2次/d正中神经电刺激治疗。以上治疗均以2周为1个疗程,共2个疗程。以治疗开始、治疗2周、治疗4周为观察节点,比较两组患者治疗前后的格拉斯哥昏迷量表(GCS)评分、脑电图(EEG)评分、白细胞介素-6(IL-6)水平,并在治疗结束两个月后比较两组患者格拉斯哥预后量表(GOS)评分。结果:与对照组相比,治疗组GCS、EEG、GOS评分明显增加,IL-6浓度明显降低,差异均有统计学意义(P<0.05)。结论:在常规疗法的基础上加用麝香四黄汤联合正中神经电刺激相较于仅加用正中神经电刺激可以更有效地促进痰热血瘀型脑外伤后昏迷患者意识障碍的恢复,并显著改善预后,且安全可靠。Objective:To observe the regaining consciousness effect of Shexiang Sihuang Decoction combined with median nerve electrical stimulation(MNES)on coma patients with traumatic brain injury(TBI)of phlegm-heat and blood stasis.Methods:A total of 60 patients with coma due to TBI of phlegm-heat and blood stasis were randomly divided into the control group and the treatment group,with 30 cases in each group.The control group was treated with regaining of consciousness,including multi-sensory stimulation,hyperbaric oxygen,exercise rehabilitation,brain protective agent,and MNES was used twice a day.The treatment group was treated with conventional consciousness regaining,Shexiang Sihuang Decoction(one dose per day,twice nasal feeding),and MNES(twice a day).The two groups were treated for 4 weeks.Glasgow coma scale(GCS)score,electroencephalogram(EEG)score,and interleukin-6(IL-6)level were compared between the two groups before treatment,after 2 weeks of treatment and 4 weeks of treatment.Glasgow outcome scale(GOS)score was also compared between the two groups at the time point of 2 months after treatment.Results:Compared with those in the control group,the scores of GCS,EEG and GOS were increased,and IL-6 level was decreased in the treatment group(P<0.05).Conclusion:On the basis of conventional methods,Shexiang Sihuang Decoction combined with MNES can more effectively promote the recovery of consciousness disorder and significantly improve the prognosis of coma patients with TBI of phlegm-heat and blood stasis,compared with single MNES.The therapy is safety and reliable.

关 键 词：麝香四黄汤 正中神经电刺激 痰热血瘀 颅脑外伤 促醒 脑病康复 

分 类 号：R245.9[医药卫生—针灸推拿学]