羚角钩藤汤加减联合安宫牛黄丸治疗心肺复苏后缺血缺氧性脑病的体会  

Experience of modified Antelope horn and uncaria decoction combined with Angong Niuhuang pill in treating hypoxic ischemic encephalopathy after cardiopulmonary resuscitation

作　　者：卢轩禹 王波[2] 卢云[3] Lu Xuanyu;Wang Bo;Lu Yun(Beijing University of Traditional Chinese Medicine,Beijing 100029,China;Department of Critical Care Medicine,West China Hospital,Sichuan University,Chengdu 610041,Sichuan,China;Department of Emergency,Afiliated Hospital of Chengdu University of Traditional Chinese Medicine,Chengdu 610072,Sichuan,China)

机构地区：[1]北京中医药大学,北京100029 [2]四川大学华西医院重症医学科,四川成都610041 [3]成都中医药大学附属医院急诊科,四川成都610072

出　　处：《中国中西医结合急救杂志》2023年第6期668-672,共5页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：四川省名中医工作室建设项目(2100601)。

摘　　要：目的观察羚角钩藤汤加减合安宫牛黄丸治疗心肺复苏(CPR)后缺血缺氧性脑病(HIE)的临床疗效.方法回顾性分析2021年12年18日卢云教授参与会诊的四川大学华西医院重症监护病房(ICU)收治的1例CPR后HIE患者的临床资料,观察中药治疗HIE的临床效果.结果患者男性,40岁,既往体健,因CPR后出现昏迷、癫痫大发作、中枢性高热、颅内高压等,头颅CT提示广泛脑水肿,西医给予有创呼吸机辅助通气、控制体温、升压、镇静、镇痛、抗癫痫、脱水、保肝和维持内环境及营养支持等对症治疗方案.西医治疗22d后,患者症状控制不佳.请求中医会诊,结合患者四诊(神昏、高热、惊厥、形体肥胖、面色痿黄、唇红、舌红苔白腻、脉弦数弱),中医辨证为肝热生风、痰热蒙闭心窍,使用羚角钩藤汤加减联合安宫牛黄丸治疗,每日1剂,水煎服,麝香、羚羊角粉分3次冲汤,鼻饲下;安宫牛黄丸1粒,人参30g煎汤化开鼻饲下,每日2次.治疗10d后,患者意识清醒,可遵嘱完成简单动作,脱机状态,舌红苔薄白少,脉弦弱.汤剂去泽泻、大黄、麝香,羚羊角粉增至3g,生白芍增至30 g,安宫牛黄丸减至每日1粒,用法同上.西医治疗停用降温、脱水、镇痛、保肝治疗,减量抗癫痫药物.20 d后患者神清,症状缓解,舌红苔少,脉细弱,头颅CT示:脑水肿明显缓解.西医治疗仅用丙戊酸纳1600 mg、每12h1次管喂抗癫痫及镇静治疗.40 d随访,患者意识清醒,对答切题,能正常活动,停用镇静治疗,转出ICU至神经内科康复治疗.随访1年后患者已能正常生活、工作.结论中医药的有效介入在CPR后脑复苏中有很大发挥空间,复元醒脑,清肝息风,利水泻浊等法能有效降低患者脑水肿,控制癫痫发作.Objective To observe the clinical efficacy of modified Antelope horn and uncaria decoction combined with Angong Niuhuang pill in the treatment of hypoxic-ischemic encephalopathy(HIE)after cardiopulmonary resuscitation(CPR).Methods Clinical data of 1 patient with HIE after CPR admitted to the intensive care unit(ICU)of West China Hospital of Sichuan University on December 18,2021 was retrospectively analyzed,to observe the influence of TCM on HIE.The patient was consulted by Professor Lu Yun.Results The patient,a 40-year-old male,developed coma,grand mal seizures,central high fever,and intracranial hypertension after CRP.Patient was previously healthy.The head CT scan revealed extensive brain edema.The patient was treated by invasive ventilator assisted ventilation,temperature control,pressure management,sedation,analgesia,anti-epilepsy medication,dehydration management,liver protection,maintenance of internal environment,and nutritional support.However,after 22 days of western medicine treatment,the patient's symptoms remained poorly controlled.The patient was requested for TCM consultation.Combined with the four diagnosis of the patient,including fainting,high fever,convulsions,obesity,yellow face,red lips,red tongue,white and greasy tongue coating,and weak pulse,the TCM dialectics was liver heat to cause wind,phlegm heat to close the heart.Modified Antelope horn and uncaria decoction combined with Angong Niuhuang pill,were utilized for treatment.The patient received one dose of Chinese medicine decoction per day,with Moschus and Saigae Tataricae Cornu powder administered three times via nasal feeding.One Angong Niuhuang pill was administered with Ginseng decoction via nasal feeding,twice daily.After 10 days of treatment,the patient exhibited alertness and was able to successfully carry out simple actions as ordered.He was removed from the ventilator.Notably,the patient presented with a red tongue,thin white tongue coating,and a weak and stringy pulse.The doctor made the following adjustments to the treatment pl

关 键 词：缺血缺氧性脑病 中枢性高热 癫痫大发作 羚角钩藤汤 安宫牛黄丸 

分 类 号：R541.78[医药卫生—心血管疾病]