清震汤加减联合微创血肿清除术治疗高血压脑出血临床研究  

Clinical Study on Modified Qingzhen Decoction Combined with Minimally Invasive Hematoma Removal for Hypertensive Intracerebral Hemorrhage

作　　者：王莉[1] 周翠玲[1] 麻伟兴[1] 李燕[1] WANG Li;ZHOU Cuiling;MA Weixing;LI Yan(Department of Neurosurgery,Lishui Municipal Central Hospital,Lishui Zhejiang 323000,China)

机构地区：[1]丽水市中心医院神经外科,浙江丽水323000

出　　处：《新中医》2024年第10期30-34,共5页New Chinese Medicine

摘　　要：目的:观察清震汤加减联合微创血肿清除术治疗高血压脑出血的治疗效果。方法:抽取98例高血压脑出血患者为研究对象,按照随机数字表法分为试验组和对照组各49例。对照组行微创血肿清除术,术后给予西医常规治疗,试验组在对照组基础上联合清震汤加减治疗。比较2组颅内压(ICP)、美国国立卫生院卒中量表(NIHSS)评分与格拉斯哥昏迷指数(GCS),脑水肿体积和持续时间,血清肿瘤坏死因子-α(TNF-α)、神经生长因子(NGF)、基质金属蛋白酶-9(MMP-9)水平及中医证候评分。结果:术前,2组ICP值比较,差异无统计学意义(P>0.05);术后即刻及24 h、72 h、1周,试验组相同时间点的ICP值均低于对照组(P<0.05)。术前,2组NIHSS、GCS指数评分比较,差异无统计学意义(P>0.05);术后14 d,试验组NIHSS评分低于对照组(P<0.05),GCS指数高于对照组(P<0.05)。术后,试验组脑水肿体积、脑水肿持续时间低于对照组,差异有统计学意义(P<0.05)。术前,2组血清TNF-α、MMP-9、NGF水平比较,差异无统计学意义(P>0.05)。术后14 d,2组血清TNF-α、MMP-9水平较术前下降(P<0.05),血清NGF水平较术前上升(P<0.05);且试验组血清TNF-α、MMP-9水平低于对照组(P<0.05),NGF水平高于对照组(P<0.05)。术前,2组半身不遂、口眼歪斜、神志昏蒙等中医证候评分比较,差异无统计学意义(P>0.05);术后14 d,试验组上述各项中医证候评分均低于对照组(P<0.05)。结论:微创血肿清除术联合清震汤加减治疗高血压脑出血可降低ICP,减轻卒中症状和昏迷指数,减轻脑水肿,改善中医证候及炎症反应。Objective:To observe the curative effect of the therapy of modified Qingzhen Decoction combined with minimally invasive hematoma removal on hypertensive intracerebral hemorrhage.Methods:A total of 98 patients with hypertensive intracerebral hemorrhage were selected as the study subjects and divided into the trial group and the control group according to the random number table method,with 49 cases in each group.The control group was given minimally invasive hematoma removal,and routine western medicine after surgery,and the trial group was additionally treated with modified Qingzhen Decoction based on the treatment of the control group.The intracranial pressure(ICP),scores of National Institute of Health Stroke Scale(NIHSS)and Glasgow Coma Scale(GCS),volume and duration of cerebral edema,levels of serum tumor necrosis factor-α(TNF-α),nerve growth factor(NGF)and matrix metalloproteinase-9(MMP9)and traditional Chinese medicine(TCM)syndrome scores were compared between the two groups.Results:Before surgery,there was no significant difference being found in the comparison of ICP value between the two groups(P>0.05).The moment,24 hours,72 hours and one week after surgery,the ICP value in the trial group at the same time point was respectively lower than that in the control group(P<0.05).Before surgery,there was no significant difference being found in the comparisons of scores of NIHSS and GCS between the two groups(P>0.05);fourteen days after surgery,the NIHSS score in the trial group was lower than that in the control group(P<0.05),and the GCS score was higher than that in the control group(P<0.05).After surgery,the volume and duration of cerebral edema in the trail group were lower than those in the control group,the difference being significant(P<0.05).Before surgery,there was no significant difference being found in the comparisons of levels of serum TNF-α,MMP-9 and NGF between the two groups(P>0.05).Fourteen days after surgery,the levels of serum TNF-αand MMP-9 in the two groups were decreased when compared

关 键 词：高血压脑出血 微创血肿清除术 清震汤 颅内压 脑水肿 炎症因子 

分 类 号：R743.34[医药卫生—神经病学与精神病学]