通腑中药结合西医治疗脑出血后脑水肿的效果及对炎症反应、水肿标志物和功能预后的影响  

Effect of Tongfu Chinese Medicine Combined with Western Medicine in the Treatment of Cerebral Edema After Cerebral Hemorrhage and Its Impact on Inflammatory Response,Edema Markers and Functional Prognosis

作　　者：周胜男 宋雅婷[4] 王旭欣 马少瑾 高丽英 ZHOU Shengnan;SONG Yating;WANG Xuxin;MA Shaojin;GAO Liying(The Third Department of Rongjun Rehabilitation,the Third Rongjun Youfu Hospital of Hebei Province,Baoding,Hebei 071000,China;Quality Control Office,the Third Rongjun Youfu Hospital of Hebei Province,Baoding,Hebei 071000,China;the Fourth Department of Rongjun Rehabilitation,the Third Rongjun Youfu Hospital of Hebei Province,Baoding,Hebei 071000,China;Department of Rehabilitation,Hebei Provincial Hospital of Traditional Chinese Medicine,Shijiazhuang 050013,China;Department of Brain Diseases,Chengde Provincial Hospital of Traditional Chinese Medicine,Chengde,Hebei 067000,China)

机构地区：[1]河北省第三荣军优抚医院荣军康复三科,河北保定071000 [2]河北省第三荣军优抚医院质控办,河北保定071000 [3]河北省第三荣军优抚医院荣军康复四科,河北保定071000 [4]河北省中医院康复科,石家庄050013 [5]承德市中医院脑病科,河北承德067000

出　　处：《临床误诊误治》2025年第4期94-100,共7页Clinical Misdiagnosis & Mistherapy

基　　金：河北省中医药管理局2018年度中医药类科研计划课题(2018026)。

摘　　要：目的探讨通腑中药结合西医治疗脑出血后脑水肿的效果及对炎症反应、水肿标志物及功能预后的影响。方法选取2022年5月至2024年5月收治的脑出血后脑水肿患者102例,随机数字表法分为西医组、联合组,每组51例。西医组采用常规西医治疗,联合组采用通腑中药结合西医治疗,均治疗14 d。比较2组治疗前后水肿体积、颅内压、格拉斯哥昏迷量表(GCS)评分、美国国立卫生研究院卒中量表(NIHSS)评分、炎症反应指标[核转录因子-κB(NF-κB)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、C反应蛋白(CRP)]、水肿标志物[基质金属蛋白酶-9(MMP-9)、水通道蛋白4(AQP4)],以及临床疗效、功能预后[脑卒中改良Rankin量表(mRS)]、不良反应发生情况。结果治疗3、14 d后,联合组水肿体积、颅内压、NIHSS评分低于西医组,GCS评分高于西医组(P<0.05)。治疗3、14 d后,联合组血清TNF-α、CRP、IL-6、NF-κB低于西医组(P<0.05)。治疗3、14 d后,联合组血清MMP-9、AQP4低于西医组(P<0.05)。联合组总有效率为98.04%(50/51),高于西医组的84.31%(43/51,P<0.05)。治疗后3个月,联合组功能预后优良率为94.12%(48/51),高于西医组的78.43%(40/51,P<0.05)。联合组不良反应发生率与西医组比较无明显差异(P>0.05)。结论通腑中药结合西医治疗脑出血后脑水肿具有显著效果,能有效减轻脑水肿,改善神经功能,抑制炎症反应,并提高患者功能预后质量。Objective To explore the effect of Tongfu Chinese medicine combined with Western medicine in the treatment of cerebral edema after cerebral hemorrhage and its impact on inflammatory response,edema markers and functional prognosis.Methods A total of 102 patients with cerebral edema after cerebral hemorrhage admitted from May 2022 to May 2024 were divided into Western medicine group(n=51)and combination group(n=51)by random number table method.The Western medicine group was treated with conventional Western medicine,and the combination group was treated with Tongfu Chinese medicine combined with Western medicine for 14 d.Edema volume,intracranial pressure,Glasgow Coma Scale(GCS)score,National Institutes of Health Stroke Scale(NIHSS)score,inflammatory response indexes[nuclear transcription factor-κB(NF-κB),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),C-reactive protein(CRP)],edema markers[matrix metalloproteinase-9(MMP-9),aquaporin 4(AQP4)]before and after treatment,clinical efficacy,functional prognosis[Modified Rankin Scale(mRS)],and occurrence of adverse reactions between the two groups were compared.Results At 3 and 14 d after treatment,the edema volume,intracranial pressure and NIHSS scores in the combination group were lower than those in the Western medicine group,while the GCS scores were higher than those in the Western medicine group(P<0.05).At 3 and 14 d after treatment,serum TNF-α,CRP,IL-6 and NF-κB in the combination group were lower than those in the Western medicine group(P<0.05).At 3 and 14 d after treatment,serum MMP-9 and AQP4 in combination group were lower than those in Western medicine group(P<0.05).The total effective rate of the combination group was 98.04%(50/51),which was higher than that of the Western group 84.31%(43/51,P<0.05).At 3 months after treatment,the excellent and good rate of functional prognosis of the combination group was 94.12%(48/51),which was higher than that of the Western medicine group 78.43%(40/51,P<0.05).There was no significant difference in the incidence

关 键 词：脑出血 脑水肿 通腑中药 颅内压 炎症反应 基质金属蛋白酶-9 水通道蛋白4 预后 

分 类 号：R743.34[医药卫生—神经病学与精神病学]