安宫牛黄丸辅助西药治疗高血压脑出血的临床疗效观察.docx
安宫牛黄丸辅助西药治疗高血压脑出血的临床疗效观察张旭尹忠民张可帅Summary目的：探寺寸安宫牛黄丸配合西药尼莫地平对高血压脑出血(HICH)患者临床效果的影响。方法：选取2016年4月至2017年4月沈阳市第二中医院收治的HICH患者92例作为研究对象，按照用药方案不同，分为观察组(n=47)和对照组(n=45) o观察组以安宫牛黄丸结合尼莫地平治疗，对照组单纯使用西药尼莫地平治疗。检测2组治疗前、治疗7 d后血清神经递质，治疗3个月后的日常生活活动Barthel指数、应激激素指标变化，记录治疗7 d内的不良反应。结果：1)观察组在用药后，血清神经递质指标NTF(5. 64±0. 91) ng/mL、GABA (9. 14±1. 15) umol/L, NGF (87. 92±3. 64)pg/mL 显著高于对照组,Glu (70. 89±3. 04) umol/L. NPY (169. 46±7. 32)Ug/L、NSE (12.58±1.08) ug/L、Gly (227. 52±17. 63) umol/L. Asp(27. 23±1.58) U/L显著低于对照组(P<0. 05) ；2)观察组在用药后，血清应激激素指标 AD (0. 50±0. 16) ng/mL、Cor (275. 12±10. 25) nmol/L 显著高于对照组，CRH (7. 54±1.26) pmol/L. NE (322. 13±10. 62) ng/L、Ang-II(41.62±3.01) ng/L、ACTH (6. 54±0. 75) pmol/L, MDA (3. 22±0. 46)nmol/mL. AVP (2. 18±0. 67) ng/L 显著低于对照组(P<0. 05) ；3)观察组在用药后日常生活活动Barthel指数总分(81. 15±4. 62)分显著高于对照组(64. 48±3. 78)分(P<0. 05) ；4)观察组不良反应率(14. 89%)和对照组(17. 78%)差异无统计学意义(P>0.05) o结论：对于HICH患者，在西药尼莫地平治疗基础上，增加中药安宫牛黄丸治疗能够有效改善患者神经递质、应激激素表达水平，提高患者日常生活能力，不良反应较低。Key安宫牛黄丸；高血压脑出血；西药；尼莫地平；疗效;Barthel指数；血清神经递质；血清应激激素Clinical Efficacy Observation on Angong Niuhuang Pills Combined withWestern Medicine for the Treatment of Hypertensive IntracerebralHemorrhageZhang Xul, Yin Zhongmin2, Zhang Keshuai2(1 Department of Neurosurgery, Second Traditional Chinese MedicineHospital of Shenyang, Shenyang 110101, China； 2 No.463 Hospital ofPLA, Shenyang 110042, China)Abstract Objective： To investigate the clinical effects of AngongNiuhuang Pills combined with nimodipine for the treatment ofhypertensive intracerebral hemorrhage (HIGH) . Methods： From April2016 to April 2017, 92 patients with HICH were selected in SecondTraditional Chinese Medicine Hospital of Shenyang. According to thedifferent medication schemes, they were divided into the observationgroup (47 cases) and the control group (45 cases) . The observationgroup was treated with Angong Niuhuang Pills combined withnimodipine, and the control group was treated with nimodipine alone.The serum neurotransmitters were detected before and after 7 days ofthe treatment in both groups. After 3 months of treatment, thechanges of Barthel index, stress hormone index were detected and theside effects were recorded within 7 days during the treatment.Results： 1) In the study group after medication, the serumneurotransmitters NTF (5. 64 + 0. 91) ng/mL, GABA (9. 14 + 1. 15) u mol/L,NGF (87. 92±3. 64) pg/mL were significantly higher than those of thecontrol group. Glu (70. 89±3. 04) u mol/L, NPY (169. 46±7. 32) u g/L,NSE (12.58±1.08) ug/L, Gly (227. 52±17. 63) umol/L, Asp(27. 23± 1. 58) U/L were significantly lower than those of the controlgroup (P<0. 05) . 2) In the study group, the serum stress hormoneindex AD (0. 50±0. 16) ng/mL, Cor (275. 12± 10. 25) nmol/L weresignificantly higher than that of the control group. CRH(7. 54±1.26) pmol/L, NE (322. 13±10. 62) ng/L, Ang-II (41.62±3.01)ng/L, ACTH (6. 54±0. 75) pmol/L, MDA (3. 22±0. 46) nmol/mL, AVP(2. 18±0. 67) ng/L were significantly lower than that of the controlgroup (P<0. 05) . 3) The total Barthel index score of the study group(81. 15±4. 62) was significantly higher than that of the controlgroup (64. 48±3. 78) (P<0. 05) . 4) There was no significantdifference in the adverse reaction rate between the study group(14.89%) and the control group (17.78%) (P<0.05) . Conclusion： Forthe patients with HIGH, on the basis of the western medicinenimodipine, the addition of Angong Niuhuang Pills can effectivelyimprove the neurotransmitter, stress hormone expression and improvethe ability of daily life for patients, and the side effects areless.Key Words Angong Niuhuang Pills； Hypertensive intracerebralhemorrhage； Western medicine； Nimodipine； Curative effects； Barthelindex； Serum neurotransmitter； Serum stress hormone：R255. 2： Adoi： 10. 3969/j. issn. 1673-7202. 2019. 03. 036高血压性脑出血(Hypertens Ive intracerebral Hemorrhage, HICH)致残、致死率相对较高，发患者数逐年增加，危害严重。对于HICH的西医治疗，通常以保守治疗与手术治疗为主。前者多采取营养神经、降颅内压等对症支持疗法1-2。H1CH在中医理论中属“中风病”范畴，病因和中风窍闭有关。安宫牛黄丸为传统中成药，已有动物实验证实3-4,安宫牛黄丸在开窍醒脑方面有一定作用，可用于突发中风急症的治疗。本研究现对安宫牛黄丸辅助西医治疗HICH的疗效进行分析，现报道如下。1资料与方法1. 1 一般资料选取2016年4月至2017年4月沈阳市第二中医院收治的HICH患者92例作为研究对象，按照用药方案不同，分为对照组（n=45）和观察组(n=47) o对照组中男27例，女18例；年龄4275岁，平均年龄(57. 19±4. 27)岁；病程26 d,平均病程(3.24±0. 14) d；出血量4274mL,平均出血量(56. 15±L39) niL；出血部位：脑室7例，基底节区22例，脑干4例，丘脑11例，小脑1例。观察组中男30例，女17例；年龄4476岁，平均年龄(55. 08±3. 16)岁；病程18 d,平均病程(4. 37±0. 25) d；出血量4580 mL,平均出血量(54. 82±1.28) mL；出血部位：脑干6例，基底节区18例，小脑2例，丘脑12例，脑室9例。2组性别、年龄、病程、出血量和出血部位等一般资料比较，差异无统计学意义(P>0.05),具有可比性。1.2 诊断标准1)西医诊断标准为第四届全国脑血管会议(1995年)发布的关于断标准，患者均经颅脑CT证实为HICH,出血量在4080 mL。2)中医诊断标准符合由中医药管理局制定的中药新药临床研究指导原则，由具有丰富经验的中医主任医师辨证分型5-6。1.3 纳入标准患者年龄3080岁；预计生存期超过7 d；临床资料完整，全程配合治疗;未产生呼吸衰竭、肺部感染等严重并发症。1.4 排除标准出血量过多，而需手术治疗者；对研究用药产生过敏症状者；因脑动脉瘤、脑血管畸形诱发的H1CH；中途失访者。1.5 治疗方法2组均采用西医降温、降血压、降颅压、补液、保持呼吸通畅等对症支持治疗。此外，对照组应用尼莫地平注射液(上海信谊金朱药业公司，国药准字H20030151) 10 mg,加入500 mL生
