脑脉解痉汤减少微血栓防治动脉瘤性蛛网膜下腔出血后迟发性脑缺血的临床研究

摘要

Objective To investigate the efficacy,safety and the possible mechanism of Naomai Jiejing decoction (NJD)for treat-ment of delayed cerebral ischemia (DCI)in patients with aneurysmal subarachnoid hemorrhage.Methods Sixty patients were ran-domly divided into two groups:Treatment group (n=30)treated by NJD 1 and western medicine,and control group (n=30)treated by NJD 2 and western medicine.The incidence of DCI,National Institutes of Health Stroke Scale (NIHSS)score,the number of micro thrombosis,the difference of the TCD middle cerebral artery mean flow velocity,and levels of PAF and ADP were observed at 3 d,7 d,14 d.Results The incidence of DCI,NIHSS score,and the number of micro thrombi in treatment group was significantly lower than that in control group at 7 d,and 14 d (P<0.05).The average middle cerebral artery blood flow velocity was lower than that in control group at 7 d (P<0.05),there was no significant difference at 14 d (P>0.05).Plasma PAF and ADP levels were lower than that in control group (P<0.05)at 7 d and 14 d.Mortality rate (2 cases in the treatment group and 3 cases in control group)was not statistically significant in two treatment groups (P>0.05).Conclusion NJD could suppress PAF and ADP activity.It could reduce the formation of micro thrombosis,incidence of DCI and the neurological deficit,and improve prognosis in aSAH patients.%目的：探讨专方脑脉解痉汤防治动脉瘤性蛛网膜下腔出血(aSAH)围术期DCI的有效性、安全性及可能作用机制。方法采用前瞻性的随机对照试验设计,将60例患者分为治疗组及对照组,每组30例,两组均采用西医基础治疗。治疗组：术前予基础治疗+尼莫地平+脑脉解痉汤1号方；术后予基础治疗+尼莫地平+脑脉解痉汤2号方。对照组：基础治疗+尼莫地平。比较各组入院3 d、7 d、14 d 时DCI发生率及美国国立卫生院卒中量表(NIHSS)评分、经颅多普勒超声(TCD)检测微血栓数目、大脑中动脉平均血流速度及血浆血小板活化因子(PAF)、二磷酸腺苷(ADP)水平；出院时、90 d 后的改良 Rankin 量表(mRS)评分以及总体死亡率。结果14 d时评价56例,死亡4例,其中治疗组2例,对照组2例90 d随访终点评价病例数为54例(治疗组28例,对照组26例),失访1例,死亡1例,均为对照组患者。治疗组DCI发生率、NIHSS评分、微血栓数目在7 d、14 d时明显低于对照组,差异有统计学意义(P<0.05),大脑中动脉平均血流速度7d时低于对照组,差异有统计学意义(P<0.05),14d时差异无统计学意义(P>0.05)。血浆PAF水平在7 d、14 d时低于对照组,差异有统计学意义(P<0.05)；血浆 ADP水平在7 d、14 d时高于对照组,差异有统计学意义(P<0.05)。总计死亡5例,其中治疗组2例,对照组3例,两组死亡率比较差异无统计学意义(P>0.05)。结论采用脑脉解痉汤结合常规西医治疗能够抑制PAF及ADP活性,减少微血栓的形成,降低aSAH 患者DCI发生率,减少神经功能缺损,从而改善预后。