[1]崔磊 高乐.宁神止痉汤治疗aSAH介入术后脑血管 痉挛的机制研究[J].现代中医药,2022,1(01):133-136.[doi:10.13424/j.cnki.mtcm.2022.01.027]
　CUI Lei GAO Le.Study on The Mechanism of Ningshen Zhijing Decoction in Treatment of Cerebral Vasospasm After Intervention of aSAH[J].Modern Traditional Chinese Medicine,2022,1(01):133-136.[doi:10.13424/j.cnki.mtcm.2022.01.027]
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宁神止痉汤治疗aSAH介入术后脑血管 痉挛的机制研究
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《现代中医药》[ISSN:1006-6977/CN:61-1281/TN]

卷:
1
期数:
2022年01期
页码:
133-136
栏目:
临床精粹
出版日期:
2022-01-20

文章信息/Info

Title:
Study on The Mechanism of Ningshen Zhijing Decoction in Treatment of Cerebral Vasospasm After Intervention of aSAH
文章编号:
1672-0571(2022)01-0133-04
作者:
崔磊 高乐
西安市中医医院，陕西 西安 710021
Author(s):
CUI Lei GAO Le
Xi'an hospital of Traditional Chinese Medicine, Xi'an 710021,China
关键词:
关键词：蛛网膜下腔出血; 脑血管痉挛; 治疗
Keywords:
Key words：Subarachnoid hemorrhage; Cerebral vasospasm; Treatment
分类号:
R246.1
DOI:
10.13424/j.cnki.mtcm.2022.01.027
文献标志码:
A
摘要:
摘 要：目的 研究宁神止痉汤治疗aSAH介入术后脑血管痉挛的作用及其机制。方法 选择aSAH介入术后患者63例，随机分为两组，其中治疗组33例、对照组30例。两组均给予尼莫地平泵入及常规治疗，治疗组在此基础上加用宁神止痉汤每日一剂，两组均治疗14 d。检测不同时期ET-1、S100-β水平及TCD检查Vm、linde-gard、PI变化，对比颅脑CT新发脑梗死率。结果 两组入院时血清ET-1、S100-β水平及TCD检查Vm、linde-gard、PI水平无明显差异（P＞0.05），治疗组治疗后ET-1、S100-β水平显著低于对照组同期水平（P＜0.05）；治疗组Vm、linde-gard、PI水平在第7、14 d显著低于对照组同期水平（P＜0.05）；治疗组患者新发脑梗死病灶2例（61%），对照组新发脑梗死病灶4例（13.3%），治疗组新发脑梗死率显著低于对照组（P＜0.05）。结论 中药宁神止痉汤联合尼莫地平能够有效减轻aSAH介入术后患者的脑血管痉挛程度，降低新发脑梗死的发生率，其机制可能与降低ET-1及S100-β水平、改善血管内皮功能、预防脑细胞损伤有关。
Abstract:
Abstract：Objective To study the effect and mechanism of Ningshen Zhijing decoction in the treatment of cerebral vasospasm after intervention of aSAH. Methods 63 patients after aSAH intervention were randomly divided into two groups, including 33 cases in the treatment group and 30 cases in the control group. Both groups were treated with nimodipine pump and routine treatment. On this basis, the treatment group was treated with Ningshen Zhijing decoction once a day. Both groups were treated for 14 days. ET-1 and S100-β in different periods were detected. The changes of Vm, Linde-gard and PI were examined by TCD, and the rate of new cerebral infarction on brain CT was compared. Results Serum level of ET-1,S100-β and Vm, Linde-gard,PI detected by TCD at admission in the two groups had no significant difference (P>0.05).The levels of ET-1 and S100-β in the treatment group were significantly lower than those in the control group after treatment (P＜0. 05）；The levels of Vm, Linde-gard and PI in the treatment group were significantly lower than those in the control group after treatment and on the 7th and 14th day (P<0.05). There were 2 cases (6.1%) of new cerebral infarction in the treatment group and 4 cases (13.3%) in the control group. The rate of new cerebral infarction in the treatment group was significantly lower than that in the control group (P<0.05). Conclusion Ningshen Zhijing decoction combined with nimodipine can effectively reduce the degree of cerebral vasospasm and the incidence of new cerebral infarction in patients after aSAH intervention, and its mechanism may be related to the reduction of ET-1 and S100-β Level, improve vascular endothelial function and prevent brain cell injury.

参考文献/References:

[1］Rabinstein AA,Lanzino G.Aneurysmal Subarachnoid Hemorrhage：Unanswered Questions[J].Neurosurgery Clinics of North Americal,2018,29(2):255-262.
[2］Roberts D,Nourollah-Zadeh E.Cerebral vasospasm after subarachnoid hemorrhage:Is more endovascular therapy the answer[J].Neurology,2019,93(5):192-193．
[3］VanLieshout JH,Dibue-Adjei M,Cornelius JF,et al.An introduction to the pathophysiology of aneurysmal subarachnoid hemorrhage[J].Neurosurgical Review,2018,41(4):917-930．
[4］中华医学会神经病学分会.中国蛛网膜下腔出血诊治指南2015[J].中华神经科杂志,2016,49(3):182-191.
[5］中华医学会神经外科学分会.脑血管痉挛防治神经外科专家共识[J].中国卒中杂志,2008,3(5):356-362.
[6］中华中医药学会.脑出血中医诊疗指南[J].中国中医药现代远程教育,2011,9(23):110-112.
[7］Rabinstein AA,Lanzino G,Wijdicks EF.Multidisciplinary management and emerging therapeutic strategies in aneurysmal subarachnoid haemorrhage[J].Lancet Neurology,2010,9(5):504-519.
[8］房雅楠,隋汝波.EDNRA和EDNRB基因单核苷酸位点多态性与缺血性脑卒中的相关性[J].中国老年学杂志,2016,36(18):4446-4449.
[9］杨呈浩,陈岷辉,丁昊.动脉瘤性蛛网膜下腔出血患者血清血管假性血友病因子、内皮素-1含量变化及与脑血管痉挛的关系[J].中风与神经疾病杂志,2016,33(6):521-524.
[10］喻蕾.内皮素、氧合血红蛋白与蛛网膜下腔出血后脑血管痉挛的关系[J].中国实用医药,2015,10(20):48-49.
[11］吴权洋.特异性内皮素受体拮抗剂对蛛网膜下腔出血后脑微循环作用的CT灌注成像研究[D].沈阳：中国医科大学,2019.
[12］李晖,戴孝森,卓开全.尼莫地平与前列地尔联合治疗动脉瘤性蛛网膜下腔出血伴脑血管痉挛患者炎症因子和ET-1、CGRP、VEGF水平的影响[J].脑与神经疾病杂志,2019,27(7):438-442.
[13］Alejandro V，Reyes RXA，Maria Florencia A，et al.S100B alters neuronal survival anddendrite extension via RAGE-mediated NF- κ B signaling[J].Journal of Neurochemistry,2011,117(2):321-332.
[14］Santos G，Barateiro A，Gomes CM，et al.Impaired oligodendrogenesis and myelinationby elevated S100B levels during neurodevelopment[J].Neuropharmacology，2017,129:69-83.
[15］杨波,刘艳芳,边立衡,等.血浆S100B蛋白预测动脉瘤性蛛网膜下腔出血短期预后及并发症的研究[J].中国神经精神疾病杂志,2015,41(11):674-678.
[16］谢锋,叶敏,赖湘,等.动脉瘤性蛛网膜下腔出血患者血清S100B蛋白和NSE水平与Hunt-Hess分级及预后的关系[J].海南医学,2020,31(5):563-565.
[17］王玉妹,唐思魏,石广志.蛛网膜下腔出血后迟发性脑血管痉挛的发病机制和治疗进展[J].中国卒中杂志,2016,11(6):494-500.
[18］郭蓉娟,韩刚,王颖辉,等.72例蛛网膜下腔出血急性期患者中医症状学与病机分析[J].北京中医药大学学报(中医临床版),2005,12(4):11-13.
[19］吕晶.从痰、热、实浅析蛛网膜下腔出血(中风)中医病机[J].辽宁中医药大学学报,2015,17(10):57-59.
[20］许小泰,尚娟,韩菊梅.蛛网膜下腔出血中医证治规律的研究[J].世界最新医学信息文摘,2018,18(18):161-162.

备注/Memo

备注/Memo:
基金项目：国家自然科学基金项目（81673832）
更新日期/Last Update: 2022-02-18