医药学论文：中药活血化瘀汤治疗脑损伤及颅内血肿的研究

【摘要】 目的 使用活血化瘀疗法治疗外伤性颅内血肿和脑震荡，并对其疗效进行评价。方法 选择适应非手术治疗的外伤性颅内血肿666例，随机分为活血化瘀治疗组434例，使用以丹参、当归、红花、川芎为主方的口服中药汤剂；对照组232例使用常规的脱水、改善微循环和对症治疗。分别比较不同部位，不同大小血肿的吸收时间。选择有自觉头痛、头晕、记忆力障碍等症状明显的脑损伤1221例，随机分为活血化瘀治疗组和脑震宁、脑复康、脑活素、赖氨酸及天麻密环片治疗组，分别比较症状缓解情况和治疗有效率。结果 脑内血肿活血化瘀汤治疗组比西药组血块吸收时间平均缩短了32.04%，P＜0.001。硬膜外血肿，其血肿量为3～10ml或25～30ml者，两组对照无显著差异，血肿在10～25ml，活血化瘀汤组血肿吸收时间缩短了22.71%，P＜0.001。急性、亚急性硬膜下血肿活血化瘀汤治疗组血肿吸收时间平均缩短了35.77%，P＜0.001。活血化瘀疗法用于脑伤后头痛、头昏、记忆力下降及恐惧症等的治愈好转率为80.88%。结论 以丹参、当归、红花、川芎为主方的活血化瘀汤具有活血散瘀、止痛安神、养血益智之功效，能有效的促进部分外伤性颅内血肿的提早吸收，在消除和缓解脑外伤后的相应临床症状方面具有肯定的疗效。
【关键词】 颅脑损伤；颅内血肿；活血化瘀
【Abstract】 Objective Investigation and evaluation for treatment to brain injury and intracranial hematoma(IH)treated with traditional Chinese of promoting blood circulation and removing blood stasis.Methods 666 cases treated by non-operation were researched.The group with traditional Chinese of promoting blood circulation and removing blood stasis were 434 cases，treated with the agents including dan-shen root，angelica，safflower， szechwan lovge rhizome， etc.The control group was 232 cases by regular treatment with dehydration， improving microcirculation， etc. Comparing with parts，time of different intracranial hematoma absorbed，respectively.A group with promoting blood circulation and removing blood stasis and 6 groups with NaoZHN，NaoFK，cerebrolysin， lysine， tall gastrodia tuber，which of them were selected from 1221 cases with symptoms of headache， dizziness， memory disorder obviously，were compared with situation of remission of symptoms above and outcome of therapeutic efficiency.Results The average time of blood clot absorption within brain that the group was treated by promoting blood circulation and removing blood stasis was less 32.04%(P＜0.001) than that of other groups. There was no difference between epidural hematoma(3～10ml or 25～30ml) and other groups， but the average time of absorption in hematoma(10～25ml) was less 22.71%(P＜0.001) than that of other groups， the average time of absorption in acute and subacute subdural hematoma were less 35.77%(P＜0.001) than that of other groups.The effective rate of the treatment of traditional Chinese of promoting blood circulation and removing blood stasis for headache after brain injury， dizziness， memory disorder and fearful mood was 80.88%.Conclusion The agents of treatment using including dan-shen root， angelica，safflower， szechwan lovge rhizome has a function of promoting blood circulation and removing blood stasis， analgesia and smooth the nerves， support circulation and benefit wisdom.This treatment can improve absorption of intracranial hematoma happened by brain injury and reduce and relieve of the corresponding symptoms.
【Key words】 brain injury；intracranial hematoma；promoting circulation and removing stasis
我院自1990年7月～2004年12月应用中药活血化瘀汤加减治疗外伤性颅内血肿、脑挫裂伤、脑震荡共434例。血肿吸收的速度、脑伤后自觉症状的减轻和消除均明显提前，治疗效果明显。
1 临床资料
活血化瘀汤治疗颅脑损伤434例，男273例，女161例，年龄最大者78岁，最小者3岁，平均36岁。致伤原因：车祸伤298例，坠落伤61例，打击伤49例，其它26例。受伤机制：减速伤277例，加速伤7l例，复杂性损伤80例，枪弹伤6例。本组伤员出现颅内血肿者230例(脑内血肿67例，硬膜外血肿59例，硬膜下血肿104例)，属急性血肿203例，亚急性血肿27例。脑挫裂伤54例，脑震荡150例。对照组232例，其年龄、性别、出血量、意识状态和受伤时间与对照组比较无显著性差异。
2 方法
本组选择活血化瘀汤保守治疗的颅内血肿病例，其适应证为：血肿量均在30ml以下，GCS≥8分，ICP＜2.0kPa，无脑疝和家属拒绝手术治疗的病例，且病情相对稳定。活血化瘀汤治疗组和对照组，在伤后早期均使用一定量的脱水药及激素以降低颅内压。待意识好转，呕吐停止后开始内服或鼻饲活血化瘀汤，成人每日100～200ml每日两次，儿童酌减。两组病例在姑息治疗过程中有8例意识障碍加深出现脑疝而改为手术治疗，其中活血化瘀汤治疗组3例，西药治疗组5例。脑震荡病例入院后即开始服活血化瘀汤并与使用脑复康、脑震宁、脑活素、天麻密环片治疗组对照。
3 结果
3.1 中药活血化瘀治疗颅内血肿的结果 非手术治疗的颅内血肿共462例，随机分为活血化瘀汤治疗组230例，西药治疗组232例（使用20%甘露醇、速尿、激素），再根据颅内血肿量的多少分为三组，第一组血肿量在3～10ml，第二组血肿量11～25ml，第三组血肿量26～30ml。根据血肿部位不同又分为脑内血肿组，硬膜外血肿组，急性、亚急性硬膜下血肿组。分别在治疗后3天、5天、7天、10天、14天、24天、30天复查CT对血肿的吸收情况进行分组对比，并经统计学处理。结果见表1～3。