通窍活血汤对重型颅脑损伤的疗效及部分机制研究(1)
摘要 目的：探讨通窍活血汤对重型颅脑损伤微创血肿清除术后患者的治疗效果和作用机制。方法：选取2018年5月至2019年4月广州市中西结合医院收治的重型颅脑损伤微创血肿清除术患者124例作为研究对象，按住院号的单双号平均分为对照组和观察组，每组62例。对照组予术后常规治疗，观察组在对照组基础上加用通窍活血汤加减口服治疗，均治疗2周。观察并比较2组治疗1周、完成治疗后肿瘤坏死因子-α(TNF-α)、白细胞介素-1(IL-1)的变化，观察并比较2组患者治疗前、完成治疗后神经功能、血液流变学、血流动力学和相关评分的变化。结果：观察组患者治疗1周、完成治疗后，TNF-α、IL-1、GFAP、NSE、S100β蛋白、血黏稠度、血小板聚集指数、血管阻力指数、搏动指数下降幅度等指标均较对照组明显(P<0.05)，最大峰值流速、平均流速、MMSE、FCA、GCS评分增加幅度亦均较对照组明显(P<0.05)。结论：通窍活血汤能抑制重型颅脑损伤微创血肿清除术后炎性反应和应激反应，改善脑微循环，促进神经功能恢复，提高生命质量。
关键词 通窍活血汤;重型颅脑损伤;微创血肿清除术;炎性反应因子;血流动力学;应激反应;疗效;氧化应激
Abstract Objective：To explore the effects of Tongqiaohuoxue Decoction(tqhxd)on severe craniocerebral injury after minimally invasive hematoma removal.Methods：From May 1，2018 to April 30，2019，a total of 124 patients with severe craniocerebral injury undergoing minimally invasive hematoma removal in Guangzhou Integrative Chinese and Western Hospital were selected as the study objects.According to the hospitalization number，they were divided into 2 groups.The control group(n=62)was treated with routine treatment after operation.And the study group(n=62)was treated with modified oral treatment of Tongqiao Huoxue Decoction for 2 weeks on the basis of the control group.The changes of tumor necrosis factor-α(TNF-α)and interleukin-1(IL-1)were observed and compared in the 2 groups at different time points，and the changes of nerve function，hemorheology，hemodynamics and related scores were observed and compared in the 2 groups at the time of enrollment and at the completion of the treatment course.Results：The decrease of TNF-α，IL-1，GFAP，NSE，S100 β，blood viscosity，platelet aggregation index，vascular resistance index and pulsation index in the study group was larger than that in the control group(P<0.05).The maximum peak flow rate，average flow rate，MMSE，FCA，and GCS scores increased more than those in the control group(P<0.05)Conclusion：Tongqiao Huoxue Decoction can inhibit the inflammatory reaction and stress reaction of severe craniocerebral injury，improve cerebral microcirculation，promote the recovery of nerve function and improve the quality of life.
Keywords Tongqiao Huoxue Decoction; Severe craniocerebral injury; Minimally invasive hematoma removal; Inflammatory factors; Hemodynamics; Stress response; Therapeutic effects; Oxidative stress
中圖分类号：R269文献标识码：Adoi：10.3969/j.issn.1673-7202.2020.13.020
重型颅脑损伤是神经外科常见疾病，多数因外界暴力直接或间接损害头部所致。随着近年社会建设日益发展，交通事故伤有所增加，颅脑损伤发病率逐年上升。目前在治疗上以微创血肿清除术为主要治疗手段，调查显示，影响术后疗效的主要是并发症——外伤后脑积水，其中细胞因子在脑外伤后多种病理生理变化，包括脑水肿形成、脑间质炎性反应发生及脑胶质细胞增生和修复中起重要作用[1]，如肿瘤坏死因子-α(TNF-α)、白细胞介素-1(IL-1)等。TNF-α是由活化细胞产生的小分子多肽物质，可促进炎性反应细胞聚集和激活，释放炎性反应递质，增加单核细胞黏附作用，诱导其他细胞产生，加快血管内皮通透性，参与脑组织损伤过程。IL-1则是一种有多向性生物活性炎性物质，对炎性反应和免疫反应有调节作用，是临床最常见炎性反应递质[2]。中医认为，外伤术后脑积水主要是跌扑损伤、撞击等暴力作用于头部，损伤脑络，引起脑络瘀阻，而头为诸阳之会，外伤后瘀血蒙蔽清窍，从而出现昏迷、头晕、头痛、健忘、失眠等症，为本虚标实证，以肾虚为本，以瘀血、痰浊、水饮为标，在治疗上强调活血通窍。通窍活血汤出自《医林改错》，由赤芍、川芎、桃仁、红花等组成，具有活血化瘀、通窍活络作，广泛运用于颅脑损伤的治疗中。现代药理学研究证实，通窍活血汤具有减少神经元损伤，改善脑缺血，保护脑组织，抑制炎性反应的作用。本研究采用通窍活血汤治疗重型颅脑损伤微创血肿清除术后，发现其在促进颅脑血液循环，抑制炎性反应上优势显著，报道如下。, http://www.100md.com(练志明 简林养 谢伟坚)
关键词 通窍活血汤;重型颅脑损伤;微创血肿清除术;炎性反应因子;血流动力学;应激反应;疗效;氧化应激
Abstract Objective：To explore the effects of Tongqiaohuoxue Decoction(tqhxd)on severe craniocerebral injury after minimally invasive hematoma removal.Methods：From May 1，2018 to April 30，2019，a total of 124 patients with severe craniocerebral injury undergoing minimally invasive hematoma removal in Guangzhou Integrative Chinese and Western Hospital were selected as the study objects.According to the hospitalization number，they were divided into 2 groups.The control group(n=62)was treated with routine treatment after operation.And the study group(n=62)was treated with modified oral treatment of Tongqiao Huoxue Decoction for 2 weeks on the basis of the control group.The changes of tumor necrosis factor-α(TNF-α)and interleukin-1(IL-1)were observed and compared in the 2 groups at different time points，and the changes of nerve function，hemorheology，hemodynamics and related scores were observed and compared in the 2 groups at the time of enrollment and at the completion of the treatment course.Results：The decrease of TNF-α，IL-1，GFAP，NSE，S100 β，blood viscosity，platelet aggregation index，vascular resistance index and pulsation index in the study group was larger than that in the control group(P<0.05).The maximum peak flow rate，average flow rate，MMSE，FCA，and GCS scores increased more than those in the control group(P<0.05)Conclusion：Tongqiao Huoxue Decoction can inhibit the inflammatory reaction and stress reaction of severe craniocerebral injury，improve cerebral microcirculation，promote the recovery of nerve function and improve the quality of life.
Keywords Tongqiao Huoxue Decoction; Severe craniocerebral injury; Minimally invasive hematoma removal; Inflammatory factors; Hemodynamics; Stress response; Therapeutic effects; Oxidative stress
中圖分类号：R269文献标识码：Adoi：10.3969/j.issn.1673-7202.2020.13.020
重型颅脑损伤是神经外科常见疾病，多数因外界暴力直接或间接损害头部所致。随着近年社会建设日益发展，交通事故伤有所增加，颅脑损伤发病率逐年上升。目前在治疗上以微创血肿清除术为主要治疗手段，调查显示，影响术后疗效的主要是并发症——外伤后脑积水，其中细胞因子在脑外伤后多种病理生理变化，包括脑水肿形成、脑间质炎性反应发生及脑胶质细胞增生和修复中起重要作用[1]，如肿瘤坏死因子-α(TNF-α)、白细胞介素-1(IL-1)等。TNF-α是由活化细胞产生的小分子多肽物质，可促进炎性反应细胞聚集和激活，释放炎性反应递质，增加单核细胞黏附作用，诱导其他细胞产生，加快血管内皮通透性，参与脑组织损伤过程。IL-1则是一种有多向性生物活性炎性物质，对炎性反应和免疫反应有调节作用，是临床最常见炎性反应递质[2]。中医认为，外伤术后脑积水主要是跌扑损伤、撞击等暴力作用于头部，损伤脑络，引起脑络瘀阻，而头为诸阳之会，外伤后瘀血蒙蔽清窍，从而出现昏迷、头晕、头痛、健忘、失眠等症，为本虚标实证，以肾虚为本，以瘀血、痰浊、水饮为标，在治疗上强调活血通窍。通窍活血汤出自《医林改错》，由赤芍、川芎、桃仁、红花等组成，具有活血化瘀、通窍活络作，广泛运用于颅脑损伤的治疗中。现代药理学研究证实，通窍活血汤具有减少神经元损伤，改善脑缺血，保护脑组织，抑制炎性反应的作用。本研究采用通窍活血汤治疗重型颅脑损伤微创血肿清除术后，发现其在促进颅脑血液循环，抑制炎性反应上优势显著，报道如下。, http://www.100md.com(练志明 简林养 谢伟坚)