桂苓脑路通颗粒辅助治疗继发性脑积水患者的效果

doi:10.3760/cma.j.cn441417-20241129-10028

摘要/Abstract

摘要：

目的　探究桂苓脑路通颗粒辅助治疗继发性脑积水的临床效果。方法　选取2020年8月至2024年8月西安中医脑病医院收治的发病不超过3个月的92例轻度继发性脑积水患者为前瞻性研究对象，采用抽签法将患者分为西医治疗组和联合治疗组，各46例。西医治疗组男29例，女17例，年龄（60.43±4.66）岁，病程1～3（2.44±0.31）个月。联合治疗组男25例，女21例，年龄（61.65±4.71）岁，病程1～3（2.49±0.37）个月。西医治疗组给予营养神经、改善循环、平衡电解质等基础治疗，联合治疗组在西医治疗组的基础上给予西安中医脑病医院制剂室制备的桂苓脑路通颗粒。两组患者持续治疗4周。比较两组患者的中医临床症状疗效、临床疗效、日常生活活动能力量表（BI）评分、格拉斯哥昏迷评分法（GCS）评分、颅内压、脑室指数、Huckman值、Evan’s指数、胼胝体夹角、外周血中枢神经特异蛋白（S100β）、神经元特异性烯醇化酶（NSE）、髓鞘碱性蛋白（MBP）和血管内皮生长因子（VEGF）水平等的差异。采用χ²检验、t检验进行统计学分析。结果　治疗后，联合治疗组中医临床症状疗效和临床疗效高于西医治疗组［97.824%（45/46）比86.957%（40/46）、95.652%（44/46）比82.609%（38/46）］，差异均有统计学意义（均P<0.05）；联合治疗组的BI、GCS评分高于西医治疗组［（84.76±8.66）分比（79.44±8.14）分、（10.33±1.57）分比（9.62±1.49）分］，差异均有统计学意义（t=3.036、2.225，均P<0.05）；联合治疗组的颅内压、脑室指数、Huckman 值、Evan’s指数和胼胝体夹角低于西医治疗组［（168.04±20.20）mmHg（1mmHg=0.133kPa）比（179.28±21.48）mmHg、（30.51±2.14）比（32.25±2.66）、（15.18±4.08）mm比（17.69±4.13）mm、（0.31±0.06）比（0.34±0.08）、（90.01±9.23）°比（94.14±11.53）°］，差异均有统计学意义（均P<0.05）；联合治疗组的S100β、NSE、MBP和VEGF水平低于西医治疗组［（289.01±6.43）ng/L比（311.62±7.17）ng/L、（20.48±3.12）μg/L比（29.17±3.85）μg/L、（7.85±1.95）mg/L比（10.15±2.07）mg/L、（87.83±55.42）ng/L比（118.16±67.63）ng/L］，差异均有统计学意义（均P<0.05）。结论　桂苓脑路通颗粒辅助治疗可显著改善继发性脑积水患者的日常生活能力、意识状态及影像学指标（降低颅内压、脑室指数等），并下调S100β、NSE等神经损伤标志物水平，具有良好临床疗效。

关键词: 桂苓脑路通颗粒辅助治疗, , , 继发性脑积水, , , 日常生活能力, , , 颅内压, , , 外周血神经损伤标志物

Abstract:

Objective　To explore the clinical effect of adjuvant treatment with Guiling Naolutong granules for patients with granules secondary hydrocephalus. Methods　A total of 92 patients with secondary hydrocephalus who were treated at Xi'an Chinese Medicine Encephalopathy Hospital from August 2020 to August 2024 and had the onset less than 3 months were selected as the study objects. The patients were divided into a western medicine treatment group and a combined treatment group by drawing lots, with 46 cases in each group. In the Western medicine treatment group, there were 29 males and 17 females, with an age of (60.43±4.66) years and a disease duration of 1 to 3 (2.44±0.31) months. In the combined treatment group, there were 25 males and 21 females, with an age of (61.65±4.71) years and a disease duration of 1 to 3 (2.49±0.37) months. The Western medicine treatment group was given basic treatments,such as nourishing the nerves, improving circulation and balancing electrolytes. The combined treatment group was given Guiling Naoluotong Granules, prepared in the preparation room of Xi 'an Traditional Chinese Medicine Brain Disease Hospital on the basis of the Western medicine treatment group. The two groups of patients were treated continuously for 4 weeks. The Chinese medicine symptom efficacies, clinical efficacies, scores of Barthel Index (BI) and GGlasgow Coma Scale (GCS) , intracranial pressures, ventricle indexes, Huckman values, Evan's indexes, corpus callosum angles, and levels of S100β, NSE, MBP and VEGF in peripheral blood were compared between the two groups. χ² and t tests were used for the statistical analysis. Results　After treatment, the combined treatment group demonstrated significantly higher efficacy in improving TCM clinical symptoms and overall clinical effectiveness compared to the Western medicine group [97.824% (45/46) vs. 86.957% (40/46), and 95.652% (44/46) vs. 82.609% (38/46)]; there were statistical differences (all P<0.05).The combined treatment group exhibited significantly higher BI and GCS scores than the Western medicine group [(84.76 ± 8.66) vs. (79.44 ± 8.14), and (10.33 ± 1.57) vs. (9.62 ± 1.49)]; there were statistical differences (t=3.036、2.225，all P<0.05).Additionally, the combined treatment group showed significantly lower values in intracranial pressure, ventricular index, Huckman value, Evan's index, and corpus callosum angle compared to the Western medicine group [(168.04 ± 20.20) mmHg (1 mmHg = 0.133 kPa) vs. (179.28 ± 21.48) mmHg, (30.51 ± 2.14) vs. (32.25 ± 2.66), (15.18 ± 4.08) mm vs. (17.69 ± 4.13) mm, (0.31 ± 0.06) vs. (0.34 ± 0.08), and (90.01 ± 9.23)° vs. (94.14 ± 11.53)°]; there were statistical differences (all P<0.05).Furthermore, the combined treatment group had significantly lower levels of S100β, neuron-specific enolase (NSE), myelin basic protein (MBP), and vascular endothelial growth factor (VEGF) compared to the Western medicine group [(289.01 ± 6.43) ng/L vs. (311.62 ± 7.17) ng/L, (20.48 ± 3.12) μg/L vs. (29.17 ± 3.85) μg/L, (7.85 ± 1.95) mg/L vs. (10.15 ± 2.07) mg/L, and (87.83 ± 55.42) ng/L vs. (118.16 ± 67.63) ng/L]; there were statistical differences(all P<0.05). Conclusion　Guiling Naolutong granules as adjuvant therapy significantly improves daily living ability, consciousness status, and neuroimaging parameters (e.g, reduces intracranial pressure and ventricular indices) in patients with secondary hydrocephalus, while downregulating neuroinjury biomarkers (S100β, NSE, etc.), demonstrating favorable clinical efficacy.

Key words:

djuvant treatment with Guiling Naolutong , granules, , Secondary hydrocephalus, , Daily living ability, , Intracranial pressure, , Markers of peripheral blood nerve injury ,

李辉陈波秦宝娟李红妮詹远玲徐晓丹张少婷苏萍陈霄. 桂苓脑路通颗粒辅助治疗继发性脑积水患者的效果 [J]. 国际医药卫生导报, 2025, 31(10): 1718-.

Li Hui, Chen Bo, Qin Baojuan, Li Hongni, Zhan Yuanling, Xu Xiaodan, Zhang Shaoting, Su Ping, Chen Xiao. [J]. International Medicine and Health Guidance News, 2025, 31(10): 1718-.

参考文献

[1]刘笑宇,常健博,张笑,等.继发性脑积水发病机制研究进展[J].中国现代神经疾病杂志,2023,23(6):490-495.继发性脑积水发病机制研究进展.

[2]王华伟,周剑云,王月,等.不同角度电动起立床训练对脑外伤致脑积水患者脑室-腹腔分流术后意识障碍及日常生活活动能力的影响[J].中国医刊,2024,59(7):797-800.DOI:10.3969/j.issn.1008-1070.2024.07.024.

[3]朱新喜,江振华,刘晶晶,等.老年自发型蛛网膜下腔出血患者并发脑积水的影响因素[J].中国老年学杂志,2022,42(5):1062-1065. DOI:10.3969/j.issn.1005-9202.2022.05.012.

[4]孙毅,王希,刘兴东,等.创伤性蛛网膜下腔出血并发分流依赖性脑积水危险因素分析及列线图预测模型的构建[J].中华神经医学杂志, 2022, 21(10):1026-1029.DOI:10.3760/cma.j.cn115354-20220629-00457.

[5]钱中润,陈一楠,杨涛,等.不同穿刺路径对继发交通性脑积水的临床疗效分析[J].临床神经外科杂志, 2023, 20(4):441-444.DOI:10.3969/j.issn.1672-7770.2023.04.016.

[6]夏善朋,杜超,侯利杰.脑室—腹腔分流术后分流管远端移位至腹壁1例[J].中国实验诊断学, 2024, 28(5):553-554.DOI:10.3969/j.issn.1007-4287.2024.05.012.

[7]张学文,祝海平.脑脊液分流术后裂隙脑室综合征的临床特点及治疗[J].康颐, 2022(21):188-190.DOI:10.12332/j.issn.2095-6525.2022.21.063.

[8]罗流,李明非,何刚,等.活血豁痰法防治急性脑出血后脑积水的多中心、前瞻性、队列研究[J].北京中医药大学学报,2024,47(5):603-610.DOI:10.3969/j.issn. 1006-2157. 2024.05.003.

[9]怡文辉,陈霄,王凯悦,等.中医内科临床诊疗专家共识·脑积水(正常压力脑积水)[J].中国医药导刊, 2023, 25(8):767-772.DOI:10.3969/j.issn.1009-0959.2023.08.001.

[10]中国医师协会神经外科医师分会.中国脑积水规范化治疗专家共识(2013版)[J].中华神经外科杂志,2013,29(6):634-637.DOI:10.3760/cma.j.issn.1001-2346.2013.06.035.

[11]郑筱萸.中药新药临床研究指导原则:试行[J].中国医药科技出版社, 2002.

[12]姚国杰,于多,杜威.脑室-腹腔分流术后并发症的诊疗路径探讨[J].中国临床神经外科杂志, 2022, 27(11):957-960.DOI:10.13798/j.issn.1009-153X.2022.11.027.

[13]李宝梅,王静,吕士银,等.艾灸与贴敷调理对颅脑损伤患者胃肠功能紊乱的影响[J].国际医药卫生导报, 2023, 29(2):5.DOI:10.3760/cma.j.issn.1007-1245.2023.02.021.

[14]张容超,郭奎奎,郭新荣,等.基于脑源性神经营养因子探讨针灸治疗颅脑损伤的可能机制[J].针灸临床杂志, 2023, 39(2):102-105.DOI:10.19917/j.cnki.1005-0779.023040.

[15]Yadav V , Sahu A , Pandey N ,et al.A comprehensive study of risk factors predicting hydrocephalus following decompressive craniectomy in traumatic brain injuries[J].Egyptian Journal of Neurosurgery, 2024, 39(1):127-131.DOI:10.1186/s41984-024-00323-3.

[16]范雪君,柴清喜,李建军,等.脑室出血后脑积水改良与传统脑室-腹腔分流术近期效果对比研究[J].河南外科学杂志, 2024, 30(2):99-101.

[17]朱静文,田财军,贾裕智,等.薯蓣汤加减辅助治疗正常压力性脑积水疗效观察[J].山东医药, 2023, 63(20):51-54.DOI:10.3969/j.issn.1002-266X.2023.20.012.

[18]殷立夫.中西医结合综合方案治疗脑出血后脑积水临床观察[J].光明中医,2022,37(1):134-136.DOI:10.3969/j.issn.1003-8914.2022.01.046.

[19]李昂,冯庆琪,于朝春,等.正常压力脑积水的中医药治疗进展[J].四川中医, 2023, 41(6):216-219.

[20]史润霞,张文珊,张用华.血府逐瘀汤联合针刺治疗脑创伤后脑积水的临床观察[J].中国民间疗法,2022,30(5):81-84.DOI:10.19621/j.cnki.11-3555/r.2022.0527.

[21]杜晓刚,宋虎杰.宋虎杰教授三位一体综合方案治疗水瘀互结型小儿脑积水的临床效果[J].临床医学研究与实践,2021,6(28):125-127.DOI:10.19347/j.cnki.2096-1413.202128039.

[22]苏丞,孙双喜,孟苗苗,等.基于网络药理学探讨五苓散治疗脑积水的作用机制[J].中西医结合心脑血管病杂志, 2022, 20(23):4244-4250.DOI:10.12102/j.issn.1672-1349.2022.23.004.

[23]朱医博.归芪祛风合剂联合胞磷胆碱片治疗脑出血术后脑积水临床观察[J].实用中医药杂志, 2024, 40(2):292-295.

[24]王凌立,刘燎原.五苓散治疗中风后脑积水的临床效果[J].临床医学研究与实践,2024,9(33):155-158.DOI:10.19347/j.cnki.2096-1413.202433039.

[25]韩晓玲,杨云,唐华,等.人参对缺血性心脏病的保护作用及机制研究进展[J].河北医药, 2022, 44(20):3163-3166.DOI:10.3969/j.issn.1002-7386.2022.20.031.