安宮牛黃丸輔助西藥治療高血壓腦出血的臨床療效觀察

張旭　尹忠民　張可帥

摘要?目的：探討安宮牛黃丸配合西藥尼莫地平對高血壓腦出血（HICH）患者臨床效果的影響。方法：選取2016年4月至2017年4月沈陽市第二中醫院收治的HICH患者92例作為研究對象，按照用藥方案不同，分為觀察組（n=47）和對照組（n=45）。觀察組以安宮牛黃丸結合尼莫地平治療，對照組單純使用西藥尼莫地平治療。檢測2組治療前、治療7 d后血清神經遞質，治療3個月后的日常生活活動Barthel指數、應激激素指標變化，記錄治療7 d內的不良反應。結果：1）觀察組在用藥后，血清神經遞質指標NTF（5.64±0.91）ng/mL、GABA（9.14±1.15）μmol/L、NGF（87.92±3.64）pg/mL顯著高于對照組，Glu（70.89±3.04）μmol/L、NPY（169.46±7.32）μg/L、NSE（12.58±1.08）μg/L、Gly（227.52±17.63）μmol/L、Asp（27.23±1.58）U/L顯著低于對照組（P<0.05）;2）觀察組在用藥后，血清應激激素指標AD（0.50±0.16）ng/mL、Cor（275.12±10.25）nmol/L顯著高于對照組，CRH（7.54±1.26）pmol/L、NE（322.13±10.62）ng/L、Ang-Ⅱ（41.62±3.01）ng/L、ACTH（6.54±0.75）pmol/L、MDA（3.22±0.46）nmol/mL、AVP（2.18±0.67）ng/L顯著低于對照組（P<0.05）;3）觀察組在用藥后日常生活活動Barthel指數總分（81.15±4.62）分顯著高于對照組（64.48±3.78）分（P<0.05）;4）觀察組不良反應率（14.89%）和對照組（17.78%）差異無統計學意義（P>0.05）。結論：對于HICH患者，在西藥尼莫地平治療基礎上，增加中藥安宮牛黃丸治療能夠有效改善患者神經遞質、應激激素表達水平，提高患者日常生活能力，不良反應較低。

關鍵詞?安宮牛黃丸;高血壓腦出血;西藥;尼莫地平;療效;Barthel指數;血清神經遞質;血清應激激素

Clinical Efficacy Observation on Angong Niuhuang Pills Combined with Western Medicine for the Treatment of Hypertensive Intracerebral Hemorrhage

Zhang Xu1，Yin Zhongmin2，Zhang Keshuai2

（1 Department of Neurosurgery，Second Traditional Chinese Medicine Hospital of Shenyang，Shenyang 110101，China; 2 No.463 Hospital of PLA，Shenyang 110042，China）

Abstract?Objective：To investigate the clinical effects of Angong Niuhuang Pills combined with nimodipine for the treatment of hypertensive intracerebral hemorrhage（HICH）. Methods：From April 2016 to April 2017，92 patients with HICH were selected in Second Traditional Chinese Medicine Hospital of Shenyang. According to the different medication schemes，they were divided into the observation group（47 cases）and the control group（45 cases）. The observation group was treated with Angong Niuhuang Pills combined with nimodipine，and the control group was treated with nimodipine alone. The serum neurotransmitters were detected before and after 7 days of the treatment in both groups. After 3 months of treatment，the changes of Barthelindex，stress hormone index were detected and the side effects were recorded within 7 days during the treatment. Results：1）In the study group after medication，the serum neurotransmitters NTF（5.64±0.91）ng/mL，GABA（9.14±1.15）μmol/L，NGF（87.92±3.64）pg/mL were significantly higher than those of the control group. Glu（70.89±3.04）μmol/L，NPY（169.46±7.32）μg/L，NSE（12.58±1.08）μg/L，Gly（227.52±17.63）μmol/L，Asp（27.23±1.58）U/L were significantly lower than those of the control group（P<0.05）. 2）In the study group，the serum stress hormone index AD（0.50±0.16）ng/mL，Cor（275.12±10.25）nmol/L were significantly higher than that of the control group. CRH（7.54±1.26）pmol/L，NE（322.13±10.62）ng/L，Ang-Ⅱ（41.62±3.01）ng/L，ACTH（6.54±0.75）pmol/L，MDA（3.22±0.46）nmol/mL，AVP（2.18±0.67）ng/L were significantly lower than that of the control group（P<0.05）. 3）The total Barthel index score of the study group（81.15±4.62）was significantly higher than that of the control group（64.48±3.78）（P<0.05）. 4）There was no significant difference in the adverse reaction rate between the study group（14.89%）and the control group（17.78%）（P<0.05）. Conclusion：For the patients with HICH，on the basis of the western medicine nimodipine，the addition of Angong Niuhuang Pills can effectively improve the neurotransmitter，stress hormone expression and improve the ability of daily life for patients，and the side effects are less.

Key Words?Angong Niuhuang Pills; Hypertensive intracerebral hemorrhage; Western medicine; Nimodipine; Curative effects; Barthel index; Serum neurotransmitter; Serum stress hormone

中圖分類號：R255.2文獻標識碼：Adoi：10.3969/j.issn.1673-7202.2019.03.036

高血壓性腦出血（Hypertens Iveintracerebral Hemorrhage，HICH）致殘、致死率相對較高，發患者數逐年增加，危害嚴重。對于HICH的西醫治療，通常以保守治療與手術治療為主。前者多采取營養神經、降顱內壓等對癥支持療法[1-2]。HICH在中醫理論中屬“中風病”范疇，病因和中風竅閉有關。安宮牛黃丸為傳統中成藥，已有動物實驗證實[3-4]，安宮牛黃丸在開竅醒腦方面有一定作用，可用于突發中風急癥的治療?！?br>