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[目的]观察辨证分期联合西药治疗脑血管破裂急性期疗效。[方法]使用随机平行对照方法,将80例住院患者按掷骰子法简单随机分为两组。对照组40例出血量不多或神经系统损害较轻:卧床休息、吸氧、监控生命体征、调整高血压、降低颅内压、维持水电解质平衡、应用镇静、抗脑血管痉挛、防治并发症;出血量多或神经功能严重障碍:抢救治疗,避免移动,伴尿失禁或急性尿潴留,留置气囊导尿管导尿;密切监测生命体征,降低颅内血压;急救利血平,20%甘露醇、激素,20%白蛋白制剂联合降压;CT显示颅内血肿直径>3cm,行穿刺抽血减压;呼吸减慢或呼吸衰竭气管插管,保证呼吸道通畅,气囊和呼吸机机械辅助呼吸;清除鼻腔分泌物及口腔呕吐物;呼吸间停用气管切开;中枢性高热伴肺部感染、尿路感染,脑出血急性期易并发高热,冰敷后期采用降温毯,降低体温。治疗组40例辨证分期:前两周清热活血化瘀,通腑醒脑汤(生大黄15g,三七粉3g,黄连6g,栀子、黄芩各10g,白茅根20g,郁金12g),1剂/d,水煎200m L,早晚口服;后两周祛瘀通窍汤(水蛭6g,大黄12g,红花6g,郁金12g,丹参16g,三七粉3g,牛膝20g),1剂/d,水煎250m L,早晚口服;第二周起针刺,取地仓、百会、神阙、曲池、合谷、足三里、颊车、肩髃、外关、太冲、三阴交、解溪、环跳、阴陵泉、阳陵泉、太溪等,选穴10~12个/次,留针30min,1次/d,共15d;西药治疗同对照组。观测临床症状、神经功能缺损、不良反应。治疗1疗程,判定疗效。[结果]治疗组痊愈14例,显效21例,无效1例,恶化2例,死亡2例,总有效率87.50%。对照组痊愈7例,显效18例,无效2例,恶化6例,死亡7例,总有效率62.50%。治疗组疗效优于对照组(P<0.05)。[结论]辨证分期联合西药治疗脑血管破裂急性期效果显著,值得推广。
[Objective] To observe the syndrome differentiation staging combined with Western medicine in the treatment of cerebrovascular rupture acute phase effect. [Methods] Using randomized parallel control method, 80 inpatients were randomly divided into two groups according to the method of dice rolling. Control group, 40 cases of small amount of bleeding or less nervous system damage: bed rest, oxygen, monitoring vital signs, adjusting high blood pressure, reducing intracranial pressure, maintaining water and electrolyte balance, the application of sedation, anti-cerebral vasospasm, prevention and treatment of complications ; More bleeding or severe neurological dysfunction: rescue treatment, to avoid movement, with incontinence or acute urinary retention, catheter indwelling balloon catheterization; close monitoring of vital signs and reduce intracranial blood pressure; rescue reserpine, 20% of mannose Alcohol, hormones, 20% albumin preparations combined with antihypertension; CT showed intracranial hematoma diameter> 3cm, puncture blood pressure decompression; slow breathing or endotracheal intubation respiratory failure, to ensure airway patency, air bag and ventilator mechanical assisted breathing ; Removal of nasal secretions and oral vomit; respiratory tracheotomy disabled; central fever with pulmonary infection, urinary tract infection, acute cerebral hemorrhage complicated by high fever, ice cooling late blankets reduce body temperature. 40 cases of treatment group syndrome differentiation stage: the first two weeks of heat and blood circulation, Tongfu Xingnao soup (rhubarb 15g, notoginseng powder 3g, berberine 6g, gardenia, skullcap the 10g, Rhizoma Imperatae 20g, turmeric 12g), 1 Decoction of 200m L, decoction of morning and evening orally; after two weeks of stasis Tongqiao (leech 6g, rhubarb 12g, saffron 6g, turmeric 12g, Salvia 16g, notoginseng powder 3g, Achyranthes 20g), 1 / d, decoction 250m L, oral and sooner or later; the second week of acupuncture, take the warehouse, Baihui, Shenque, Quchi, Hegu, Zusanli, buccal car, shoulder 髃, the government, Taichong, Sanyinjiao, solution River, ring jump, Yinlingquan, Yanglingquan, too Creek, choose points 10 ~ 12 / time, needle 30min, 1 / d, a total of 15d; Western medicine treatment with the control group. Observation of clinical symptoms, neurological deficits, adverse reactions. Treatment of a course of treatment to determine the efficacy. [Result] In the treatment group, 14 cases were cured, 21 cases were markedly effective, 1 was ineffective, 2 cases were deteriorated and 2 died. The total effective rate was 87.50%. In the control group, 7 cases were cured, 18 cases were markedly effective, 2 cases were ineffective, 6 cases were deteriorated and 7 died. The total effective rate was 62.50%. The treatment group was better than the control group (P <0.05). [Conclusion] Syndrome differentiation combined with western medicine has a significant effect in the treatment of acute cerebrovascular rupture and is worth popularizing.