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目的:观察蛛网膜下腔出血(SAH)后脑脊液内皮素1(ET-1)、一氧化氮(NO)水平的变化,探讨脑脉解痉汤对SAH后脑血管痉挛(CVS)的防治作用。方法:采用前瞻性的随机对照试验设计,60例患者分为实验组及对照组,实验组给予西医治疗及脑脉解痉汤口服,对照组给予西医治疗,用酶标记免疫吸附测定法(ELISA法)检测发病后3天和7天脑脊液ET-1和NO水平,多普勒检测出血后第7天脑血管痉挛的发生率。结果:①实验组CVS发生10例(33.3%),对照组CVS发生17例(56.7%),有统计学差异(P﹤0.05);②对照组和实验组脑脊液ET-1水平在出血后3天无明显差异(P>0.05),对照组和实验组的ET-1水平随时间递增(P<0.05),但对照组增加更明显,差异有统计学意义(P<0.05)。③对照组和实验组脑脊液NO水平在出血后3天无明显差异(P>0.05),对照组和实验组的NO水平随时间递减(P<0.05),但对照组降低更明显,差异有统计学意义(P<0.05)。结论:采用脑脉解痉汤治疗后,SAH患者脑脊液中ET-1水平下降,而NO水平则上升,脑血管痉挛的发生率下降,提示脑脉解痉汤对SAH后CVS有较好的防治作用。
Objective: To observe the changes of cerebrospinal fluid endothelin-1 (ET-1) and nitric oxide (NO) after subarachnoid hemorrhage (SAH) and to explore the preventive and therapeutic effects of Naomai Xiejue decoction on cerebrovascular vasospasm (CVS) after SAH. Methods: A prospective randomized controlled trial was designed. Sixty patients were divided into experimental group and control group. The experimental group was treated with western medicine and Naomaisheji Decoction orally. The control group was treated with western medicine. Enzyme-linked immunosorbent assay (ELISA) Method) to detect the levels of ET-1 and NO in cerebrospinal fluid 3 days and 7 days after onset, and the incidence of cerebral vasospasm on the 7th day after Doppler hemorrhage. Results: ① CVS occurred in 10 cases (33.3%) in experimental group and 17 cases (56.7%) in CVS in control group (P <0.05). ② The levels of ET-1 in cerebrospinal fluid in control group and experimental group were significantly higher than those in control group (P> 0.05). The ET-1 level in control group and experimental group increased with time (P <0.05), but the control group increased more obviously, the difference was statistically significant (P <0.05). (3) NO levels in cerebrospinal fluid in control group and experimental group had no significant difference at 3 days after hemorrhage (P> 0.05), NO in control group and experimental group decreased with time (P <0.05), but the control group decreased more obviously Significance (P <0.05). Conclusion: After treatment with Naomaishejutang, the level of ET-1 in cerebrospinal fluid of patients with SAH decreased while the level of NO increased while the incidence of cerebral vasospasm decreased, suggesting that Naomaizhisiju Decoction could better prevent CVS after SAH effect.