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目的 探讨刺五加注射液预防和治疗蛛网膜下腔出血后脑血管痉挛(cerebral vasospasm,CVS)的疗效及其机制。方法 根据1994年中华医学会第4届全国脑血管病学术会议修订的诊断标准,44例蛛网膜下腔出血患者,随机分为刺五加组(20例)和对照组(24例),两组均于发病48h内接受治疗。对照组采用常规药物治疗,刺五加组在常规疗法基础上加用刺五加注射液100ml,每日1次静脉滴注,共治疗7d。采用放射免疫分析法测定血浆内皮素水平。结果 应用刺五加注射液治疗1个月后,刺五加组CVS的发生率与病死率(均为10.0％)明显低于对照组(37.5％),差异有显著性意义(均P<0.05)。再出血发生率分别为15.0％和16.7％,两组比较差异无显著性意义(P>0.05)。刺五加组血浆内皮素水平明显低于对照组(P<0.05或P<0.01)。结论 刺五加注射液防治蛛网膜下腔出血后CVS疗效确实,既可促进神经功能尽快恢复,又不增加再出血的危险性。其机制之一可能系与降低血浆内皮素水平有关。
Objective To investigate the efficacy and mechanism of Acanthopanax senticosus injection in the prevention and treatment of cerebral vasospasm (CVS) after subarachnoid hemorrhage. Methods According to the revised diagnostic criteria of the 4th National Cerebrovascular Disease Conference of Chinese Medical Association in 1994, 44 patients with subarachnoid hemorrhage were randomly divided into acanthopanax group (n = 20) and control group (n = 24) Group were treated within 48h onset. Control group using conventional drug treatment, acanthopanas group in the conventional therapy plus acanthopanax injection 100ml, daily intravenous infusion, a total of 7d. Plasma endothelin levels were determined by radioimmunoassay. Results After acanthopanax senticosus injection for 1 month, the incidence and mortality of CVS in Acanthopanax senticosus group (10.0%) were significantly lower than those in control group (37.5%) (all P <0.05 ). The incidences of rebleeding were 15.0% and 16.7% respectively, with no significant difference between the two groups (P> 0.05). Acanthopanax senticosus plasma ET level was significantly lower than the control group (P <0.05 or P <0.01). Conclusion Acanthopanax senticosus prevention and treatment of CVS after subarachnoid hemorrhage is indeed effective, can promote neurological recovery as soon as possible, without increasing the risk of rebleeding. One of its mechanisms may be related to reducing plasma endothelin levels.