卢军锋 彭伟献

[摘要] 目的 探討阶梯降压治疗联合中药柴苓汤治疗高血压脑出血的临床效果。 方法 选择2018年8月～2019年8月在我院治疗的急性高血压脑出血60例患者进行研究，采用随机分组的方法分为两组，观察组30例，对照组30例。对照组给予阶梯降压法治疗及其他常规治疗。观察组在此基础上给予中药柴苓汤治疗。比较治疗第7天、第14天两组患者NIHSS评分、血肿量、中医证候积分，比较治疗14 d后两组临床疗效。 结果 （1）观察组治疗后第7天、第14天NIHSS评分较对照组低，差异显著（P<0.05）。（2）观察组治疗后第7天、第14天中医证候积分改善显著，较对照组低，差异显著（P<0.05）。（3）治疗后第7天、第14天，观察组血肿体积显著小于对照组，差异显著（P<0.05）。（4）临床疗效观察组较对照组优，差异有统计学意义（P<0.05）。 结论 阶梯降压治疗联合中药柴苓汤治疗高血压脑出血可显著改善临床疗效，改善神经功能缺损评分。

[关键词] 阶梯降压;柴苓汤;高血压;脑出血

[中图分类号] R743.34          [文献标识码] A          [文章编号] 1673-9701（2020）16-0005-04

Observation on the clinical effect of step-down antihypertensive therapy combined with Chinese herbal medicine Chailing decoction in the treatment of hypertensive cerebral hemorrhage

LU Junfeng   PENG Weixian

Department of Emergency， Hangzhou Hospital of TCM， Hangzhou   310007， China

[Abstract] Objective To explore the clinical effect of step-down antihypertensive therapy combined with Chinese herbal medicine Chailing decoction in the treatment of hypertensive cerebral hemorrhage. Methods 60 patients with acute hypertensive cerebral hemorrhage who were treated in our hospital from August 2018 to August 2019 were selected for study. The method of random grouping was used to divide the patients into two groups， with 30 cases in observation group and 30 cases in control group. The control group was given step-down antihypertensive treatment and other conventional treatment. The observation group was given Chailing decoction on this basis. The NIHSS scores， hematoma volume， and TCM syndrome scores of both groups of patients at 7 days and 14 days of treatment were compared， and the clinical effects were compared between the two groups after 14 days of treatment. Results （1）The NIHSS scores on the 7th and 14th days after treatment in the observation group were lower than those in the control group， and the differences were significant（P<0.05）. （2）The TCM syndrome scores in the observation group were improved significantly on the 7th and 14th days after treatment， which was lower than that in the control group， and the differences were significant（P<0.05）. （3）On the 7th and 14th days after treatment， the hematoma volume in the observation group was significantly smaller than that in the control group， and the difference was significant（P<0.05）. （4）The clinical effect in the observation group was better than that in the control group， and the difference was statistically significant（P<0.05）. Conclusion Step-down antihypertensive therapy combined with Chinese herbal medicine Chailing decoction can significantly improve clinical efficacy and improve neurological deficit scores.

[Key words] Step-down antihypertension; Chailing decoction; Hypertension; Cerebral hemorrhage

长期高血压导致脑动脉硬化是引起高血压脑出血的病理基础。在非损伤性脑出血的病因中，高血压占60%左右，是高血压病种最严重的并发症之一。血压控制不理想、反复波动是高血压脑出血的重要危险因素。其他还有疲劳、情绪激动、长期便秘、慢性呼吸道感染等可引起一过性颅内压增高，也可诱发高血压脑出血。高血压脑出血包括内科治疗和外科治疗，控制血液是重要的基础治疗之一，但在临床工作中还应避免血压突然迅速下降。阶梯降压是在伤后不同时间将血压控制在不同的目标水平[1]。既往研究显示，阶梯降压用于硬脑膜下血肿的治疗，可改善患者的预后，促进血肿消失[2]。柴苓汤是传统重要方剂，具有分利阴阳和解表里的功效，可用于痰证难治性高血压的治疗[3]。本文分析柴苓汤辅助治疗高血压脑出血，以期为临床治疗提供参考，现报道如下。……