CN114949086B - 一种治疗脑出血的组合物 - Google Patents
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Abstract
本发明公开了一种治疗脑出血的组合物,它是含有如下重量配比的原料药制备而成:黄芪800~900份,桂枝200~300份,大血藤300~400份,泽泻400~500份,大黄100~200份,三七100~200份,麝香1~3份。经动物试验证明,本发明组合物可减轻脑出血模型大鼠血肿大小,降低脑组织含水量,提升脑组织SOD和CAT活性,对脑组织MDA含量和神经学功能评分也有降低趋势,对急性脑出血具有显著的治疗效果。
Description
技术领域
本发明具体涉及一种治疗脑出血的组合物。
背景技术
脑出血是卒中最严重的一种类型,其30d死亡率高达35%~52%,半数以上的死亡发生在发病后2天内,6个月后仅有1/5的患者能生活自理,脑出血患者急性期的高死亡率可能与脑出血继续出血有关,继续出血使血肿进一步增大,导致临床症状的进行性恶化甚至死亡,随着头颅CT的推广使用,动态观察证实脑出血患者入院后一段时间内存在继续出血,血肿增大现象,给临床早期诊断与治疗提供了可能。
脑出血后,由于血肿的压迫,血红蛋白及脑组织缺血等引发一系列病理生理变化,造成脑水肿、颅内高压。脑出血后造成的继发性损伤的主要因素包括炎症反应、继发性代谢产物毒性、血脑屏障破坏以及继发性血管源性水肿的形成。其中脑水肿是脑出血后致死、致残关键因素和病理基础。脑水肿会加重、恶化脑组织的血供和神经细胞内环境紊乱等,从而加重神经细胞损伤,是脑出血后神经元受第二次打击的中心环节,也是脑出血后继发脑损伤的主要标志。血管破坏是脑出血后脑水肿的直接原因,而血脑屏障(blood brainbarrier,BBB)功能障碍是其关键环节。目前用于急性脑出血的中药制剂多为活血化瘀、益气、通腑泻热、清热解毒等,例如,专利CN105535449A,一种治疗脑血管病的药物,其仅具有止血活血的双重作用,对于出血引起的血脑屏障损害、脑水肿等临床症状的改善并不理想。
发明内容
为解决上述问题,本发明提供了一种治疗脑出血的组合物,它是含有如下重量配比的原料药制备而成:
黄芪800~900份,桂枝200~300份,大血藤300~400份,泽泻400~500份,大黄100~200份,三七100~200份,麝香1~3份。
进一步地,它是含有如下重量配比的原料药制备而成:
黄芪800~850份,桂枝200~220份,大血藤300~350份,泽泻400~450份,大黄100~150份,三七100~150份,麝香1~2份。
进一步地,它是含有如下重量配比的原料药制备而成:
黄芪834份,桂枝209份,大血藤334份,泽泻417份,大黄125份,三七125份,麝香1.25份。
更进一步地,所述泽泻为盐泽泻;所述大黄为生大黄;所述麝香为人工麝香。
进一步地,它是由原料的粉末、或原料的水或有机溶剂提取物为活性成分,加上药品上可接受的辅料制备而成的口服制剂。
更进一步地,所述口服制剂为溶液剂、颗粒剂、丸剂或胶囊剂,优选颗粒剂。
更进一步地,所述颗粒剂是由下述重量配比的原料制备而成:
黄芪834份,桂枝209份,大血藤334份,盐泽泻417份,生大黄125份,三七125份,人工麝香1.25份、糊精491份。
本发明还提供了一种前述组合物的制备方法,它包括如下步骤:
1)按配比称取原料;
2)取三七粉碎,加乙醇混匀,40~60℃密闭24~72小时,干燥,粉碎得三七粉;取人工麝香,加12~18倍量的糊精混合,再加乙醇制粒,干燥,得人工麝香颗粒;
3)取黄芪、桂枝、大血藤、盐泽泻、生大黄,加水浸泡,煎煮,滤过,滤液浓缩成稠膏,加糊精、步骤2)所得三七粉,制粒,整粒,再加步骤2)所得人工麝香颗粒混匀,即得。
进一步地,步骤2)所述取三七粉碎,加0.5倍量85%乙醇混匀,50℃密闭48小时,干燥,粉碎,得三七粉;取人工麝香,加16倍量的糊精混合,再加6.4倍量85%乙醇制粒,30℃干燥,得人工麝香颗粒;步骤3)所述取黄芪、桂枝、大血藤、盐泽泻、生大黄,加7倍量水浸泡1.5h,煎煮三次,每次1h,滤过,滤液浓缩至70-80℃相对密度1.10-1.20,加生大黄重量的3~4倍量的糊精、步骤2)所得三七粉,制粒,整粒,再与步骤2)所得人工麝香颗粒混匀,即得。
本发明还提供了一种前述的组合物在制备治疗脑出血的药物中的用途。
进一步地,所述药物是治疗急性脑出血的药物。
更进一步地,所述药物是减小脑血肿、降低脑组织含水量,提升脑组织SOD和CAT活性,降低脑组织MDA含量和/或降低神经学功能评分的药物。
本发明的组合物中麝香芳香走窜,通行十二经,开通诸窍,善入细络,具有开窍醒神的功效,为君药。黄芪大补元气,气行则血行,气能摄血;三七散瘀止血,二者共为臣药,起着益气、活血、化瘀功效。桂枝温通经脉,助阳化气,血得温则行;泽泻利水渗湿,化浊;生大黄推陈出新,通利解毒,且能活血化瘀,荡涤邪气,三者共为佐药,起温经利水,化痰泻浊,化瘀解毒功效。大血藤具有解毒,活血,祛风,为使药。全方针对脑出血后的关键环节---血脑屏障损害、脑水肿而起作用,能促进患者神志清醒、减轻脑水肿、促进血肿吸收、改善神经功能缺损。
经动物试验证明,本发明组合物可减轻脑出血模型大鼠血肿大小,降低脑组织含水量,提升脑组织SOD和CAT活性,对脑组织MDA含量和神经学功能评分也有降低趋势。对急性脑出血具有显著的治疗效果。
显然,根据本发明的上述内容,按照本领域的普通技术知识和惯用手段,在不脱离本发明上述基本技术思想前提下,还可以做出其它多种形式的修改、替换或变更。
以下通过实施例形式的具体实施方式,对本发明的上述内容再作进一步的详细说明。但不应将此理解为本发明上述主题的范围仅限于以下的实例。凡基于本发明上述内容所实现的技术均属于本发明的范围。
附图说明
图1对脑出血模型大鼠组织形态学的影响(HE 40×)
具体实施方式
实施例1、本发明药物的制备
配方:黄芪834g、桂枝209g、大血藤334g、盐泽泻417g、生大黄125g三七125g、人工麝香1.25g、糊精491g。
制备方法:
1)按配比称取原料,三七粉碎后加入62.5ml乙醇(85%),混匀,50℃密闭48小时,50℃干燥,粉碎,得三七粉;
2)取人工麝香,与20g糊精混合,加入8ml 85%乙醇,制粒,30℃干燥至无醇味,得人工麝香颗粒;
3)取黄芪、桂枝、大血藤、盐泽泻和生大黄,加7倍量w/w水,浸泡1.5小时,煎煮三次,每次1小时,滤过,滤液浓缩至相对密度1.10-1.20(70-80℃)的清膏,加入糊精471g及步骤1)所得三七粉,制粒,整粒;再与步骤2)所得人工麝香颗粒混匀,分装,即得药物颗粒(即后续的麝香化瘀醒脑颗粒)。
实施例2、本发明药物的制备
配方:黄芪800g、桂枝200g、大血藤300g、盐泽泻400g、生大黄100g三七100g、人工麝香1g、糊精491g。
制备方法:
1)按配比称取原料,三七粉碎后加入62.5ml乙醇(85%),混匀,50℃密闭48小时,50℃干燥,粉碎,得三七粉;
2)取人工麝香,与20g糊精混合,加入8ml 85%乙醇,制粒,30℃干燥至无醇味,得人工麝香颗粒;
3)取黄芪、桂枝、大血藤、盐泽泻和生大黄,加7倍量w/w水,浸泡1.5小时,煎煮三次,每次1小时,滤过,滤液浓缩至相对密度1.10-1.20(70-80℃)的清膏,加入糊精471g及步骤1)所得三七粉,制粒,整粒;再与步骤2)所得人工麝香颗粒混匀,分装,即得药物颗粒(即后续的麝香化瘀醒脑颗粒)。
实施例3、本发明药物的制备
配方:黄芪850g、桂枝220g、大血藤350g、盐泽泻450g、生大黄150g三七150g、人工麝香2g、糊精491g。
制备方法:
1)按配比称取原料,三七粉碎后加入62.5ml乙醇(85%),混匀,50℃密闭48小时,50℃干燥,粉碎,得三七粉;
2)取人工麝香,与20g糊精混合,加入8ml 85%乙醇,制粒,30℃干燥至无醇味,得人工麝香颗粒;
3)取黄芪、桂枝、大血藤、盐泽泻和生大黄,加7倍量w/w水,浸泡1.5小时,煎煮三次,每次1小时,滤过,滤液浓缩至相对密度1.10-1.20(70-80℃)的清膏,加入糊精471g及步骤1)所得三七粉,制粒,整粒;再与步骤2)所得人工麝香颗粒混匀,分装,即得药物颗粒(即后续的麝香化瘀醒脑颗粒)。
以下通过试验例来说明本发明的有益效果。
试验例1本发明麝香化瘀醒脑颗粒研究
1试验目的与试验设计
1.1试验目的
观察麝香化瘀醒脑颗粒对急性脑出血模型大鼠的保护作用,为临床应用提供药理学依据。
1.2试验设计
本试验参照国家食品药品监督管理局有关主要药效学研究的技术要求进行临床前药效学研究。
(1)主要研究方法:
采用自体血液注入法复制大鼠急性脑出血模型,参照Bederson评分法评估神经功能损伤程度;用苏木精-伊红(HE)染色观察脑组织病理形态学变化;用干-湿重法测定各组大鼠的脑组织含水量;用生化法测定脑组织内SOD、MDA和CAT含量。
(2)给药剂量、方法、时间:麝香化瘀醒脑颗粒临床拟用量为49.02g生药/日/人(0.817g生药/kg)。根据实验动物与人体表面积比,设计大鼠给药剂量,详见表1。
表1麝香化瘀醒脑颗粒大鼠给药剂量设计表
2试验材料
2.1药物
2.1.1受试品
麝香化瘀醒脑颗粒水提部分干浸膏粉,批号:20210326,每克相当于原药材5.01g。三七粉与人工麝香粉末,批号:20210331。由西南医科大学附属中医医院提供。
受试药物配制:称取黄芪、桂枝、大血藤、盐泽泻和生大黄(按实施例1制备方法取得的清膏,烘干)的干浸膏粉19.28g;称取三七粉(按实施例1制备)6.3g;称取人工麝香粉末0.063g。加适量水混合研磨,定容至105ml,作为原液。取原液60ml作为麝香化瘀醒脑颗粒高剂量组用药(溶液浓度为0.98g生药/ml,相当于临床用药量的12倍);取原液30ml加水稀释成60ml作为麝香化瘀醒脑颗粒中剂量组用药(溶液浓度为0.49g生药/ml,相当于临床用药量的6倍);取原液15ml加水稀释成60ml作为麝香化瘀醒脑颗粒低剂量组用药(溶液浓度为0.245g生药/ml,相当于临床用药量的3倍)。
2.1.2对照药物
辛伐他汀片,山东鲁抗医药集团赛特有限责任公司生产,规格:10mg/片×7片/板×2板/盒,产品批号:201009,有效期至2022年10月29日。
配制方法:取辛伐他汀片6片,在乳钵中研磨成细粉,加入适量0.5%CMC-Na研磨制成混悬液,定容至60ml,用前振摇混匀。浓度为0.1%,给药剂量为10mg/kg。
2.2实验动物及环境条件
SD大鼠,雄性,体重260-300g,SPF级合格动物,由四川省中医药科学院实验动物中心提供,生产许可证号:SCXK(川)2018-19。
实验动物使用许可证号:SYXK(川)2018-100。室温20~24℃,日温差不超过4℃,相对湿度40-70%,日光灯照明,12小时明暗相间,自动定时过滤通风换气,换气频度10次/小时。实验动物每笼5只分笼饲养,自由饮水,常规全价饲料,定时定量喂养。
垫料:辐照灭菌玉米芯垫料;适用范围:SPF级大(小)鼠;制造单位:成都达硕实验动物有限公司;
饲料:辐照灭菌维持饲料;适用范围:SPF级大(小)鼠;制造单位:成都达硕实验动物有限公司;执行标准:GB14924.2-2001,GB14924.3-2010;生产许可证:SCXK(川)2018-028;给料方法:自由摄取。
饮水:实验动物饮用水(超纯水);制备仪器:艾科浦超纯水系统;机器型号:ADW-4001-C;机器编号:AQE08120001;执行标准号:YZB/渝0015-2002;产品注册证号:020059;生产厂商:重庆颐洋企业发展有限公司;供水方法:饮水瓶盛装,自由摄取。
2.3主要仪器与试剂
脑立体定位仪,美国STOELTING公司;
QSI(quintessential stereotaxic injector),美国STOELTING公司
低温冰箱,日本三洋;
微量进样器,上海安亭微量进样器厂生产
真空采血管,成都瑞琦医疗科技有限责任公司,批号:21031211,有效期至20230311。
超氧化物歧化酶(SOD)试剂盒,批号:20210617,有效期至20211216;微量丙二醛(MDA)测试盒,批号:20210604,有效期至20220603;过氧化氢酶(CAT)可见光试剂盒,批号:20210616,有效期至20211215;总蛋白测定试剂盒,批号:20210610,有效期至20211209。均由南京建成生物工程研究所生产。
水合氯醛,成都市科龙化工试剂厂,250g/瓶,批号:2020061201。
甲醛,成都市科龙化工试剂厂,250g/瓶,批号:2021033101。
骨蜡,强生公司出品,规格:2.5g,生产批号:AN9559,有效期至20260331。
3试验方法
3.1急性脑出血模型的建立
方法造模:6%的水合氯醛(5mL/kg)腹腔注射麻醉后,将大鼠以俯卧位固定在脑立体定位仪上,调整立体定位仪,使门齿沟的水平面比耳间线水平面低2.4mm,使前后囟处于同一水平面。剪去头顶被毛,皮肤消毒,在前囱附近沿头皮正中纵行切开约1.5cm,暴露颅骨,无菌操作暴露前囟和矢状缝,以前囟为中心,于前囟前0.5mm,中线向右旁开3mm处钻一直径为0.8mm的小孔。将大鼠胸前区消毒,用微量注射器取心脏血约60μL,迅速将微量注射器通过颅骨钻孔垂直进针至尾状核部(进针深度6mm),用微量泵按照25μL/min的速度,将大鼠自体血50μL注入至尾状核内,注血完成留针10min后再缓慢地退针,用骨蜡对颅骨钻孔进行封闭后缝合手术切口,进行常规消毒后将大鼠侧卧位放置于单独鼠笼。假手术组只行进针,不注入自体血,手术操作同其余各组。以上操作均遵守无菌原则。
3.2分组及给药
取大鼠一批,随机取10只作为正常对照组,10只作为假手术组。其余大鼠按上述方法进行造模手术。将造模成功的大鼠随机分成5组,即模型组、麝香化瘀醒脑颗粒低剂量组、麝香化瘀醒脑颗粒中剂量组、麝香化瘀醒脑颗粒高剂量组和辛伐他汀10mg/kg组。假手术组手术操作同给药组,只行进针,不注入自体血。各组大鼠灌胃给药,正常对照组、假手术组、模型组均予以等量纯水,灌胃容积均为10mL/kg,每日1次,共7次,进行神经学功能评分和脑组织病理形态学检测。
另取大鼠一批,分组及造模方法同上,每组6只,给药3天。用来测定脑组织含水量和SOD、MDA和CAT水平的检测。
3.3检测指标
3.3.1神经学功能评分造模结束后1天~3天,均参照Bederson评分法评估神经功能损伤程度。Bederson评分[3,4]:轻抓大鼠尾巴,提起高于桌面10cm,正常大鼠两个前爪伸向桌面。脑损伤大鼠,其对侧前肢屈曲,姿势变化从轻度屈腕、伸肘、肩外展,到严重的腕肘屈曲、肩内旋外展。提起大鼠尾部,用手轻推大鼠肩部,直到前肢滑动几公分,不同方向重复数次。
神经学功能评分标准:0分:无神经功能缺损;1分:前肢出现屈曲成分(即提尾悬空实验阳性),不伴其他不正常;2分:侧推抵抗力下降(即侧向推力实验阳性),伴前肢屈曲,无转圈行为;3分:同2级行为,伴自发性旋转(自由活动时向瘫痪侧划圈)。
3.3.2脑水肿检测采用干-湿重法检测脑含水量。于给药3天后,待测脑水肿的大鼠麻醉后断头,剥开硬脑膜,取出整个大脑。沿中线将脑组织切成两半,去除右脑前部额极,以进针孔为界冠状切开,前半部分出血灶及血肿周围脑组织损伤区检测脑组织含水量,后半部分出血灶及血肿周围脑组织损伤区匀浆后待测生化指标。取进针孔前侧脑组织,称湿重后置于100℃的恒温干燥箱中,烘烤24h后称干重。
脑组织含水量(%)=(湿重-干重)/湿重×100%。
3.3.3脑组织SOD、MDA和CAT水平的检测取大鼠进针孔后侧约2mm厚的脑组织,冻存于低温冰箱中,待检测SOD、MDA和CAT水平。称重后,制成10%脑组织匀浆,按试剂盒说明书检测脑组织SOD、MDA和CAT水平。
3.4脑组织病理形态学检查
给药7天后,各组大鼠麻醉后用10%甲醛灌注固定脑组织,开颅取脑组织固定液中固定,沿造模注射针孔做垂直冠状切面,分别沿额叶和枕叶方向每间隔1.5mm做垂直冠状面取材至无瘀血处,正常对照和假手术组做同部位取材。脑组织片梯度乙醇脱水,二甲苯透明、浸蜡,包埋、切片,HE染色,光学显微镜下4倍物镜照相,用Image pro plus5.1图像分析系统分别测量每个脑组织片尾状核区域瘀血面积,计算每只动物脑组织瘀血总面积。
3.5统计学方法
数据用±s表示,采用Graphpad prism7统计软件,符合正态分布采用One-WayANOVA检验,不符合正态分布用Kruskal-Wallis检验。P<0.05表示差异具有统计学意义。
4试验结果
4.1麝香化瘀醒脑颗粒对脑出血模型大鼠神经学功能评分的影响
神经学功能评分结果发现:正常对照组评分均为0分,假手术组除手术后1天有1例评分为1分,其它时间均为0分;模型组和各给药组在手术后前2天评分为1-2分,第3天大部分为0-1分。麝香化瘀醒脑颗粒在手术后第2天与模型组比较虽有降低趋势,但没有明显差异(P>0.05),评分情况见表1。
表1麝香化瘀醒脑颗粒对脑出血模型大鼠神经学功能评分的影响(n=10)
*P<0.05,**P<0.01与模型组比较
4.2麝香化瘀醒脑颗粒对脑出血模型大鼠脑组织含水量的影响
与假手术组比较,模型组脑组织含水量明显升高(P<0.01)。与模型组比较,麝香化瘀醒脑颗粒各剂量组脑组织含水量均有降低(P<0.01或P<0.05),脑组织含水量情况见表2。
表2麝香化瘀醒脑颗粒对脑出血模型大鼠脑组织含水量的影响(n=6)
*P<0.05,**P<0.01与模型组比较
4.3麝香化瘀醒脑颗粒对脑出血模型大鼠脑组织氧化应激指标的影响
与假手术组比较,模型组脑组织SOD和CAT活性明显降低(P<0.05),MDA含量明显升高。麝香化瘀醒脑颗粒各剂量组脑组织SOD和CAT活性较模型组均有所升高,麝香化瘀醒脑颗粒2.45g生药/kg组和9.80g生药/kg组SOD活性与模型组比较有明显差异(P<0.01);麝香化瘀醒脑颗粒各剂量组脑组织MDA含量较模型组均有降低趋势,但无明显差异(P>0.05),见表3。
表3对脑出血模型大鼠脑组织氧化应激指标的影响(n=6)
*P<0.05,**P<0.01与模型组比较
4.4脑组织病理形态学检查结果
镜下见正常对照组额叶皮质及尾状核区域神经细胞形态正常、排列有序,未见瘀血及炎症灶分布;假手术组除1只动物额叶皮质区有少量出血外,其余皮质及尾状核区域均未见瘀血及炎症灶分布;造模大鼠经额叶向尾状核区域定量注射自体血后,血液在注射区域向周围浸润形成不规则瘀血灶,并伴不同大小面积的脑组织液化性坏死、水肿以及炎细胞浸润,其余区域脑组织未见明显异常病理改变。与模型组比较,麝香化瘀醒脑颗粒各剂量组脑瘀血面积有不同程度的减少,尤其9.80g生药/kg组瘀血面积明显减少(P<0.05),且炎细胞浸润及水肿也有明显的改善。结果见表4、图1。
表4麝香化瘀醒脑颗粒对脑出血模型大鼠瘀血面积的影响
*P<0.05,**P<0.01与模型组比较
5试验结论
本发明选用大鼠自体血注入法复制大鼠急性脑出血模型,考察麝香化瘀醒脑颗粒对急性脑出血模型大鼠的影响。连续3天、7天给予麝香化瘀醒脑颗粒针对模型大鼠治疗,结果发现:
麝香化瘀醒脑颗粒各剂量组神经学功能评分在手术后第2天与模型组比较虽有一定降低趋势,无统计学意义;
麝香化瘀醒脑颗粒各剂量组脑组织含水量较模型组均显著降低(P<0.01或P<0.05);
麝香化瘀醒脑颗粒各剂量组脑组织SOD和CAT活性较模型组均有所升高,麝香化瘀醒脑颗粒2.45g生药/kg组和9.80g生药/kg组SOD活性与模型组比较有明显差异(P<0.01);麝香化瘀醒脑颗粒各剂量组脑组织MDA含量较模型组均有降低趋势,无统计学意义。
组织病理学检查发现:造模大鼠经额叶向尾状核区域定量注射自体血后,血液在注射区域向周围浸润形成不规则瘀血灶,并伴不同大小面积的脑组织液化性坏死、水肿以及炎细胞浸润,其余区域脑组织未见明显异常病理改变。与模型组比较,麝香化瘀醒脑颗粒各剂量组脑组织瘀血面积有不同程度的减少,尤其9.80g生药/kg组瘀血面积明显减少(P<0.05),且炎细胞浸润及水肿也有明显的改善。
综上所述,试验结果提示麝香化瘀醒脑颗粒对急性脑出血具有显著治疗作用。
试验例2本发明组合物的临床疗效
1.临床资料
病例来源于2019年10月至2020年12月西南医科大学附属中医医院神经内科和神经外科住院患者。入院后按照纳入标准与排除标准筛选出50例中小量脑出血急性期患者,数字化随机1:1分为对照组和试验组。两组一般资料差异无统计学意义(P>0.05),具有可比性。
2纳入标准
(1)符合中医中风病诊断标准和西医脑出血的诊断标准病例;
(2)年龄在40-80岁,病程从发病起24小时以内者;
(3)出血部位:幕上、基底节区,且血肿未破入脑室者;
(4)出血量在30mL及以下者;
(5)首次发病或既往患中风(缺血性或出血性)但未遗留后遗症;
(6)心、肝、肾、血液系统等无严重害怕你功能障碍者;
(7)签署知情同意书。
3排除标准
(1)各种原因的继发性脑出血(包括颅内动脉瘤破裂、动静脉畸形或肿瘤出血、药物相关性脑出血者等);蛛网膜下腔出血;混合性卒中;多灶性出血;基底节区出血破入脑室者;除基底节外的其他部分脑出血者;脑疝形成;中线结构移位超过5min;同侧侧脑室受压闭塞超过1/2;同侧脑池、脑沟模糊或消失;血肿量>30ml;
(2)有消化道出血者;
(3)病程超过24小时者;
(4)年龄超过80岁或小于40岁;
(5)有严重并发症,如心肝肾功能不全,血液病及严重感染,精神病患者等;
(6)既往患中风或其他神经系统疾病且伴有肢体功能障碍者;
(7)妊娠或哺乳期妇女,对本方案中药物成分过敏者;
(8)对本方案中药物成分过敏者。
4.疗效判断标准
临床疗效评定分级标准:参照1995年全国第四届脑血管病学术会议《临床疗效评定标准》,以神经功能缺损积分的减少(功能改善)与病人总的生活能力状态评定。
①基本痊愈功能缺损评分减少90—100%,病残程度0级。
②显著进步功能缺损评分减少46—89%,病残程度1—3级。
③进步功能缺损评分减少18—45%。
④无变化功能缺损评分减少或增加在18%以内。
⑤恶化功能缺损评分增加18%上。
注:计算公式(尼莫地平法)为[(治疗前积分-治疗后积分)÷治疗前积分]×100%。
美国国立卫生研究院卒中量表(The National Institutes of Health StrokeScale,NIHSS)因其操作方便、客观适用且内容全面而成为世界上应用最广泛的神经功能缺损评分系统,其能很好地评估患者的临床治疗效果和预后情况。日常生活活动能力评定的最佳量表是Barthel指数(Barthel index,BI),可评估脑卒中后患者的生活独立程度,分数与日常生活独立程度成正比。其评定方式简单、可信、灵敏度高,故在临床上得到广泛运用。改良Rankin量表(mRS)在日常活动能力的基础上增加了日常工作能力,在一定程度上反映了中风患者的社会生活能力,可综合判定脑卒中患者的功能恢复情况。
由2名通过专业培训的固定神经内科人员对两组患者分别于入院第1天、治疗后第7天进行NIHSS评分、BI指数、mRS评分以及血肿、脑水肿的数据分析。以P<0.05认为差异有统计学意义。
5.1基础治疗方案
(1)一般治疗:保持安静休息,心电血压氧饱监测,有低氧血症者给予吸氧。低盐低脂饮食。
(2)血压管理:当急性脑出血患者收缩压>180~220mmHg时,应积极使用静脉降压药物密切监控下降低血压,初始阶段(数分钟到1小时内)血压控制的目标为平均动脉压的降低幅度不超过治疗前水平的25%;在随后的2~6小时内将血压降至较安全水平,160/100mmHg左右可作为参考的降压目标值。急性期可使用尼卡地平、乌拉地尔、硝酸甘油等,病情稳定后可采用口服降压药。临床常用一线降压药均可使用,常用CCB、ACEI、ARB。可选用左旋氨氯地平(2.5mg,QD-Bid)、缬沙坦(80mg,Qd-Bid),根据血压调节用药频率,控制血压在140/90mmHg左右。
(3)血糖管理:定期监测血糖,控制血糖在7.7~10.0mmol/L的范围内,避免血糖过高或过低。超过11.1mmol/L,可考虑予以胰岛素治疗,低于2.8mmol/L,予以10%~20%葡萄糖口服或注射治疗。
(4)体温管理:体温≥38.5℃,给予物理降温。必要时可临时给与柴胡注射液2mL,肌肉注射,或口服布洛芬混悬液。考虑存在感染患者,应早期作培养及药敏实验,选用有效抗生素治疗。
(5)并发症治疗:颅内高压的处理:a.抬高床头约30°,头位于中线上,以增加颈静脉回流,降低颅内压。b.镇痛和镇静。对需要气管插管或其他类似操作的患者,需要静脉应用镇静剂。镇静剂应逐渐加量,尽可能减少疼痛或躁动引起颅内压升高。常用的镇静药物有:二异丙酚、依托咪酯、咪达唑仑等。镇痛药有:吗啡、芬太尼等。c.脱水降低颅内压。可采用脑水肿监测仪,扰动系数正常值范围为6~9,>9时可酌情给予降颅内压治疗。可选用20%甘露醇125ml静脉快滴,1日3次~1日4次;可配合使用甘油果糖250ml静脉滴注,1日2次~1日1次;可联合白蛋白、速尿使用。5~10天内逐渐减量至停用。d.脑室引流:如脑出血患者出现严重脑积水(脑室扩大),且药物脱水治疗无明显效果的情况下,可考虑行脑室引流,以挽救生命。痫性发作的处理:有癫痫发作者应给予抗癫痫药物治疗。疑似癫痫发作者,应考虑持续脑电图监测。如监测到痫样放电,应给予抗癫痫药物治疗。不推荐预防性应用抗癫痫药物。
(6)其他:制作《中风病康复小手册》,发放给每位患者。鼓励患者尽早活动、腿抬高;尽可能避免下肢静脉输液,特别是瘫痪侧肢体。
5.2分组治疗
对照组:按基础治疗方案治疗。
观察组:在基础治疗方案治疗基础上,给与口服麝香化瘀醒脑颗粒治疗(按实施例1制备)。服法:温水冲服,3次/日,1包/次,疗程7天。口服困难者可给予胃管灌胃。整个试验过程中不使用其他与本治疗方案具有相同功效的中药汤剂及中成药口服和静脉滴注。
6.治疗结果
6.1中风病症分级量化评分表
治疗前对照组和观察组患者中风病症状分级量化评分的差异无统计学意义;治疗后,对照组与观察组患者中风病症状分级量化评分均显著下降,观察组患者中风病症状分级量化评分显著低于对照组,t=3.674,P=0.001,差异具有统计学意义。见表5。
表5观察组与对照组在治疗前后中风病症状分级量化评分变化的比较
6.2NIHSS评分
组间比较结果显示:治疗前对照组和观察组患者NIHSS评分的差异无统计学意义,但是治疗后观察组患者NIHSS评分的水平显著低于对照组,t=3.200,P=0.002,差异具有统计学意义。此外,组内比较结果显示:对照组与观察组患者治疗后NIHSS评分均显著下降,见表6。
表6观察组与对照组在治疗前后NIHSS评分变化的比较
6.3BI指数
组间比较结果显示:治疗前对照组和观察组患者BI指数的差异无统计学意义,但是治疗后观察组患者BI指数的水平显著高于对照组,t=-2.231,P=0.030,差异具有统计学意义。此外,组内比较结果显示:对照组与观察组患者治疗后BI指数均显著升高,见表7。
表7观察组与对照组在治疗前后BI指数变化的比较
6.4mRS评分
组间比较结果显示:治疗前对照组和观察组患者mRS评分的差异无统计学意义,但是治疗后观察组患者mRS评分的水平显著低于对照组,t=3.138,P=0.003,差异具有统计学意义。此外,组内比较结果显示:对照组与观察组患者治疗后mRS评分均显著下降,见表4。
χ2检验用于比较观察组与对照组治疗7天后mRS评分的分布情况,分析结果显示:观察组治疗7天后mRS小于等于1分者的占比为64.0%,显著高于对照组的20.0%,χ2=8.210,P=0.004,差异具有统计学意义,见表8。
表8观察组与对照组在治疗前后mRS评分变化的比较
6.5颅内血肿量
组间比较结果显示:治疗前对照组和观察组患者颅内血肿量的差异无统计学意义,但是治疗后观察组患者颅内血肿量显著低于对照组,Z=-2.086,P=0.037,差异具有统计学意义。此外,组内比较结果显示:对照组与观察组患者治疗后血肿量均显著下降,见表9。
表9观察组与对照组在治疗前后颅内血肿量变化的比较
6.6脑水肿量
组间比较结果显示:治疗前对照组和观察组患者脑水肿的差异无统计学意义,但是治疗后观察组患者颅内血肿量显著低于对照组,Z=416.0,P=0.045,差异具有统计学意义。此外,组内比较结果显示:对照组患者治疗后脑水肿量无统计学意义,观察组患者治疗后脑水肿量显著下降,Z=-4.372,P=<0.001,见表10。
表10观察组与对照组在治疗前后脑水肿量变化的比较
综上,麝香化瘀醒脑颗粒联合西医基础治疗能有效促进中小量ICH患者颅内血肿吸收,改善临床症状,减少神经功能缺损,提高患者日常生活自理能力。麝香化瘀醒脑颗粒能够降低出血侧血脑屏障的高通透性,改善出血侧血脑屏障功能,进而减轻脑水肿。
Claims (10)
1.一种治疗脑出血的组合物,其特征在于:它是含有如下重量配比的原料药制备而成:
黄芪800~900份,桂枝200~300份,大血藤300~400份,泽泻400~500份,大黄100~200份,三七100~200份,麝香1~3份。
2.根据权利要求1所述的组合物,其特征在于:它是含有如下重量配比的原料药制备而成:
黄芪800~850份,桂枝200~220份,大血藤300~350份,泽泻400~450份,大黄100~150份,三七100~150份,麝香1~2份。
3.根据权利要求2所述的组合物,其特征在于:它是含有如下重量配比的原料药制备而成:
黄芪834份,桂枝209份,大血藤334份,泽泻417份,大黄125份,三七125份,麝香1.25份。
4.根据权利要求3所述的组合物,其特征在于:所述泽泻为盐泽泻;所述大黄为生大黄;所述麝香为人工麝香。
5.根据权利要求1~4任一项所述的组合物,其特征在于:它是由原料的粉末、或原料的水或有机溶剂提取物为活性成分,加上药品上可接受的辅料制备而成的口服制剂;所述口服制剂为溶液剂、颗粒剂、丸剂或胶囊剂。
6.一种权利要求1~5任一项所述的组合物的制备方法,其特征在于:它包括如下步骤:
1)按配比称取原料;
2)取三七粉碎,加乙醇混匀,40~60℃密闭24~72小时,干燥,粉碎得三七粉;取麝香,加12~18倍量的糊精混合,再加乙醇制粒,干燥,得人工麝香颗粒;
3)取黄芪、桂枝、大血藤、泽泻、大黄,加水浸泡,煎煮,滤过,滤液浓缩成稠膏,加糊精、步骤2)所得三七粉,制粒,整粒,再加步骤2)所得人工麝香颗粒混匀,即得。
7.根据权利要求6所述的制备方法,其特征在于:步骤2)所述取三七粉碎,加0.5倍量85%乙醇混匀,50℃密闭48小时,干燥,粉碎,得三七粉;取麝香,加16倍量的糊精混合,再加6.4倍量85%乙醇制粒,30℃干燥,得人工麝香颗粒;步骤3)所述取黄芪、桂枝、大血藤、泽泻、大黄,加7倍量水浸泡1.5h,煎煮三次,每次1h,滤过,滤液浓缩至70-80℃相对密度1.10-1.20,加大黄重量的3~4倍量的糊精、步骤2)所得三七粉,制粒,整粒,再与步骤2)所得人工麝香颗粒混匀,即得。
8.权利要求1~5任一项所述的组合物在制备治疗脑出血的药物中的用途。
9.根据权利要求8所述的用途,其特征在于:所述药物是治疗急性脑出血的药物。
10.根据权利要求9所述的用途,其特征在于:所述药物是减小脑血肿、降低脑组织含水量,提升脑组织SOD和CAT活性,降低脑组织MDA含量和降低神经学功能评分的药物。
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