目的 探究蘇合香丸聯(lián)合尼莫地平治療蛛網(wǎng)膜下腔出血后腦血管痙攣的臨床療效。方法 選取2018年5月—2021年5月南陽市南石醫(yī)院收治的110例蛛網(wǎng)膜下腔出血后腦血管痙攣患者，所有患者隨機分為對照組（55例）和治療組（55例）。對照組靜脈滴注尼莫地平注射液，注入5%葡萄糖溶液500 mL中，初始速度為0.5 mg/h，若血壓無大幅下降可在2 h后改為1 mg/h，不間斷給藥，治療2周。再口服尼莫地平片，60 mg/次，4次/d，治療1周。治療組在對照組的基礎上口服蘇合香丸，每天早晚各1粒，連續(xù)治療3周。觀察兩組的臨床療效，比較兩組患者神經(jīng)功能，大腦前、中、后動脈平均血流速度，炎性因子和血管內(nèi)皮功能因子水平。結(jié)果 治療后，治療組總有效率為90.91%，對照組總有效率為74.55%，組間比較具有明顯差異（P＜0.05）。治療后，兩組美國國立衛(wèi)生研究院卒中量表（NIHSS）評分均明顯降低（P＜0.05），且與對照組比較，治療組NIHSS評分明顯降低（P＜0.05）。治療后，兩組大腦前、中、后動脈平均血流速度均明顯降低（P＜0.05），且治療組大腦前、中、后動脈平均血流速度明顯高于對照組（P＜0.05）。治療后，兩組血清超敏C反應蛋白（hs-CRP）、白細胞介素-8（IL-8）、腫瘤壞死因子（TNF-α）水平均明顯降低（P＜0.05），且與對照組相比，治療組血清hs-CRP、IL-8、TNF-α水平明顯降低（P＜0.05）。治療后，兩組血清內(nèi)皮素-1（ET-1）、血管內(nèi)皮生長因子（VEGF）水平均明顯降低，血清降鈣素基因相關(guān)肽（CGRP）水平明顯升高（P＜0.05），且與對照組比較，治療組血清ET-1、VEGF水平明顯降低，血清CGRP水平明顯升高（P＜0.05）。結(jié)論 蘇合香丸聯(lián)合尼莫地平治療蛛網(wǎng)膜下腔出血后腦血管痙攣具有較好的臨床療效，可有效提高神經(jīng)功能，改善腦血流速度和血管內(nèi)皮功能，減輕炎癥反應，安全性較好。

Objective To explore the clinical effect of Suhexiang Pills combined with nimodipine in treatment of cerebral vasospasm after subarachnoid hemorrhage.Methods Patients (110 cases) with cerebral vasospasm after subarachnoid hemorrhage in Nanshi Hospital of Nanyang from May 2018 to May 2021 were randomly divided into the control group (55 cases) and the treatment groups (55 cases). Patients in the control group were iv administered with Nimodipine Injection, dissolved with 5% glucose solution 500 mL. The initial rate was 0.5 mg/h, and if there was no significant decrease in blood pressure, it could be changed to 1 mg/h after 2 h, and the drug was administered continuously for 2 weeks. After that, patients in the control group were po administered with Nimodipine Tablets, 60 mg/time, four times daily, treated for 1 week. Patients in the treatment group were po administered with Suhexiang Pills on the basis of the control group, one capsule every morning and evening, treated for 3 weeks. After treatment, the clinical efficacies were evaluated, and the neurological function, the average blood flow velocity of anterior, middle, and posterior cerebral arteries, and the levels of inflammatory factors and vascular endothelial function factors in two groups were compared.Results After treatment, the total effective rate of the treatment group was 90.91%, that of the control group was 74.55%, and there was a significant difference between two groups (P < 0.05). After treatment, the NIHSS score of two groups were significantly decreased (P < 0.05), and compared with the control group, the NIHSS score of the treatment group was significantly lower (P < 0.05). After treatment, the average blood flow velocity of anterior, middle, and posterior cerebral arteries in two groups were significantly decreased (P < 0.05), and the average blood flow velocity of anterior, middle, and posterior cerebral arteries in the treatment group was significantly higher than those in the control group (P < 0.05). After treatment, the serum levels of hs-CRP, IL-8, and TNF-α in the two groups were significantly decreased (P < 0.05), and the serum levels of hs-CRP, IL-8, and TNF-α in the treatment group were significantly lower than those in the control group (P < 0.05). After treatment, the serum levels of ET-1 and VEGF in two groups were significantly decreased, but the serum level of CGRP in two groups were significantly increased (P < 0.05). Compared with the control group, the serum levels of ET-1 and VEGF were significantly lower, but the serum level of CGRP in the treatment group was significantly higher (P < 0.05).Conclusion Suhexiang Pills combined with nimodipine has clinical curative effect in treatment of cerebral vasospasm after subarachnoid hemorrhage, can effectively improve neurological function, cerebral blood flow velocity, and vascular endothelial function, and reduce inflammatory reaction, with good safety.

R971

河南省高等學校重點科研項目（20A310011）