| PART 1:Clinical observationObjective:Through clinical observation on impact of related parameters in patients of acute phase of cerebral hemorrhage by traditional Chinese medicineof in stages, to esearch of the clinical curative effects of traditional Chinese medicine therapy of stages in acute phase of cerebral hemorrhage, to develop the clinical treatment plan of the acute phase of cerebral hemorrhage, and conform to the clinical practice, standardized and effective, easy popularization and application, in order to improve the clinical curative effect of the disease. Methods:By the method of clinical trial with stochastic parallel controlled,60 patients with acute phase of cerebral hemorrhage were randomly divided into observation group (30 cases) and control group (30 cases), the control group given conventional western medicine treatment, including stable vital signs, neural control of blood pressure, blood glucose, and nutrition, improve cerebral metabolism, etc, the observation group based on the using of traditional Chinese medicine treatment in stages, Acute phase 1-3 and 4-14 were given Chinese medicine medicinal broth evidence-based medicine, and methods of proprietary Chinese medicine cooperate with acupuncture treatment, both the two groups were detected the clinical curative effect and TCM symptom rating scale score, NIHSS score, Rankin testing scores, the Barthel index score on the start of treatment and 14 day after treatment, and in the start of treatment,7 dsy and 14 days after treatment were given CT examination for intracranial hematoma in patients and detectived safety indicators, including routine blood, liver and kidney function, blood coagulation, etc, and compared two groups of clinical curative effect and influences on the targets of the above situation, analyze and evaluate the efficacy and safety of the two groups. Results:1?Traditional Chinese medicine group (observation group) of patients with TCM symptom rating scale score, NIHSS score, Rankin scores, the Barthel index score, intracranial hematoma volume improvement is better than pure western medicine treatment group (control group), P< 0.05; Syndromes curative effect of observation group, the clinical curative effect of western medicine, the effect of intracranial hematoma were significantly higher than that of control group, P<0.05. 2?The two kinds of treatment for the patient's vital signs, liver and kidney function, blood routine, coagulation indexes were not cause adverse effects, such as good security. Conclusions:In acute phase of cerebral hemorrhage patients using traditional Chinese medicine treatment in stages more effective than western medicine treatment, that can improve the patient's nerve function, improve the cure rate, improve patient quality of life, safe and effective, and is worth promoting.PART 2:Animal ExperimentsObjective:Explore the effects on brain edema in rat with intracerebral hemorrhageand and the mechanism of Zhilonghuoxuetongyu capsule, to provide experimental basis for clinical use of Zhilonghuoxuetongyu capsule treatment in acute phase of cerebral hemorrhage. Methods:255 healthy male SD rats were randomly divided into sham-operation group, model group, high dose of Zhilonghuoxuetongyu capsule group, medium dose of Zhilonghuoxuetongyu capsule group, low dose of Zhilonghuoxuetongyu capsule group, using autologous blood injection preparation of cerebral hemorrhage rat model, the drug group were respectively feed with Zhilonghuoxuetongyu capsule of 0.3 g/kg/d,0.6 g/kg/d,1.2 g/kg/d, the model group, sham-operation group were feed with saline such as drug group volume (3ml/times), dosing frequency saline such drug group.After each corresponding intervention, detected neurobehavioral score (NSS) of rats, determination of brain tissue and testing water content and cerebral coefficient of rats, observation hemorrhage hematoma surrounding tissue pathology in HE staining, Evans blue method is used to detect the permeability of blood brain barrier, electron microscope to observe the ultrastructure of blood brain barrier, Western blot method to detect the expression of proteins of associated with brain edema, including AQP-4, MMP-9 and TIMP-1, and useing PT-PCR method to detect the expression of mRNA expression of AQP-4, MMP-9 and TIMP-1. Results:1?Cerebral hemorrhage model rats 12 h visible on brain edema after surgery, after 48 h and 72 h edema degree aggravating gradually, nerve function defect is gradually obvious, NSS score increases, then the brain water content and cerebral coefficient also gradually rise, HE staining on brain edema, interstitial osteoporosis, structure disorder around hematoma. Were given Zhilonghuoxuetongyu capsule of low, middle and high dose drug intervention treatment,12 h,48 h and 72 h after surgery, edema in rats is improved compared with model group, nerve function score than the fall, cerebral water content and cerebral coefficient than also decreased (P< 0.01), HE dyed visible brain tissue around hematoma edema have different degrees of improvement.2?Cerebral hemorrhage model rats 12 h after surgery the permeability of blood brain barrier changes can be found in brain tissue EB content increased significantly, is elevated in 48 h after surgery is most obvious, compared with a slight decline when 72 h.Electron microscopy ultrastructure showed 48 h after surgery, the entire vascular cavity shape is irregular, basement membrane thickness, capillaries surrounding edema, sparse, electron density is reduced, endothelial local bulging, part stripping and basement membrane, blood brain barrier structure damage. When given by allowing the dragon blood stasis capsule low, middle and high dose drug intervention treatment,12 h,48 h and 72 h after surgery, the permeability of blood brain barrier in rats all have different degree of improvement in the model group (P<0.01), brain tissue EB content than fell, electron microscopy ultrastructure observation found that blood vessels surrounding edema degree is relatively mild, obviously improve the structure of the blood brain barrier.3?Cerebral hemorrhage model rats 12 h,48 h and 72 h after surgery in brain tissue AQP-4, MMP-9 and TIMP-1 protein and gene expression has the obvious rise, among them, the AQP-4 higher protein and gene expression is progressive, increase was most pronounced in 72 h, MMP-9 and TIMP-1 protein and gene expression has significantly increased, reached a peak at 48 h rise obviously and, at the time of 72 h fell slightly.And vermiculite dragon blood stasis capsule low, middle and high dose of intervention group 12 h,48 h and 72 h after surgery in group rats AQP-4, MMP-9 protein expression and gene of relative amount all have varying degrees of decline, and protein and TIMP-1 gene was increased, the relative expression quantity compared with model group, had significant difference (P<0.01). Conclusions:1?Zhilonghuoxuetongyu capsule can obviously improve the symptoms of cerebral hemorrhage rats nerve function defect, make nerve function defect scale relief, water content and decrease cerebral hemorrhage rats and cerebral coefficient, thus make significant improvement degree of brain edema.2?Zhilonghuoxuetongyu capsule can obviously improve the cerebral hemorrhage rats blood brain barrier permeability, reduced the content of brain tissue EB, the organizational structure of the protective blood brain barrier to avoid the blood brain barrier damage, so as to reduce the edema degree of brain tissue.3?Zhilonghuoxuetongyu capsule could significantly lowers the AQP cerebral hemorrhage rats had the potential to four, MMP-9 protein and gene expression, at the same time, higher protein and gene expression of TIMP-1, thus improving brain edema around the hematoma.4? Zhilonghuoxuetongyu capsule had exist certain concentration-response relationship with the above pharmacological effects, the high dose group effect is the most obvious than the other group. |
PDF Full Text Request