研究疾病:
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急性脑出血后脑积水
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研究疾病代码:
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Target disease:
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hydrocephalus after acute cerebral hemorrhage
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Target disease code:
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研究类型:
Study type:
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观察性研究
Observational study
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研究设计:
Study design:
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非随机对照试验
Non randomized control
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研究所处阶段:
Study phase:
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其它
Others
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研究目的:
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本研究通过多中心、前瞻性队列研究,研究影响脑出血后脑积水的发病因素,建立急性脑出血后脑积水的预测模型,制定急性脑出血后脑积水中医药防治方案,进而制定急性脑出血后脑积水防治规范。
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Objectives of Study:
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This study used a multi-center, prospective cohort study to study the factors affecting the hydrocephalus after cerebral hemorrhage, establish a predictive model of hydrocephalus after acute cerebral hemorrhage, develop a medical treatment program for hydrocephalus after acute cerebral hemorrhage, and then develop acute cerebral hemorrhage Regulations for the prevention and treatment of hydrocephalus.
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药物成份或治疗方案详述:
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中西医结合队列:即西医内科基础治疗+活血豁痰中药综合治疗;
西医队列:西医内科治疗方案,即西医内科基础治疗(参照2018年中国脑血管病防治指南)
(1)西医内科基础治疗:
①休息:头高20°-30°卧位休息
②心电监护
③吸氧:保持 PaCO2维持在 30-40mmHg
④控制血压:收缩压维持在140-160mmHg或者平均动脉压维持在100-130mmHg
⑤控制血糖:血糖控制在7.7-10mmol/L范围内
⑥营养支持治疗:根据体重计算每日热量25-30Kcal/kg,若合并感染高热者酌情增加能量供给量
⑦防治并发症
(2)合并颅内高压者使用高渗脱水剂:20%甘露醇注射液125ml,静脉加压滴入,每6小时应用一次。若患者在使用甘露醇的过程中出现肝肾功能损害,则逐次减少甘露醇用量1次,加用速尿20mg静脉注射1日1次。
(3)活血豁痰中药综合治疗:三七 10g、人参 30g、水蛭10g、桃仁 10g、红花 15g、赤芍30g、 当归20g、生黄芪30g、酒大黄10g等;
上述中药为一剂剂量,中药饮片由四川省医药公司统一供给,委托第三方机构统一进行加工,每剂中药用一次性真空塑料密封包装分装为3袋,每袋100ml。服药方法:每次1袋,1日3次,饭后半小时温服。疗程为28天。
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Description for medicine or protocol of treatment in detail:
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Integrative Chinese and Western Medicine Cohort: the basic treatment of Western medicine internal medicine + blood circulation and blood stasis;
Western medicine cohort: Western medicine medical treatment program, that is, basic medical treatment of Western medicine (refer to the 2018 Chinese cerebrovascular disease prevention and treatment guide).
(1) Basic medical treatment of Western medicine:
1. rest: head height 20 -30 degree lying rest;
2. ECG monitoring;
3. oxygen: keep PaCO2 at 30-40mmHg;
4. control blood pressure: systolic blood pressure maintained at 140-160mmHg or average arterial pressure maintained at 100-130mmHg;
5. control blood sugar: blood sugar control in the range of 7.7-10mmol/L;
6. nutritional support treatment: calculate daily calorie 25-30Kcal/kg according to body weight, if combined with high fever, increase energy supply as appropriate;
7. prevention and treatment of complications:
(1) Those with combined intracranial hypertension use hypertonic dehydrating agent: 20% mannitol injection 125ml, intravenous infusion, once every 6 hours. If the patient has liver and kidney dysfunction during the process of using mannitol, the amount of mannitol is reduced once, and 20 mg of furosemide is administered intravenously once a day.
(2) Comprehensive treatment of traditional Chinese medicine for promoting blood circulation and phlegm: Sanqi 10g, ginseng 30g, leeches 10g, peach kernel 10g, safflower 15g, red peony root 30g, angelica 20g, raw scutellaria 30g, wine rhubarb 10g, etc.;
The above-mentioned Chinese medicine is a dose, and the traditional Chinese medicine decoction pieces are uniformly supplied by Sichuan Pharmaceutical Company, and are entrusted to a third-party organization for uniform processing. Each dose of medicinal disposable vacuum plastic sealed packaging is divided into 3 bags, 100ml per bag. Medication method: 1 bag each time, 3 times a day, warm clothes for half an hour after a meal. The course of treatment is 28 days.
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纳入标准:
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(1)此次为患者第一次出现脑出血
(2)患者符合脑出血诊断标准,GCS评分>4分;
(3)患者年龄在 40~75岁之间
(4)患者同意参加本试验并签订知情同意书者
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Inclusion criteria
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(1) The first time onset cerebral hemorrhage;
(2) Meet the diagnostic criteria for cerebral hemorrhage, and the GCS score is >4 points;
(3) Aged 40 and 75 years old;
(4) Agree to participate in the trial and sign the informed consent form.
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排除标准:
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(1)患者的脑出血由脑肿瘤、脑外伤、血液病(继发于抗凝剂和溶栓治疗)等引起;
(2)患者为混合性卒中或脑出血出血量严重并需手术的患者。
(3)患者出现脑疝的临床表现,包括同侧瞳孔反射消失等其他第三对脑神经麻痹表现;
(4)患者合并肺心病、不稳定心绞痛或6个月内曾发生急性心肌梗塞;
(5)患者本次AICH发病前已伴有神经功能缺损(mRS>2);
(6)患者伴有严重的心功能不全(NYHA心功能分级Ⅲ-Ⅳ级);
(7)患者伴有严重的肝功能不全(肝功能检查结果超过正常范围上限的2倍以上);
(8)患者伴有严重的肾功能不全(血肌酐超出正常范围上限的2倍以上);
(9)患者AICH发病后发生活动性消化道出血;
(10)患者患有程度较重的血液系统或其他系统的基础疾病;
(11)患者处于妊娠状态或哺乳状态,或患有严重的过敏性疾病或对多种药物过敏;
(12)患者患有造成其神经功能缺损的其他疾病,或加入本研究会加重其病情者;
(13)患者近3个月内曾参加其他临床试验;
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Exclusion criteria:
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(1) The patient's cerebral hemorrhage is caused by brain tumor, brain trauma, blood disease (secondary to anticoagulant and thrombolytic therapy);
(2) with a mixed stroke or cerebral hemorrhage with severe bleeding needs to surgery;
(3) The clinical manifestations of cerebral palsy, including the disappearance of ipsilateral pupillary reflexes and other third pairs of cranial nerve paralysis;
(4) with pulmonary heart disease, unstable angina or acute myocardial infarction within 6 months;
(5) with neurological deficits (mRS>2) before the onset of AICH;
(6) Accompanied by severe cardiac insufficiency (NYHA cardiac function classification III-IV);
(7) Accompanied by severe hepatic insufficiency (the liver function test results exceed 2 times the upper limit of the normal range);
(8) Accompanied by severe renal insufficiency (the serum creatinine is more than twice the upper limit of the normal range);
(9) Active gastrointestinal bleeding occurs after the onset of AICH in patients;
(10) The patient has a heavier blood system or other systemic underlying disease;
(11) The patient is in a state of pregnancy or breastfeeding, or has a severe allergic disease or is allergic to multiple drugs;
(12) The patient has other diseases that cause his neurological deficit, or join the study to aggravate his condition;
(13) The patient has participated in other clinical trials in the past 3 months;
(14) Patients without malignant tumors and receiving radiotherapy and chemotherapy
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研究实施时间:
Study execute time:
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从From
2019-01-30
至To
2022-01-30
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征募观察对象时间:
Recruiting time:
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从From
2019-06-30
至To
2021-06-30
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