活血化瘀法治疗脑出血作用机制实验研究进展

脑出血(ICH)是指原发性非外伤性脑实质内出血,是常见的脑血管疾病之一,其发病率高,发展迅速,恢复慢且致残率高。脑出血后脑组织发生一系列病理变化,如脑内局部血肿及其占位效应、继发脑水肿、脑细胞死亡及血脑屏障破坏等,从而引发脑损伤,导致神经功能缺损,严重影响患者生存质量,甚至危及生命。因此,寻找有效的治疗方法及药物,探索其改善神经功能的靶点及机制,减轻后遗症,提高患者的生存质量具有重要的意义。中医理论认为脑出血属于"离经之血",离经之血即为瘀血,因此,活血化瘀法在治疗脑出血中广泛应用,成为出血性中风的常规疗法。近年来学者运用现代科学方法对活血化瘀药物进行了广泛的研究,对于其作用机制进行深入探讨,发现活血化瘀法对脑出血后的一系列生理病理变化过程起着关键的干预作用,在血肿清除和改善微循环、降低死亡率和致残率方面有显著疗效。文章总结近五年活血化瘀药(三七、丹参、水蛭),方剂(补阳还五汤、抵挡汤、脑血疏口服液、通窍活血汤等)及复方注射液(丹红注射液)治疗脑出血的作用靶点,从促进血肿吸收、减轻脑水肿、减少细胞凋亡、促进血管新生、抑制炎症反应、促进神经组织的修复和再生等方面论述了活血化瘀中药治疗脑出血的实验研究进展,对其治疗作用机制进行总结,为临床运用活血化瘀法治疗脑出血及其现代科学研究提供科学依据。

Mechanism of Therapeutic Methods for Activating Blood and Removing Blood Stasis in Treatment of Cerebral Hemorrhage

Intracerebral hemorrhage (ICH) refers to the primary non-traumatic parenchymal hemorrhage, which is one of the common cerebrovascular diseases, with a high incidence, rapid development, slow recovery and high disabling rate. After intracerebral hemorrhage, a series of pathological changes occur in the brain tissue, such as local hematoma and its space occupying effect, secondary cerebral edema, death of brain cells and destruction of blood-brain barrier, which may lead to brain injury and neurological defects, seriously affect the quality of life of patients, and even endanger the life. Therefore, it is great medical value to find effective therapeutic methods and drugs, explore the mechanisms and targets for improving neurological function, reduce sequelae and improve the quality of life of patients. According to the theory of traditional Chinese medicine (TCM), cerebral hemorrhage belongs to " abnormal flow of the blood", which equals to blood stasis. In recent years, scholars conducted extensive research on drugs for promoting blood circulation to remove blood stasis with modern scientific methods, and made in-depth discussion for the mechanism, and found that therapies for activating blood and removing blood stasis, plays a key role in intervening a series of physiological and pathological changes after cerebral hemorrhage, with significant curative effects in removing hematoma, improving the microcirculation and reducing the mortality and morbidity. This article summarized drugs for promoting blood circulation to remove blood stasis (Notoginseng Radix et Rhizoma, Salviae Miltiorrhizae Radix et Rhizoma, Hirudo), formulas (Buyang Huanwu Tang, Didangtang, Naoxueshu oral liquid, Tongqiao Huoxuetang) and compound injections (Danhong injection) for the treatment of cerebral hemorrhage targets, and discussed the experimental research progress TCM for promoting blood circulation to remove blood stasis in treatment of cerebral hemorrhage in terms of promoting hematoma absorption, reducing brain edema and apoptosis, promoting angiogenesis, inhibiting the inflammatory response, and promoting the repair and regeneration of nerve tissue in nearly five years, and summarized the therapeutic mechanism, so as to provide scientific basis for clinical application of the therapeutic methods for activating blood and removing stasis to treat cerebral hemorrhage and the modern scientific research.