Lin Zhu, Juan Lu1* and Zhijun Bao

Department of Neurosurgery, Affiliated 3201 Hospital of Xi’an Jiaotong University, Hanzhong, Shaanxi 723000, 1Department of Public Education, Hainan Vocational College of Political Science and Law, Haikou, Hainan 571100, China

*Corresponding Author:
Juan Lu
Department of Public Education, Hainan Vocational College of Political Science and Law, Haikou, Hainan 571100, China
E-mail: 672241343@qq.com
This article was originally published in a special issue, “Advanced Targeted Therapies in Biomedical and Pharmaceutical Sciences”
Indian J Pharm Sci 2023:85(1) Spl Issue “79-83”

This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms

DOI: 10.36468/pharmaceutical-sciences.spl.616

Abstract

To observe the clinical effect of NaoXueShu oral liquid in the treatment of hypertensive cerebral hemorrhage is the objective of the study. 85 neurosurgery inpatients from January 2020 to December 2021 were collected. 85 patients with hypertensive intracerebral hemorrhage were randomized into 43 patients in observation group and 42 patients in control group. The control group was only given conventional treatment and the observation group was given conventional treatment and the NaoXueShu oral liquid, 10 ml each time, using the oral or nasal feeding method, 3 times/d. The changes in the National institutes of health stroke scale score, Glasgow coma scale score, Barthel index and hematoma volume were compared between the two groups at admission and after 2 w and 4 w of treatment, so as to evaluate the effect of NaoXueShu oral liquid in the treatment of hypertensive cerebral hemorrhage. There was no significant difference in National institutes of health stroke scale score, Glasgow coma scale score, Barthel index and hematoma volume between the two groups at admission (p>0.05). At 2 w and 4 w, Glasgow coma scale score and Barthel index have significantly higher (p<0.05) National institutes of health stroke scale scores and hematoma volume of the observation group were significantly lower than the control group (p<0.05). The combination of NaoXueShu oral liquid with conventional treatment can improve the neurological deficit and improve the cure rate.

Keywords

Hypertensive cerebral hemorrhage, NaoXueShu oral liquid, neurological deficit, hematoma volume

Hypertensive cerebral hemorrhage occurs due to the formation of vascular wall, hyaline degeneration or fibrinoid degeneration and focal bleeding, ischemia and necrosis under the action of long-term hypertension. It is a spontaneous cerebral hemorrhage disease during emotional agitation or a sharp increase in blood pressure. It is characterized by high morbidity, high mortality rate and high disability rate[1]. Studies in Western countries have shown that cerebral hemorrhage accounts for 8 %-15 % of all strokes. Our country is as high as 21 %~48 %[2]. It seriously threatens the health of the middle-aged and elderly patients, and brings a heavy economic burden to the patient’s families and the society.

General data:

We selected neurosurgery patients from January 2020 to December 2021, 85 patients with hypertensive cerebral hemorrhage were admitted. All patients had first episode and were definitively diagnosed by cranial Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) examination. Inclusion criteria includes a clear history of hypertension; hematoma located in the brain lobes, basal ganglia, thalamic hemorrhage; hematoma volume<30 ml; Glasgow Coma Scale (GCS) scores≥7. Exclusion criteria includes patients with severe cardiac, hepatic or renal insufficiency or coagulation dysfunction; patients with a previous history of stroke and cerebral hemorrhage caused by cerebral trauma or cerebrovascular malformation. Among them, 46 males and 39 females were aged 45 y to 70 y old (53.2±5.6 y old). Patients were randomly divided into 43 patients in the observation group and 42 patients in the control group. Gender, age, amount of hematoma volume and site of bleeding were not significant (p>0.05), which is comparable. All patients or family members signed an informed consent form. It was also submitted to the hospital ethics committee for approval.

Materials and Methods

Methods:

The control group underwent conventional neurosurgery treatment, including dehydration, cranial pressure reduction, hemostasis, nutritional nerve, control of blood pressure, prevention of peptic ulcer and symptomatic supportive treatment. Cranial CT was reviewed on the 2nd d, 1st w, 2nd w and 4th w, to understand the intracranial hematoma absorption. The observation group started nasal feeding or oral NaoXueShu oral liquid on the 2nd d, 10 ml each time, 3 times/d, for 1 mo as a single course.

Observation indicators:

Observation indicators were calculated according to the needs of the subject and reference research[3]. The hematoma was measured at admission and at 2 w and 4 w after treatment, the National Institutes of Health Stroke Scale (NIHSS) score, GCS score and Barthel Index (BI), gender and age were recorded.

Statistical analysis:

Statistical Package for the Social Sciences (SPSS) 19.0 software was used for analysis and processing, and the measurement data was measured by mean±Standard Deviation (SD) (x±s); t-test was used for comparison between and within groups; count data were analyzed by Chi square (χ2) test, p<0.05 was considered as statistically significant.

Results and Discussion

NIHSS score, hematoma volume, GCS score and BI score between the two groups were compared before treatment (p>0.05) and after treatment the GCS score and BI score of the observation group were significantly higher than those of the control group (p<0.05). The NIHSS score and hematoma volume were significantly lower than those in the control group (p<0.05) as shown in Table 1-Table 4.

Group N Before the treatment 2 w after treatment 4 w after treatment
Control group 42 16.12±4.56 14.59±1.35 11.13±2.68
Observation group 43 16.98±3.2 3 12.07±1.87 8.28±2.87

Table 1: The NIHSS Scores before and after Treatment were Compared between the Two Groups (x±s)

Group N Before the treatment 2 w after treatment 4 w after treatment
Control group 42 28.23±2.16 14.07±3.38 7.13±2.68
Observation group 43 29.16±1.94 11.36±2.35 5.24±1.36

Table 2: The Hematoma Volume Score before and after Treatment was Compared between the Two Groups (x±s)

Group N Before the treatment 2 w after treatment 4 w after treatment
Control group 42 9.00±3.42 11.00±2.32 13.00±3.72
Observation group 43 9.00±2.68 12.00±3.35 14.00±3.56

Table 3: The GCS Scores of the Two Groups before and after Treatment were Compared (x±s)

Group N Before the treatment 2 w after treatment 4 w after treatment
Control group 42 4.35±1.64 10.00±3.25 13.00±5.11
Observation group 43 3.26±1.35 12.00±4.36 14.00±4.65

Table 4: The BI Scores of the Two Groups before and after Treatment were Compared (x±s)

Comparison of changes in hematoma volume between two patients and the representative CT images of hematoma absorption progress from the patients who suffer from hypertensive cerebral hemorrhage with or without NaoXueShu treatment is shown in fig. 1 and fig. 2. NaoXueShu oral liquid promoted the hematoma absorption after 2 w of treatment.

IJPS-oral

Fig. 1: NaoXueShu oral liquid promotes the absorption of intracranial hematoma shown from CT images
Note: Left: Before the treatment and Right: Post-treatment

IJPS-volume

Fig. 2: Comparison of changes in hematoma volume between two groups
Note: Left: Before the treatment and Right: Post-treatment

The hematoma volume scores before and after treatment was compared between the two groups. NaoXueShu oral liquid promoted the hematoma absorption (fig. 3).

IJPS-scores

Fig. 3: The hematoma volume scores before and after treatment was compared between the two groups. NaoXueShu oral liquid promoted the hematoma absorption, () Control group and () Observation group

The NIHSS scores were lower at the end of w 2 and w 4 in both groups, the levels were markedly reduced in the observation group than in the control group as shown in fig. 4.

IJPS-groups

Fig. 4: Comparison of NIHSS scores between the two groups, () Observation group and () Control group

As a common cardiovascular and cerebrovascular disease, hypertensive cerebral hemorrhage has a high mortality rate and disability rate, which has great social and family hazards[4] and the neurological deficit is the main cause and the main mechanism is as follows[5,6], compression of hematoma-destroy nerve tissue; disinterrupt the nerve conduction pathway; symptoms of hemiplegia, aphasia and other neurological symptoms; secondary brain injurycerebral edema, brain tissue ischemia and hypoxia, brain tissue hypoperfusion, blood brain barrer disruption, release of free radicals and inflammatory factors, this then causes cell degeneration, axonal injury; stress response after cerebral hemorrhage, body stress response after cerebral hemorrhage leads to water and electrolyte balance, acid-base balance, blood glucose metabolism and regulatory secretion disorder aggravate cerebral injury; others include brainstem injury and dehydration, cranial pressure reduction treatment cause effective circulating blood volume decline. NaoXueShu oral liquid is a Chinese patent medicine developed by Professor Xie Daozhen of Xiyuan Hospital of China Academy of Chinese Medical Sciences after years of clinical practice, based on the development of Buyang Huanwu Decoction in "Medicine Lin Gai Cuo" and Dahuang Zhechong soup in "Synopsis of Golden Chamber"[7]. Its main components are Astragalus, leech, stone calamus, Achyranthes bidentata and tetramethylpyrazine. Modern medical clinical research shows that the main components of NaoXueShu oral liquid, paeoniflorin, astragaloside, paeonol can reduce brain tissue edema, improve ischemia and hypoxia, and have the function of nutritional nerve tissue effect[8-10].

In this study, 85 patients with hypertensive cerebral hemorrhage were randomized for treatment. After 2 w and 4 w of treatment with NaoXueShu oral liquid, the GCS score and BI score were significantly higher than that of the control group (p<0.05), the NIHSS score and the amount of intracerebral hemorrhage hematoma were significantly lower than that of the control group (p<0.05). Niu et al.[11] explained routine minimally invasive evacuation of intracranial hematoma and NaoXueShu oral liquid were used for hypertensive cerebral hemorrhage. At 2 w and 4 w after treatment, the observation group was higher than that of the control group and the BI score was higher than that of the control group. Chen et al.[12] observed NaoXueShu oral liquid treatment of acute hypertension cerebral hemorrhage in 69 cases. The NIHSS scores decreased after 2 w of treatment. There was no significant difference. However, the NIHSS score after 4 w of treatment was significantly lower than that of the control group. The conventional treatment of combined NaoXueShu oral liquid, can improve neurological defect symptoms, improve the recovery and cure rate, reduce disability rate. Zhang et al.[13,14] has shown that on the basis of rat cerebral hemorrhage model, it was found that the oral solution intervention could inhibit the opening of blood-brain barrier, reduce the occurrence and development of brain tissue edema, reduce the degree of brain injury after cerebral hemorrhage, and improve the loss of nerve function and reduce the secondary brain damage after cerebral hemorrhage by inhibiting neuronal apoptosis. Liu et al.[15] in the study of hypertensive cerebral hemorrhage, this drug was found to effectively reduce serum Interleukin-6 (IL-6) and Tumor Necrosis Factor alpha (TNF-α), prevent the aggregation of inflammatory factors, prevent the occurrence of secondary injury of hypertensive cerebral hemorrhage and promote hematoma absorption, and improve the clinical prognosis.

NaoXueShu oral liquid combined with conventional internal medicine treatment can reduce hypertension intracerebral hemorrhage causes secondary injury, protects the damaged neurons, promotes hematoma absorption, improves the symptoms of neurological deficiency and improves the quality of life.

Conflict of interests:

The authors declared no conflict of interest.

References