解语丹联合强光刺激治疗高龄脑肿瘤合并出血性认知障碍的临床过程与综合管理：一个个案报告

The Clinical Process and Comprehensive Management of Jieyu Dan Combined with Strong Light Stimulation in the Treatment of Elderly Brain Tumors with Hemorrhagic Cognitive Impairment: A Case Report

摘要: 背景：随着人口老龄化进程加快，颅内肿瘤合并自发性脑出血的高龄患者比例不断上升，因其共病复杂、治疗耐受性差、神经功能受损严重，临床治疗面临巨大挑战。传统手术及放化疗往往难以实施，西医保守治疗在控制病灶进展及促进认知恢复方面疗效有限。中医药因其整体调节、多靶点作用特点，在此类复杂病情中的潜力日益受到关注。方法：本报告呈现一例89岁高龄女性，因额叶肿瘤性病变合并多部位颅内出血致严重意识及认知障碍。入院后因高龄与身体状况极差，未行手术及放化疗，采取中西医结合个体化保守治疗策略。中医辨证为“痰瘀阻络、脑络失养”，予中药复方“解语丹”每日煎服以活血化瘀、解毒通络、醒脑开窍；同步采用每日30分钟10,000 Lux强光刺激疗法以重建生物节律，促进认知恢复。基础治疗包括脱水降颅压、止血、神经保护、抗感染、电刺激、作业治疗、吞咽训练及系统营养支持等综合干预。结果：入科时患者GCS评分为6分(E1V1M4)，MMSE与MoCA无法完成评估，Barthel指数为0，生活完全依赖。经系统治疗后第15天，GCS升至14分，患者可自主睁眼、部分定向并完成简单指令；MoCA阶段性评分为4分，提示认知功能部分恢复；Barthel指数提升至20分，影像学复查显示肿瘤病灶由6.6 × 5.7 × 4.7 cm缩小至4.4 × 2.2 × 4.0 cm，中线偏移消失，硬膜下与蛛网膜下腔出血吸收。整体生命体征稳定，无新发出血及明显并发症，临床表现呈逐步改善趋势。结论：对于无法耐受标准手术及放化疗的高龄复杂颅内肿瘤合并出血患者，中医复方解语丹联合强光刺激为核心的中西医结合保守治疗策略，可能有助于促进病灶吸收、改善意识与认知功能、提高生活质量，展现出良好的耐受性与潜在疗效。该干预方案为类似重症高龄患者的非侵袭性治疗提供了可行思路，但其作用机制与疗效仍需在大样本、多中心前瞻性研究中进一步验证。

Abstract: Background: With the acceleration of population aging, the proportion of elderly patients with intracranial tumors complicated by spontaneous intracranial hemorrhage is continuously rising. Due to the complexity of comorbidities, poor treatment tolerance, and significant neurological impairment, clinical treatment faces huge challenges. Traditional surgery and radiotherapy/chemotherapy are often difficult to implement, and the efficacy of conservative treatment in Western medicine is limited in controlling lesion progression and promoting cognitive recovery. Traditional Chinese medicine is increasingly being recognized for its potential in such complex conditions due to its holistic regulation and multi-targeted effects. Methods: This report presents a case of an 89-year-old female patient with a frontal lobe tumor and multiple intracranial hemorrhages leading to severe consciousness and cognitive disorders. Upon admission, due to advanced age and very poor physical condition, she did not undergo surgery or radiotherapy/chemotherapy and instead adopted a combined individualized conservative treatment strategy of Chinese and Western medicine. The Chinese medicine diagnosis was “phlegm-stasis obstructing collaterals, brain collaterals insufficiently nourished,” and the herbal formula “Jieyu Dan” was used daily to invigorate blood, remove stasis, detoxify and open collaterals, and awaken the mind; at the same time, a daily 30-minute 10,000 Lux bright light stimulation therapy was employed to rebuild biological rhythms and promote cognitive recovery. Basic treatment included comprehensive interventions such as dehydration to reduce intracranial pressure, hemostasis, neuroprotection, anti-infection, electrical stimulation, occupational therapy, swallowing training, and systemic nutritional support. Results: Upon admission, the patient had a GCS score of 6 (E1V1M4), was unable to complete the MMSE and MoCA assessments, and had a Barthel index of 0, being completely dependent in daily life. After systematic treatment, by day 15, the GCS improved to 14, the patient could open her eyes independently, was partially oriented, and could follow simple instructions; the MoCA phase score was 4, indicating partial recovery of cognitive function; the Barthel index increased to 20, and imaging review showed that the tumor size reduced from 6.6 × 5.7 × 4.7 cm to 4.4 × 2.2 × 4.0 cm, midline shift disappeared, and subdural and subarachnoid hemorrhages were absorbed. Overall, vital signs were stable, with no new bleeding or significant complications, and clinical presentation showed a trend of gradual improvement. Conclusion: For elderly patients with complex intracranial tumors complicated by hemorrhage who cannot tolerate standard surgery and radiotherapy/chemotherapy, a conservative treatment strategy combining the Chinese herbal formula Jieyu Dan and strong light stimulation may help promote lesion absorption, improve consciousness and cognitive function, and enhance quality of life, demonstrating good tolerance and potential efficacy. This intervention provides a feasible approach for non-invasive treatment in similar severely ill elderly patients, but its mechanisms and effects still need to be further validated in large-sample, multi-center prospective studies.