通窍活血汤联合丁苯酞治疗脑梗死后血管性痴呆的疗效及其对患者痴呆程度、认知功能的影响  

Efficacy of Tongqiao Huoxue Decoction combined with butylphthalide in the treatment of vascular dementia after cerebral infarction and its impact on the severity of dementia and cognitive function in patients

作　　者：梅倩倩 董会 吉金荣 MEI Qian-qian;DONG Hui;JI Jin-rong(Comprehensive Internal Second Department,Henan Provincial Third People's Hospital,Zhengzhou 450000,Henan,CHINA;Department of Neurology,the First People's Hospital of Xinxiang City,Xinxiang 453099,Henan,CHINA)

机构地区：[1]河南省直第三人民医院综合内二科,河南郑州450000 [2]新乡市第一人民医院神经内科一病区,河南新乡453099

出　　处：《海南医学》2024年第9期1228-1233,共6页Hainan Medical Journal

基　　金：2020年河南省医学科技攻关计划联合共建项目(编号:LHGJ20201920)。

摘　　要：目的观察通窍活血汤联合丁苯酞治疗脑梗死后血管性痴呆(VD)患者的临床疗效,并探讨其对患者痴呆程度、认知功能的影响。方法选取2021年2月至2023年2月河南省直第三人民医院收治的94例脑梗死后VD患者纳入研究,按随机数表法分为西药组和中西药联合组,每组47例。西药组患者在对症支持治疗基础上予以丁苯酞治疗,中西药联合组患者在对症支持治疗基础上予以通窍活血汤联合丁苯酞治疗,均连续治疗3个月。治疗后比较两组患者的临床疗效,以及治疗前、治疗1个月、治疗3个月后的痴呆程度[临床痴呆评定量表(CDR)]、认知功能[简易精神状态检查量表(MMSE)]、生活能力[生活能力量表(ADL)]、炎症因子[白细胞介素(IL)-6、IL-18、肿瘤坏死因子(TNF)-α]、神经相关因子[脑源性神经营养因子(BDNF)、神经生长因子(NGF)、降钙素基因相关肽(CGRP)]水平。结果中西药联合组患者的临床治疗总有效率为93.62%,明显高于西药组的78.72%,差异有统计学意义(P<0.05);中西药联合组患者治疗1个月和3个月后的CDR评分分别为(1.11±0.20)分、(0.72±0.14)分,明显低于西药组的(1.27±0.28)分、(0.85±0.19)分,ADL评分分别为(20.37±3.17)分、(15.16±2.03)分,明显低于西药组的(22.89±4.05)分、(18.25±3.14)分,MMSE评分分别为(19.41±2.32)分、(26.01±2.34)分,明显高于西药组的(17.25±2.37)分、(24.31±2.22)分,差异均具有统计学意义(P<0.05);中西药联合组患者治疗1个月、3个月后的血清IL-6、IL-18、TNF-α水平明显低于西药组,而血清BDNF、NGF、CGRP水平明显高于西药组,差异均有统计学意义(P<0.05)。结论通窍活血汤联合丁苯酞治疗脑梗死后VD可减轻患者的神经炎症反应,改善神经相关因子,从而改善脑梗死后VD患者认知功能,减轻痴呆程度,提高日常生活能力,疗效更为显著。Objective To observe the clinical efficacy of Tongqiao Huoxue Decoction combined with butylphthalide in the treatment of vascular dementia(VD)patients after cerebral infarction,and to explore its impact on the severity of dementia and cognitive function in patients.Methods A total of 94 patients with post-cerebral infarction VD admitted to Henan Provincial Third People's Hospital from February 2021 to February 2023 were selected for inclusion in the study.They were randomly divided into a western medicine group and a combined Chinese and western medicine group,with 47 patients in each group.The patients in the western medicine group were treated with butylphthalide on the basis of symptomatic supportive treatment,while the patients in the combined Chinese and western medicine group were treated with Tongqiao Huoxue Decoction combined with butylphthalide on the basis of symptomatic supportive treatment.Both groups of patients were treated continuously for 3 months.After treatment,the clinical efficacy of the two groups of patients was compared,as well as the dementia severity[Clinical Dementia Rating Scale(CDR)],cognitive function[Mini-mental State Examination(MMSE)],living ability[Activities of Daily Living Scale(ADL)],inflammatory factors[Interleukin(IL)-6,IL-18,tumor necrosis factor(TNF)-α],neuro-related factors[brain-derived neurotrophic factor(BDNF),nerve growth factor(NGF),calcitonin gene-related peptide(CGRP)]levels before treatment,at 1 month after treatment,and 3 months after treatment.Results The total clinical efficacy rate of patients in the combined Chinese and Western medicine group was 93.62%,which was significantly higher than 78.72%of the Western medicine group(P<0.05).The CDR scores of patients in the combined Chinese and Western medicine group at 1 month and 3 months after treatment were(1.11±0.20)points and(0.72±0.14)points,respectively,which were significantly lower than(1.27±0.28)points and(0.85±0.19)points of the Western medicine group;the ADL scores were(20.37±3.17)points and(15.16±2

关 键 词：脑梗死 血管性痴呆 通窍活血汤 丁苯酞 临床疗效 痴呆程度 认知功能 

分 类 号：R743.33[医药卫生—神经病学与精神病学]