丁苯酞胶囊联合针刺对缺血性脑卒中后血管性痴呆患者认知功能及脑血流动力学状态的影响  

Effects of butylphthalein capsules combined with acupuncture on cognitive function and cerebral hemodynamic status in patients with vascular dementia after ischemic stroke

作　　者：陈顺喜[1] 沈涌[2] 刘菲菲[3] 袁健辉 Chen Shunxi;Shen Yong;Liu Feifei;Yuan Jianhui(Department of Acupuncture and Rehabilitation,Hangzhou Hospital of Traditional Chinese Medicine,Hangzhou,Zhejiang 310007,China;Department of Neurology,Hangzhou Hospital of Traditional Chinese Medicine,Hangzhou 31007,Zhejiang,China;Cadre Health Care Ofice,Hangzhou Hospital of Traditional Chinese Medicine,Hangzhou,Zhejiang 310007,China)

机构地区：[1]杭州市中医院针灸康复科,浙江杭州310007 [2]杭州市中医院神经内科,浙江杭州310007 [3]杭州市中医院干部保健办公室,浙江杭州310007

出　　处：《中国药物与临床》2024年第14期895-900,共6页Chinese Remedies & Clinics

摘　　要：目的探究丁苯酞胶囊联合针刺在缺血性脑卒中后血管性痴呆患者中的应用效果及对脑血流动力学状态及认知功能的影响。方法收集2021年3月至2023年12月于杭州市中医院就诊的缺血性脑卒中后血管性痴呆患者作为研究对象,按照不同治疗方式分为对照组(52例,行常规治疗+针刺治疗)和联合组(48例,在对照组的基础上联合丁苯酞胶囊治疗)。观察比较2组患者临床疗效、血流动力学状态[大脑中动脉血流速度(Vm)、阻力指数(RI)、脉动指数(PI)]、血清相关指标[血清降钙素基因相关肽(CGRP)、血管内皮素(ET)、缺氧诱导因子-1α(HIF-1α)]、蒙特利尔认知评估量表(MoCA)评分、生活能力量表(ADL)评分以及不良反应发生情况。结果联合组治疗总有效率为95.8%,高于对照组的82.7%(χ^(2)=4.403,P=0.036);治疗后,2组患者的MMSE评分、MoCA评分均有所升高,联合组MMSE评分、MoCA评分分别为(29.0±1.0)分、(25.9±1.0)分,均高于对照组的(27.7±1.1)分、(23.1±1.2)分(t=5.950、12.442,P<0.001);治疗后2组患者的血清相关指标均有所变化,联合组CGRP为(31±6)ng/L,高于对照组的(29±6)ng/L(t=2.266,P=0.026),联合组ET、HIF-1α分别为[(69±7)pg/ml、(254±45)pg/ml],均低于对照组的[(73±7)pg/ml、(288±52)pg/ml](t=3.413、3.479,P=0.001、0.001);治疗后联合组Vm、RI、PI分别为[(19.8±1.6)cm/s、(1.59±0.19)、(0.71±0.21)],均低于对照组的[(19.2±1.3)cm/s、RI(1.74±0.23)、PI(0.78±0.11)](t=2.121、3.539、2.111,P=0.036、0.001、0.037);治疗后,联合组ADL评分为(27±6)分,低于对照组的(31±5)分(t=4.283,P<0.001);2组患者治疗期间的不良反应发生率差异无统计学意义(χ^(2)=2.211,P=0.137)。结论丁苯酞胶囊联合针刺应用于缺血性脑卒中后血管性痴呆患者效果显著,可改善患者脑缺血性及神经损伤情况,调节血流动力参数,提高患者认知水平及日常生活能力,安全可靠,有应用价值。Objective To explore the application effect of butylphthalide capsules combined with acupuncture in patients with vascular dementia after ischemic stroke and its influence on cerebral hemodynamics and cognitive function.Methods Patients with vascular dementia after ischemic stroke in Hangzhou Hospital of Traditional Chinese Medicine were selected from March 2021 to December 2023 as the subjects of this study.According to different treatment methods,they were divided into a control group(n=52,routine treatment+acupuncture treatment)and a combined group(n=48,butylphthalide capsule on the basis of control group).The clinical efficacy,hemodynamic status[middle cerebral artery blood flow velocity(Vm),resistance index(RI),pulsatility index(PD)],serum-related indicators[serum calcitonin gene-related peptide(CGRP),endothelin(ET),hypoxia-inducible factor-lα(HIF-1a)],Montreal Cognitive Assessment(MoCA)scores,Activity of Daily Living(ADL)scores,and adverse reactions of the two groups were observed and compared between two groups.Results The total effective rate of treatment in combined group was 95.8%,which was higher than 82.7%in control group(χ^(2)=4.403,P-0.036).After treatment,the MMSE and MoCA scores of both groups increased.The MMSE and MoCA scores of the combined group were(29.0±1.0)and(25.9±1.0),respectively,which were higher than those of the control group[(27.7±1.1)and(23.1±1.2),respectively](t=5.950,12.442,P<0.001).After treatment,the serum-related indicators of both groups changed.The CGRP in the combined group was(31+6)ng/L,which was higher than(29+6)ng/L in the control group(t=2.266,P=0.026).The ET and HIF-1αin the combined group were(69±7)pg/ml and(254±45)pg/ml,respectively,which were lower than(73±7)pg/ml and(288±52)pg/ml in the control group,respectively(t=3.413,3.479,P=0.001,0.001).After treatment,the hemodynamic status of the both groups decreased.The Vm,RI,and PI in the combined group were[(19.8±1.6)cm/s,(1.59±0.19),and(0.71±0.21)],respectively,which were all lower than those in the control

关 键 词：缺血性脑卒中 血管性痴呆 针刺 丁苯酞胶囊 脑血流动力学 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R749.13[医药卫生—临床医学]