盐酸多奈哌齐配合综合康复治疗对颅脑外伤后记忆障碍的疗效观察

Effect of donepezil hydrochloride combined with comprehensive rehabilitation on memory impairment of patients after traumatic brain injury

目的探讨盐酸多奈哌齐配合综合康复训练治疗颅脑外伤（TBI）后记忆障碍的疗效和安全性。方法广东省工伤康复医院神经康复科自2008年5月至2010年10月收住院行康复治疗的TBI康复期患者76例，其中给予综合康复治疗38例（对照组），综合康复治疗的基础上加用盐酸多奈哌齐治疗38例（治疗组），疗程3个月，治疗前后采用韦氏记忆量表（WMS）评价疗效并观察不良反应的发生。结果与治疗前相比，对照组治疗后长时记忆中顺数、短时记忆中图片回忆和再认、瞬时记忆（背数）、WMS量表总分升高，差异均有统计学意义（P〈0．05）；与治疗前比较，治疗组治疗后长时记忆（顺数、倒数、积累）、短时记忆中图片回忆、再认、逻辑记忆、瞬时记忆（背数）、WMS量表总分均升高，差异均有统计学意义（P〈0．05）；与对照组治疗后比较，治疗组治疗后长时记忆中积累、短时记忆中逻辑记忆、WMS量表总分升高，差异有统计学意义（P〈0．05）。盐酸多奈哌齐治疗过程中未见明显不良反应。结论盐酸多奈哌齐配合综合康复治疗对TBI后记忆障碍较单纯采用综合康复治疗疗效更好。

Objective To explore the treatment efficacy and safly of donepezil hydrochloride combined with comprehensive rehabilitation in memory impairment of patients after traumatic brain injury （TBI）. Methods Seventy-six patients with TBI, admitted to our hospital from May 2008 to October 2010, were randomly divided into control group （n=38） and treatment group （n=38） using a case-control study method; patients from control group were given memory training, cognitive training and other comprehensive rehabilitation therapy while those from treatment group were given donepezil hydrochloride combined with comprehensive rehabilitation therapy for 3 months. Wechsler memory scale （WMS） was used to evaluate the efficacy and the drug adverse reactions were observed. Results As compared with those before treatment, the scores of forward counting in the long-term memory, scores of recall and recognition in short-term memory, scores of counting without looking in immediate memory and total scores of WMS were significantly higher in the control group after treatment （P〈0.05）; as compared with those before treatment, the scores of long term memory （forward counting, backward counting and adding）, and scores of recall, recognition and logic memory in short-term memory, scores of counting without looking in immediate memory, and total scores of WMS were significantly higher in the treatment group after treatment （P〈0.05）; as compared with those in the control group after treatment, the scores of adding in long term memory, scores of logic memory in short-term memory and total scores of WMS were significantly higher in the treatment group after treatment （P〈0.05）; oral administration of donepezil hydrochloride showed no significant adverse reactions. Conclusion Donepezil hydrochloride therapy combined with memory training, cognitive training and other comprehensive rehabilitation program is more effective than comprehensive rehabilitation therapy alone for memory impairment of patients after TBI.