不同疗法对非痴呆性血管性认知障碍疗效观察

Comparison of clinical effects of several treatments for vascular cognitive impairment not dementia

目的:观察并比较不同疗法在治疗非痴呆性血管性认知障碍(vascular cognitive impairment not dementia,VCIND)患者中的临床疗效。方法:将90例VCIND患者随机分为电刺激子脑顶核(cerebellar fastigial nucleus electrical stimulation,FNS)组、奥拉西坦组和尼莫地平各30例。在常规药物治疗的基础上,FNS组采用FNS,奥拉西坦组口服奥拉西坦,尼莫地平组口服尼莫地平治疗。观察3组患者治疗前后蒙特利尔认知功能评估量表(Montreal cognitive assessment,MoCA)评分、事件相关电位-P300(event-related potentials P300,ERP-P300)及经颅多普勒超声(transcranial dopplor ultrasonic monitor,TCD)的变化,并进行比较。结果:FNS组治疗后MoCA明显增高(P<0.01),P300潜伏期缩短(P<0.01)、波幅增高(P<0.01),TCD显示治疗后平均血流速度增高(P<0.01)。奥拉西坦组治疗后MoCA较前明显增高(P<0.01),P300潜伏期缩短(P<0.01)、波幅增高(P<0.01),但TCD显示治疗前后平均血流速度的差异无统计学意义(P>0.05)。尼莫地平组治疗后TCD显示平均血流速度增高(P<0.01),而MoCA、P300潜伏期和波幅均无变化(P>0.05)。3组间治疗后MoCA评分FNS组及奥拉西坦组高于尼莫地平组(P<0.01),FNS组高于奥拉西坦组(P<0.01);治疗后P300潜伏期FNS组较奥拉西坦组及尼莫地平组更短(P<0.01),而后2组间无差异(P>0.05);治疗后波幅奥拉西坦组较FNS组及尼莫地平组更高(P<0.05),而后2组间无差异(P>0.05);治疗后TCD显示平均血流速度FNS组MCA高于奥拉西坦组及尼莫地平组(P<0.01),而后2组间无差异(P>0.05),FNS组及尼莫地平组ACA、PCA、VA高于奥拉西坦组(P<0.05),其中FNS组ACA、VA高于尼莫地平组(P<0.05),而PCA2组间无差异(P>0.05)。结论:FNS、奥拉西坦、尼莫地平均能够对VCIND患者产生治疗效果:奥拉西坦能够有效改善其认知功能;尼莫地平可改善其颅内血流供应;FNS对认知功能及颅内血流供应均有改善,效果更为全面。

Objective：To investigate the clinical effects of several treatments for vascular cognitive impairment not dementia （VCIND）. Methods：Total 90 patients with VCIND were randomly divided into the cerebellar fastigial nucleus electrical stimulation （FNS） group,oxiracetam group and nimodipine group,with 30 cases in each group. On the base of all groups receiving conventional treatments,the treatment of FNS was applied in the FNS group,oxiracetam in the oxiracetam group and nimodipine in nimodipine group. The Event-Related Potentials P300 （ERP-P300）,Montreal cognitive assessment（MoCA） and transeranial dopplor uhrasonic monitor （TCD） of all patients were observed and compared before and after the treatment. Results： FNS group：After the treatment, the scores of MoCA showed improvement （P 〈 0.01）,the latency period of P300 was significantly shorten （P 〈 0.01） and the amplitude was significantly increased （P 〈 0.01）. TCD result showed the mean velocity of blood flow improved significantly （P 〈 0.01）. Oxiracetam group：After the treatment,the scores of MoCA showed improvement （P 〈 0.01）,the latency period of P300 was significantly shorten （P 〈 0.01） and the amplitude was significantly increased （P 〈 0.01 ）,but the TCD result had no obvious improvement （P 〉 0.05）. Nimodipine group：After the treatment,TCD result showed the mean velocity of blood flow improved significantly （P 〈 0.01）,but the MoCA the latency period and the amplitude of P300 had no obvious improvement （P 〉 0.05）. After thetreatment, the score of MoCA in the FNS group and oxiracetam group were both higher than that in nimodipine group （P 〈 0.01）, and the score of the FNS group was higher than that of the oxiracetam group （P 〈 0.01）. After the treatment, the latency of P300 of the FNS group was shorten than that of the oxiracetam group and nimodipine group （P 〈 0.01）,and there was no significant difference between the oxiracetam group and nimodipine group （P 〉 0.05） ;the amplitude of P300 in the oxiracetam group was higher than that in the FNS group and nimodipine group （P 〈 0.05）,but there were no significant differences between the FNS group and nimodipine group （P 〉 0.05）. After the treatment,TCD result showed the mean velocity of blood flow of MCA in FNS group was higher than those in oxiracetam group and nimodipine group （P 〈 0.01）, but there were no significant differences between the oxiracetam group and nimodipine group （P 〉 0.05）;The mean velocity of blood flow of ACA, PCA ans VA in FNS group and nimodipine group were higher than those in oxiracetam group （P 〈 0.05）,ACA and VA of FNS group was higher than those of nimodipine group （P 〈 0.05）,but there was no significant difference in PCA between FNS group and nimodipine group （P 〉 0.05）. Conclusion：The FNS,oxiracetam and nimodipine are all beneficial in treatment of VCIND. Oxiracetam can effectively improve cognitive function ; nimodipine can effectively improve blood supply to the brain;FNS can effectively improve cognitive function and blood supply to the brain in patients with VCIND.