艾地苯醌联合尼莫地平治疗脑梗死后血管性认知功能障碍的疗效观察

Therapeutic effect of idebenone combined with nimodipine in the treatment of vascular dementia after cerebral infarction

目的观察艾地苯醌联合尼莫地平治疗脑梗死后血管性认知功能障碍（VCI）的临床疗效与安全性。方法选择2013年1月—2014年12月海南省边防总队医院收治的VCI患者109例,根据随机数字表法分为联合组（55例）、对照组（54例）,2组均给予常规对症治疗,对照组口服尼莫地平30 ng,每日3次,连续3个月;联合组在对照组基础上加服艾地苯醌30 ng,每日3次,疗程3个月。治疗后观察2组临床疗效,记录治疗后不同时点简易精神状态检查量表（MMSE）评分与日常生活活动能力评定量表（Barthel指数）评分变化与服药期间药物不良反应。结果服药3个月后联合组总有效率高于对照组（94.5%vs.81.5%）,差异有统计学意义（χ^2=4.427,P=0.035）。与治疗前比较,治疗后2组患者MMSE评分与Barthel指数评分均逐步升高（P〈0.01）。联合组治疗2个月、3个月MMSE评分显著高于对照组[（21.7±3.6）分vs.（20.2±3.2）分,t=2.303,P〈0.05;（23.8±4.2）分vs.（21.5±3.7）分,t=3.039,P〈0.05],治疗3个月后Barthel指数评分显著高于对照组[（58.1±7.5）分vs.（54.6±6.3）分,t=2.646,P=0.009]。2组服药期间胃肠道不适、低血压、面部潮红、皮疹等不良反应发生率比较,差异无统计学意义（P》0.05）。结论艾地苯醌联合尼莫地平方案较单独使用尼莫地平更能有效改善患者认知能力与生活能力,且具有较高的耐受性和临床安全性。

Objective To observe the clinical efficacy and safety of idebenone combined with nimodipine in the treatment of vascular cognitive impairment（VCI） after cerebral infarction.Methods From January 2013 to December 2014,109 cases of patients with VD in Hainan Province Frontier Corps Hospital were enrolled,according to random number table method,they were divided into combined group（55 cases） and control group（54 cases）,two groups were given routine symptomatic treatment,the control group with oral administration of nimodipine 30 mg,3 times a day,for 3 consecutive months;combined group on the basis of treatment in the control group,also added idebenone 30 mg,3 limes a day.The course of treatment was 3 months.After treatment,the clinical efficacy of the 2 groups were observed,and the mini mental state examination scale（MMSE） score and the change ol the daily living activity ability score（Barthel index） were recorded.Results Three months after taking medicine,the total efficiency of the combination group was higher（94.5%vs.81.5%）,the difference was statistically significant（χ^2=4.427,P =0.035）.Compared with before treatment,after treatment,the two groups of patients with MMSE scores Barthel Index scores were gradually increased（P〈 0.01）.Combined group＇s two months and three months ＇ MMSE score were significantly higher than control group（21.7 ± 3.6） points vs.（20.2±3.2） points,（23.8 ±4.2） points vs.（21.5 ±3.7） points,t =2.303,t =3.039,P〈0.05],after 3 months of treatment,Barthel index score was significantly higher[（58.1 ±7.5） points vs.（54.6±6.3） points.t =2.646,P =0.009].During treatment,the two groups＇ gastrointestinal discomfort,hypotension,facial flushing,rash incidence ol adverse reactions＇ differences were not statistically significant（P〉0.05）.Conclusion Idebenone and nimodipine other than single use of nimodipine can effectively improve the patient＇s life and cognition ability and has a higher tolerance and clinical safety.