多奈哌齐对一氧化碳中毒后迟发性脑病认知障碍的疗效及安全性

Efficacy and safety of donepezil on cognitive impairment of delayed encephalophthy after carbon monoxide poisoming

目的探讨多奈哌齐治疗一氧化碳中毒后迟发性脑病（DEACMP）认知障碍的临床疗效及其安全性。方法收集2004年3月至2015年9月DEACMP认知障碍患者80例，将其随机分成观察组和对照组，每组40例。对照组予高压氧、激素、预防脑水肿、清除自由基、改善脑循环、营养神经、康复训练等治疗，疗程6周；观察组在对照组基础上，予口服多奈哌齐5mg，1次／d，疗程6周。两组患者治疗前，治疗后2、4、6周进行蒙特利尔认知评估量表（MoCA）、简明智能精神状态检查量表（MMSE）评分对比，两组患者治疗后90d进行安全性评定比较。结果两组患者治疗前后MoCA、MMS评分比较差异有统计学意义（P〈0．05）；治疗后2、4、6周，观察组的MoCA、MMSE平均值较对照组均有不同程度提高，且随治疗时间扩展后，评分同步提高，但两组间比较差异未见统计学意义（P〉0．05）。两组治疗后90d安全性评定比较差异未见统计学意义（P〉0．05）。结论综合治疗能显著改善DEACMP的认知障碍，联用多奈哌齐治疗DEACMP认知障碍，能够获得临床疗效且安全可靠，其治疗作用需加大样本量、多中心及扩大多奈哌齐治疗时间进一步研究探讨。

Objective To investigate the clinical efficacy and safety of donepezil in the treatment of cognitive impairment of delayed encephalopathy after carbon monoxide poisoming （DEACMP）. Methods From March 2004 to September 2015,80 patients with cognitive impairment of DEACMP were collected, and they were randomly divided into observation group and control group, with 40 cases in each group. The control group were treated with hyperbaric oxygen, hormone, prevention of brain edema, improve brain circulation, free radical scavenging, trophic nerve, rehabili-tation training and so on, the course of treatment was 6 weeks. The observation group on the basis of the control group received oral donepezil of 5 mg, once a day, the course of treatment was 6 weeks. The scores of Montreal cognitive assessment （ MoCA）, mini-mental status examination （ MMSE ） before and after the treatment at 2, 4 and 6 weeks were compared. The safety evaluation were compared between the two groups on 90th d after treatment. Results The scores of MoCA and MMSE between the two groups before and after treatment were significantly different（P 〈0. 05）. At 2, 4 and 6 weeks after treatment, the average value of MoCA and MMSE in the observation group all increased with different degrees compared with the control group, and with the extension of treatment time, the score synchronization increased, but the scores of the MoCA and MMSE had no significant difference between the two groups （P 〉 0. 05 ）. Safety evaluation of 90th d after treatment had no significant difference between the two groups （P 〉 0. 05 ）. Conclusions Comprehensive treatment can significantly improve the cognitive impairment of DEACMP, combined with donepezil in the treatment of the cognitive impairment of DEACMP has clinical efficacy and safety, the clinical effect of donepezil need to increase the sample size, multi center and the expansion of donepezil time for further study.