化瘀通络汤治疗脑小血管病致认知功能障碍的近远期疗效观察

Near and long term curative effect of Huayu Tongluo Decoction on cognitive dysfunction caused by cerebral small vessel disease

目的观察化瘀通络汤治疗脑小血管病致认知功能障碍患者3个月及停药后6个月、9个月、12个月的临床疗效及转归。方法参照纳入及排除标准收集60例脑小血管病致认知功能障碍患者,随机分为对照组及治疗组各30例(实验过程中2组各脱落1例)。2组均给予常规治疗,治疗组在常规治疗基础上加用化瘀通络汤。2组分别在治疗3个月后和随访6个月、9个月、12个月采用简易智能状态检查量表(MMSE)、蒙特利尔认知评估表(MoCA)对患者认知功能进行评价。结果治疗3个月后,2组MMSE评分和Mo CA评分均明显升高(P均<0.05),且治疗组明显高于对照组(P均<0.05)。随访各时间点,治疗组MMSE评分和Mo CA评分均明显高于治疗前及对照组(P均<0.05);随访6个月时,对照组MMSE评分和Mo CA评分均明显高于治疗前(P均<0.05),随访9个月、12个月MMSE评分和Mo CA评分与治疗前比较差异均无统计学意义(P均>0.05)。在治疗及随访期间,治疗组有1例出现恶心呕吐,对照组有1例出现口干及便秘症状,经对症处理后症状消失。结论化瘀通络汤治疗脑小血管病致认知功能障碍患者的近期及远期疗效好,具有延缓脑小血管病致认知功能障碍向血管性痴呆转化的作用,且安全性较好。

Objective It is to observe the clinical curative effect of Huayu Tongluo decoction（HYTLD） in cognitive dysfunction caused by cerebral small vessel disease after treated for 3 months and the outcome after withdrawal of the drug for 6,9,12 months. Methods Sixty patients with cognitive dysfunction caused by cerebral small vessel disease were collected by inclusion and exclusion criteria and randomly divided into control group and treatment group（two groups each shedding one case during the experiment）. All patients were treated with conventional treatment,and added HYTLD in the treatment group. The cognitive function were evaluated by the mini-mental state examination（MMSE） and Montreal Cognitive Assessment Form（Mo CA） after 3 months of treatment and follow-up 6,9,12 months in the two groups. Results After 3 months of treatment,the MMSE score and Mo CA scores of two groups were significantly increased（all P〈0. 05）,and the improvements in the treatment group were markedly better than those in the control group（all P〈0. 05）. At each time point of follow-up,the MMSE scores and Mo CA scores in the treatment group were markedly higher than those in the control group and before treatment（all P〈0. 05）; after 6 moths of following-up,the MMSE scores and Mo CA scores in the control group were markedly higher than before treatment（all P〈0. 05）,but there was no significantly difference between before and after 9,12 months of following-up（all P〈0. 05）. During treatment and following-up period,only 1 case had mild gastrointestinal reactions in the treatment group,and 1 cases had dry mouth and constipation symptoms in the control group,all symptoms were disappeared after symptomatic treatment. Conclusion The Near and long term curative effect of HYTLD in cognitive dysfunction caused by cerebral small vessel disease is good,can slow down the transformation of cognitive dysfunction of cerebellar vascular disease to vascular dementia,and has good safety.