通窍活血汤联合丁苯酞治疗血管性痴呆瘀血内阻证临床观察

The Clinical Curative Effect of Tongqiao Huoxue Decoction Combined with Butylphthalide on Vascular Dementia

目的:观察通窍活血汤联合丁苯酞治疗血管性痴呆(vascular dementia,VD)的临床疗效。方法:选取在本院门诊就诊的血管性痴呆瘀血内阻证患者80例,随机分为观察组与对照组各40例。对照组在常规治疗基础上(包括调节血压、降血脂、控制血糖及抗血小板聚集等)给予丁苯酞软胶囊口服,每日3次,每次2粒。观察组在对照组治疗的基础上加通窍活血汤治疗。每位患者治疗前后分别进行简易精神状态量表(mini-mental state examination,MMSE)评分、蒙特利尔认知评估量表(montreal cognitive assessment,MOCA)评分、生活能力评分(living ability score,ADL)、临床痴呆评定量表(clinical dementia rating,CDR)评分,尤其是生活能力的评定,将作为判定痴呆等级的标准,并将患者各项评分进行自身前后对照比较,评定治疗前后中医证候积分的变化,同时检测两组患者治疗前后血脂、超氧化物歧化酶(super oxide dismutase,SOD)等指标,评定治疗效果。结果:治疗3个月后,观察组有效率为70.00%,对照组有效率为55.00%,两组有效率比较,差异有统计学意义(P<0.05);观察组MMSE、MOCA、ADL各项评分显著高于对照组(P<0.05);观察组CDR评分明显低于对照组(P<0.05);观察组血脂水平低于对照组(P<0.05),SOD水平高于对照组(P<0.05)。结论:通窍活血汤联合丁苯酞能够显著提高血管性痴呆患者的生活能力和认知功能,其作用机制可能与降低血液黏稠度、保护脑神经组织细胞等有关。

Objective： To observe the clinical curative effect of Tongqiao Huoxue Decoction(TQHXD） combined with butylphthalide on vascular dementia(VD）. Methods： Eighty patients with VD with accumulation of blood stasis treated in our outpatient clinic were selected and randomly divided into observation group and control group,40 cases in each group. On the basis of routine treatment(including regulating blood pressure,lowering blood fat,controlling blood sugar and anti platelet aggregation,and so on）,the ones in the control group were given Butylphthalide Soft Capsules for oral administration,3 times a day,2 capsules each time. The ones in the observation group were added TQHXD based on the treatment of the control group. Before and after the treatment,the Mini-Mental State Examination(MMSE） score,the Montreal cognitive assessment scale(Mo CA） score,the living ability score(ADL）,and the clinical dementia rating scale were scored. In particular,the assessment of life ability will be used as a criterion for judging the level of dementia. The scores of each patient were compared before and after the treatment,and the changes of TCM syndrome score before and after the treatment were evaluated. At the same time,the indexes of interleukin,tumor necrosis factor,blood lipid,cysteine and superoxide dismutase were measured before and after the treatment in the two groups,and the therapeutic effects were evaluated. Results： After 3 months＇ treatment,the effective rate was 70% in the observation group and 55% in the control group,and the scores of MMSE,Mo CA and ADL in the observation group were significantly higher than those in the control group(P〈0. 05）. The evaluation of CDR in the observation group was significantly lower than that of the control group(P〈0. 05）,and the laboratory indexes of the observation group were significantly better than those in the control group(P〈0. 05）. Conclusion： TQHXD combined with butylphthalide can significantly improve the living ability and cognitive function of patients with vascular dementia. The mechanism of its action may be related to the reduction of blood viscosity and the protection of brain tissue cells.