脑梗死急性期使用丁苯酞注射液对患者脑血流灌注和认知功能的影响

Effects of Butylphthalide Injection on Cerebral Perfusion and Cognitive Function in Patients with Acute Cerebral Infarction

目的研究伴有认知障碍的脑梗死急性期患者使用丁苯酞注射液对脑血流灌注和蒙特利尔认知评估量表(Montreal cognitive assessment scale,MoCA)评分的影响。方法将符合入组条件的80例伴有认知障碍的脑梗死急性期患者随机分为观察组(40例)和对照组(40例),对照组采用常规治疗,观察组在对照组治疗方法基础上联合丁苯酞注射液治疗,疗程14 d。治疗前后行磁共振动态磁敏感对比增强灌注加权成像(dynamic susceptibility contrast-enhanced per-fusion weighted imaging,DSC-PWI)测量缺血区脑血流灌注参数,包括缺血区脑血流量(cerebral blood flow,CBF)比值、脑血流量(cerebral blood volume,CBV)比值、平均通过时间(mean transit time,MTT)比值和达峰时间(time to peak,TTP)比值。采用MoCA量表评估认知功能。结果观察组治疗后CBF比值、CBV比值较对照组提高,MTT比值和TTP比值较对照组降低,差异均有统计学意义。观察组治疗后MoCA各亚项评分和总评分较对照组提高,差异均有统计学意义。观察组治疗前后CBV比值、CBF比值与MoCA量表总评分呈正相关(r=0.474,P=0.013;r=0.282,P=0.027),MTT比值、TTP比值与MoCA量表总评分呈负相关(r=-0.294,P=0.021;r=-0.382,P=0.019)。结论丁苯酞注射液可提高伴有认知障碍的脑梗死急性期患者缺血区脑血流灌注水平并提高MoCA评分。

Objective To investigate the effect of butylphthalide injection on cerebral blood flow perfusion and cognitive function in patients with acute cerebral infarction and cognitive impairment.Methods A total of 80 eligible patients were included in this study, all of whom were randomly divided into two groups： observation group（n =40） and control group（n =40）. Conventional therapy was used in control group, while butylphthalide injection was added to conventional therapy in observation group, with a treatment course of 14 days each group. Cerebral blood flow perfusion parameters were achieved by magnetic resonance dynamic susceptibility contrast-enhanced perfusion weighted imaging（DSC-PWI）, including ischemia relative cerebral blood flow（CBF）, cerebral blood volume（CBV）, mean transit time（MTT） and time to peak（TTP）; cognitive function was assessed with Montreal cognitive assessment（MoCA） scale. The changes of cerebral perfusion and cognitive function after treatment were analyzed.Results The relative CBF and CBV had greater increase in observation group than that in control group after 14-day treatment（P 0.05）, while the relative MTT and TTP had greater decrease in observation group than in control group（P 0.05）. Each item score and total score of MoCA in observation group were more higher than that in control group after treatment, with statistical differences（P 0.05）. The CBV and CBF after treatment were positively correlated with the total score of MoCA（r =0.474, P =0.013; r =0.282, P =0.027）, and the MTT and TTP were negatively correlated with the total score of MoCA（r =-0.294, P =0.021; r =-0.382, P =0.019） in observation group.Conclusion Butylphthalide injection can improve cerebral blood flow perfusion in ischemic region and MoCA scores in patients with acute cerebral infarction and cognitive impairment.