丘脑梗死患者认知功能障碍的特点和药物治疗的临床分析

Clinical analysis of characteristics of cognitive disorder and drug therapy in thalamic infarction patients

目的观察丘脑不同区域梗死患者的认知功能障碍特点及应用麦角林联合醒脑静治疗的疗效。方法 42例丘脑不同区域梗死患者,应用头颅核磁共振成像(MRI)检查确定丘脑梗死患者梗死部位,采用简易智能状态检查量表(MMSE)和改良Barthel指数评分量表分别对丘脑梗死前外侧型(丘脑结节动脉供血区梗死)、后外侧型(丘脑膝状体动脉供血区梗死)、内侧型(丘脑旁正中动脉供血区梗死)、背侧型(脉络膜后动脉供血区梗死)进行评分,进一步联合尼麦角林联合醒脑静治疗8周后进行疗效评价。结果经检查,42例患者中结节动脉供血区梗死11例,膝状体动脉供血区梗死10例,旁正中动脉供血区梗死12例,脉络膜后动脉供血区梗死9例。丘脑结节动脉供血区及旁正中动脉供血区梗死患者的MMSE评分均低于膝体动脉区及脉络膜后动脉供血区梗死患者,差异具有统计学意义(P<0.05)。治疗后,42例患者MMSE评分为(24.8±4.6)分,高于发病时的(18.6±5.8)分,差异具有统计学意义(t=5.43,P<0.05)。丘脑结节动脉供血区及旁正中动脉区域梗死患者改良Barthel指数评分明显低于膝状体动脉供血区及脉络膜后动脉供血区梗死患者,差异具有统计学意义(P<0.05)。治疗后,42例患者改良Barthel指数评分为(69.7±17.4)分,高于发病时的(67.6±17.4)分,差异具有统计学意义(t=3.21,P<0.05)。患者发病时及治疗8周后,改良Barthel指数评分与MMSE评分呈正相关(r=0.45,P<0.05;r=0.49,P<0.05),MMSE评分高者,认知功能障碍程度越轻,日常生活能力越好。结论不同区域丘脑梗死患者认知功能障碍具有显著差异,应用尼麦角林联合醒脑静治疗,患者认知能力提和日常生活能力显著改善。

Objective To observe characteristics of cognitive disorder in patients with thalamic infarctionin different area and curative effect by nicergoline combined with Xingnaojing for treatment.Methods A total of42patients with thalamic infarction in different area received head magnetic resonance imaging(MRI)for thalamic infarction area examination.Mini-mental state examination(MMSE)and modified Barthel index were applied to evaluate antero-lateral thalamic infarction(tuberothalamic artery blood supply area infarction),posterior-lateral thalamic infarction(thalamus geniculate body artery blood supply area infarction),interior thalamic infarction(thalamus median artery blood supply area infarction),and dorsal thalamic infarction(artery blood supply area behind choroid infarction).Curative effect was evaluated after8weeks of treatment by nicergoline combined with Xingnaojing.Results Examination showed11cases with tuberothalamic artery blood supply area infarction,10cases with thalamus geniculate body artery blood supply area infarction,12cases with thalamus median artery blood supply area infarction,and9cases with artery blood supply area behind choroid infarction in the42patients.Patients with tuberothalamic artery blood supply area infarction and thalamus median artery blood supply area infarction both had lower MMSE scores than patients with thalamus geniculate body artery blood supply area infarction and artery blood supply area behind choroid infarction,and the difference had statistical significance(P<0.05).After treatment,the42patients had higher MMSE score as(24.8±4.6)points than(18.6±5.8)points during disease attack,and the difference had statistical significance(t=5.43,P<0.05).Patients with tuberothalamic artery blood supply area infarction and thalamus median artery blood supply area infarction both had lower modified Barthel index scores than patients with thalamus geniculate body artery blood supply area infarction and artery blood supply area behind choroid infarction,and the difference had statistical significance(P<0.05).After treatment,the42patients had higher modified Barthel index score as(69.7±17.4)points than(67.6±17.4)points during disease attack,and the difference had statistical significance(t=3.21,P<0.05).During disease attack and after8weeks of treatment,modified Barthel index score and MMSE score in the patients showed positive correlation(r=0.45,P<0.05;r=0.49,P<0.05).High MMSE score in patients led to mild cognitivedisorder degree and high activity of daily living.Conclusion There are remarkable differences of cognitive disorder in patients with thalamic infarction in different area.Implement of nicergoline combined with Xingnaojing in treatment provides excellent improvement in cognitive competence and activity of daily living.