天麻素联合奥拉西坦治疗老年缺血性脑卒中后认知功能障碍的临床研究

Clinical study of Gastrodin combined with Oxiracetam in the treatment of cognitive impairment in elderly patients with ischemic stroke

目的探讨天麻素联合奥拉西坦治疗老年缺血性脑卒中后认知功能障碍的临床效果。方法选取2016年1月~2018年12月云南省第一人民医院收治的老年缺血性脑卒中后认知功能障碍患者102例,根据随机数字表法分为对照组(n=51,奥拉西坦治疗)和研究组(n=51,天麻素联合奥拉西坦治疗),两组均连续治疗1个月。比较两组临床疗效、不良反应、蒙特利尔认知评估量表(MoCA)评分、日常生活活动能力(ADL)评分及血清神经元特异性烯醇化酶(NSE)、同型半胱氨酸(Hcy)、超敏C反应蛋白(hs-CRP)水平。结果研究组治疗后的临床总有效率高于对照组(P<0.05)。治疗后,两组MoCA、ADL评分均高于治疗前,且研究组高于对照组(P<0.05)。治疗后,两组NSE、Hcy、hs-CRP水平均低于治疗前,且研究组低于对照组(P<0.05)。两组不良反应发生率比较差异无统计学意义(P>0.05)。结论天麻素联合奥拉西坦治疗可有效改善老年缺血性脑卒中后认知功能障碍,用药安全性较好,疗效确切,其具体作用机制可能与下调NSE、Hcy、hs-CRP等因子水平有关。

Objective To investigate clinical effect of Gastrodin combined with Oxiracetam in the treatment of cognitive impairment after ischemic stroke in the elderly.Methods One hundred and two elderly patients with cognitive impairment after ischemic stroke who were admitted to the First People′s Hospital of Yunnan Province from January 2016 to December 2018 were selected,they were divided into control group(n=51,Oxiracetam treatment)and study group(n=51,Gastrodin combined with Oxiracetam treatment)according to the random number table method,two groups were treated for 1 month.Clinical efficacy,adverse reactions,Montreal cognitive assessment scale(MoCA)score,activities of daily living(ADL)score and serum levels of neuron-specific enolase(NSE),homocysteine(Hcy)and high-sensitivity C-reactive protein(hs-CRP)were compared between two groups.Results The total clinical effective rate of study group was higher than that of control group(P<0.05).After treatment,the scores of MoCA and ADL in two groups were higher than those before treatment,and the scores in study group were higher than those in control group(P<0.05).After treatment,the levels of NSE,Hcy and hs CRP in two groups were lower than those before treatment,and the level in study group was lower than that in control group(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Gastrodin combined with Oxiracetam can effectively improve cognitive impairment in elderly patients with ischemic stroke.The safety of the drug is good and the effect is exact.The specific mechanism may be related to the down-regulation of NSE,Hcy,hs-CRP and other factors.