柴牡醒脑汤结合西医常规疗法治疗卒中后认知功能障碍临床研究

Clinical study on Chaimu-Xingnao Decoction combined with conventional western medicine therapy for the patients with cognitive dysfunction after stroke

目的评价柴牡醒脑汤治疗卒中后认知功能障碍的临床疗效。方法将符合入选标准的2017年2月-2019年2月本院100例卒中后认知功能障碍患者按随机数字表法分为2组,每组50例。对照组采用神经内科常规治疗+康复锻炼,观察组在对照组基础上服用柴牡醒脑汤。2组均连续治疗3个月。采用经颅彩色多普勒超声诊断仪检测血管阻力指数(vscular resistance index, RI)、脑动脉血流平均流速(aerage cerebral artery blood flow velocity, Vm)、搏动指数(plse index, PI)、最大峰值流速(maximum peak flow velocity, Vs);采用ELISA法检测VEGF、神经营养因子(nurotrophic factor, NTF)、血管紧张素-1 (angiotensin-1, Ang-1)、热休克蛋白70(hat shock protein 70, HSP70);采用神经行为认知状态检查量表(Neurobehavioral Cognitive Sate Eamination Sale, NCSE)进行认知功能评估。记录治疗期间的不良反应,评价临床疗效。结果观察组总有效率为94.0%(47/50)、对照组为78.0%(39/50),2组比较差异有统计学意义(χ2=5.316,P=0.021)。观察组治疗后RI、PI均低于对照组(t值分别为3.595、2.945,P值均<0.05),Vm、Vs值均高于对照组(t值分别为3.777、8.281,P值均<0.01);血清VEGF、NTF、Ang-1、HSP70水平均高于对照组(t值分别为6.798、16.171、8.201、5.716,P值均<0.001)。观察组治疗后专注能力、意识水平、空间结构能力、定向能力、推理能力及记忆能力评分及NCSE总分均高于对照组(t值分别为2.468、2.214、2.023、2.442、3.701、4.928,P值均<0.05)。治疗期间,2组均未发生严重不良反应。结论柴牡醒脑汤可有效改善卒中后认知功能障碍患者的脑部血液流变学指标、减轻脑组织损伤,改善患者的临床症状,提高疗效。

Objective To explore the clinical effect of Chaimu-Xingnao Decoction on cognitive dysfunction after stroke.Methods A total of 100 patients with cognitive dysfunction after stroke in our hospital from February 2017 to February 2019,who met the inclusion criteria,were randomly divided into two groups according to the number table method,50 patients in each group.The control group was given routine treatment and rehabilitation exercise,while the observation group was given Chaimu-Xingnao Decoction on the basis of the control group.Both groups were treated for 3 months.The vascular resistance index(RI),average cerebral artery blood flow velocity(Vm),pulse index(PI),and maximum peak flow velocity(VS)were measured by transcranial color Doppler ultrasound.The VEGF,neurotrophic factor(NTF),angiotensin-1(Ang-1),heat shock protein 70(HSP70)were detected by ELISA.The cognitive function was assessed by neurobehavioral cognitive state examination scale(NCSE).The adverse reactions during the treatment were recorded and the clinical effect was evaluated.Results The total effective rate of the observation group was 94.0%(47/50)and that of the control group was 78.0%(39/50),where the difference between the two groups was statistically significant(χ2=5.316,P=0.021).After treatment,RI and PI in the observation group were significantly lower than those in the control group(t values were 3.595,2.945,respectively,all Ps<0.05),Vm and Vs in the observation group were significantly higher than those in the control group(t values were 3.777,8.281,respectively,all Ps<0.01);serum VEGF,NTF,Ang-1,HSP70 in the observation group were significantly higher than those in the control group(t values were 6.798,16.171,8.201,5.716,respectively,all Ps<0.001).After treatment,the scores of focus ability,consciousness level,spatial structure ability,orientation ability,reasoning ability and memory ability and NCSE total score in observation group were significantly higher than those in the control group(t values were 2.468,2.214,2.023,2.442,3.701,4.928,respectively,all Ps<0.05).During the treatment,no serious adverse reaction occurred in both groups.Conclusion Chaimu-Xingnao Decoction can improve the hemorheology indexes of the patients with cognitive dysfunction after stroke,reduce the damage of brain tissue,improve the clinical symptoms and improve the curative effect.