酸枣仁汤加减联合奥拉西坦胶囊治疗肝阴不足型老年卒中后认知障碍伴失眠的临床疗效及对患者神经功能的影响

Clinical efficacy of Suanzaoren Decoction combined with oxiracetam capsules for elderly patients with post-stroke cognitive impairment and insomnia of hepatic yin deficiency and how it impacts on neurological function

目的 观察酸枣仁汤加减联合奥拉西坦胶囊治疗肝阴不足型老年卒中后认知障碍(PSCI)伴失眠的临床疗效及对患者神经功能的影响。方法 将124例肝阴不足型老年PSCI伴失眠患者按照随机数字表法分为2组,对照组62例予奥拉西坦胶囊治疗,治疗组62例在对照组治疗基础上应用酸枣仁汤治疗。2组均治疗4周。比较2组疗效;比较2组治疗前后简易精神状态检查量表(MMSE)评分、匹兹堡睡眠质量指数(PSQI)评分变化;比较2组治疗前后中医证候评分变化;比较2组治疗前后卒中专用生活质量量表(SS-QOL)评分变化;比较2组治疗前后神经功能指标变化。结果 治疗组总有效率93.5%(58/62),对照组总有效率80.6%(50/62),治疗组疗效优于对照组(P<0.05)。2组治疗后MMSE评分均较本组治疗前升高(P<0.05),PSQI评分均较本组治疗前降低(P<0.05),治疗后治疗组MMSE评分高于对照组(P<0.05),PSQI评分低于对照组(P<0.05)。2组治疗后中医证候各项评分及总评分均较本组治疗前降低(P<0.05),治疗后治疗组中医证候各项评分及总评分均低于对照组(P<0.05)。2组治疗后生活影响、心理状态、身体状态、自理能力评分均较本组治疗前升高(P<0.05),治疗后治疗组生活影响、心理状态、身体状态、自理能力评分均高于对照组(P<0.05)。2组治疗后神经元特异性烯醇化酶(NSE)水平均较本组治疗前降低(P<0.05),乙酰胆碱(Ach)、多巴胺(DA)、5-羟色胺(5-HT)水平均较本组治疗前升高(P<0.05);治疗后治疗组NSE水平低于对照组(P<0.05),Ach、DA、5-HT水平高于对照组(P<0.05)。结论 酸枣仁汤联合奥拉西坦胶囊治疗肝阴不足型老年PSCI伴失眠,能改善患者血清NSE、Ach、DA、5-HT水平,改善患者认知障碍和睡眠质量,改善患者中医症状,从而提高患者生活质量。

Objective To observe the clinical efficacy of Suanzaoren Decoction combined with oxiracetam capsules for elderly patients with post-stroke cognitive impairment(PSCI)and insomnia(hepatic yin deficiency)and how it impacts on neurological function.Methods Totally 124 elderly patients with PSCI and insomnia(hepatic yin deficiency)were randomly assigned 1:1 to receive either oxiracetam capsules(control group)or Suanzaoren Decoction+oxiracetam capsules(treatment group)for 4weeks.Mini-Mental State Examination(MMSE)score,Pittsburgh Sleep Quality Index(PSQI)score,traditional Chinese medicine(TCM)syndrome score,Stroke-Specific Quality-of-Life Scale(SS-QOL),nerve function indexes;the curative effect was included comparator.Results The overall effective rate was higher in the treatment group(93.5%[58/62])compared with the control group(80.6%[50/62]),(P<0.05).After treatment,MMSE score in groups was increased(P<0.05),while PSQI score was decreased(P<0.05);higher MMSE score,and lower PSQI score were detected in the treatment group than those in the control group(all P<0.05);TCM symptom scores in groups were decreased(P<0.05),which decreased in the treatment group compared with the control group(P<0.05);the scores of the influence of life,mental state,physical state,self-care ability in groups were increased(P<0.05),the treatment group was more prevalent(P<0.05);neuron-specific enolase(NSE)in groups was decreased(P<0.05),which was lower in the treatment group than in the control group(P<0.05);acetylcholine(Ach),dopamine(DA),5-hydroxytryptamine(5-HT)in groups were decreased(P<0.05),the treatment group was more common(P<0.05).Conclusion For elderly patients with PSCI and insomnia(hepatic yin deficiency),Suanzaoren Decoction combined with oxiracetam capsules can improve serum NSE,Ach,DA,5-HT levels,cognitive disorder,sleep quality,and TCM symptoms,thereby improving quality-of-life.