盐酸多奈派齐联合通窍活血汤与电针治疗轻中度颅脑损伤合并认知障碍的效果观察

Observation on the effect of donepezil hydrochloride combined with tongqiao huoxue decoction and electroacupuncture on mild to moderate brain injury with cognitive impairment

目的观察盐酸多奈派齐联合通窍活血汤与电针治疗轻中度颅脑损伤合并认知障碍的效果。方法前瞻性选取2019年4月至2022年2月秦皇岛市中医医院收治的90例颅脑损伤合并认知障碍患者为研究对象,按照随机数字表法分为对照1组,对照2组和观察组,每组30例。对照1组给予盐酸多奈派齐治疗及健康教育,对照2组在对照1组基础上给予电针干预,观察组在对照2组基础上给予通窍活血汤治疗。统计3组的疗效,比较3组干预前、干预8周后蒙特利尔认知评估量表(MoCA)评分、听觉词汇学习测验(AVLT)评分、简易精神状态检查表(MMSE)评分、脑血流状态指标[平均血流速度(Vm)、局部脑血流量(rCBF)、局部脑血容量(rCBV)]、Toll样受体(TLR)的差异。结果干预8周后,观察组总有效率为96.67%,高于对照1组(73.33%)和对照2组(80.00%),差异有统计学意义(P<0.05)。干预8周后,3组MoCA评分、AVLT评分、MMSE评分均较干预前升高,且观察组分别为(22.25±2.02)、(41.32±1.98)、(25.89±2.01)分,高于对照1组[(19.03±1.44)、(35.15±2.41)、(22.85±1.47)分]和对照2组[(21.14±1.87)、(37.58±2.01)、(24.04±1.89)分],差异均有统计学意义(P<0.05)。干预8周后,3组患者大脑中动脉Vm、rCBF、rCBV较干预前均升高,观察组分别为(56.89±3.14)cm/s、(46.36±3.25)mL/(100 g·min)、(3.26±0.34)mg/100 g,高于对照1组[(50.14±3.26)cm/s、(42.24±2.86)mL/(100 g·min)、(2.78±0.26)mg/100 g]和对照2组[(53.21±3.22)cm/s、(44.15±3.04)mL/(100 g·min)、(3.02±0.29)mg/100 g],差异均有统计学意义(P<0.05)。干预8周后,3组TLR2、TLR4较干预前下降,观察组分别为(0.73±0.12)、(1.01±0.17)μg/L,低于对照1组[(1.02±0.20)、(1.47±0.16)μg/L]和对照2组[(0.84±0.18)、(1.23±0.15)μg/L],差异均有统计学意义(P<0.05)。结论盐酸多奈派齐联合通窍活血汤与电针治疗轻中度颅脑损伤合并认知障碍可改善脑灌注,降低TLR的表达,有利于认知功能的恢复。

Objective To observe the effect of donepezil hydrochloride combined with tongqiao huoxue decoction and electroacupuncture on mild to moderate brain injury with cognitive impairment.Methods A total of 90 patients with craniocerebral injury combined with cognitive impairment admitted to Qinhuangdao Hospital of Traditional Chinese Medicine from April 2019 to February 2022 were selected as the research objects.They were divided into control group 1,control group 2 and observation group by random number table method,30 cases in each group.Patiens in control group 1 were given donepazil hydrochloride treatment and health education,patiens in control group 2 were given electroacupuncture intervention on the basis of control group 1,and patiens in observation group were given tongqiao huoxue decoction treatment on the basis of control group 2.The efficacy of three groups was statistically analyzed,scores of Montreal Cognitive Assessment Scale(MoCA),Auditory Vocabulary Learning Test(AVLT),Simple Mental State Checklist(MMSE),cerebral blood flow status indicators[mean blood flow velocity(Vm),regional cerebral blood flow(rCBF),regional cerebral blood volume(rCBV)]and toll-like receptors were compared between the three groups before intervention and 8 weeks after intervention(TLR).Results After 8 weeks of intervention,the total effective rate of observation group was 96.67%,which was higher than that of the control group(73.33%)and control group 2(80.00%),the differences were statistically significant(P<0.05).After 8 weeks of intervention,the MoCA score,AVLT score,and MMSE score of the three groups were higher than before intervention,and scores of the observation group were(22.25±2.02),(41.32±1.98),and(25.89±2.01)points,respectively,which were higher than those of the control group 1[(19.03±1.44),(35.15±2.41),(22.85±1.47)points]and the control group 2[(21.14±1.87),(37.58±2.01),and(24.04±1.89)points],the differences were statistically significant(P<0.05).After 8 weeks of intervention,three groups of middle cerebral artery Vm,rCBF,and rCBV were higher than before intervention,those of the observation group was(56.89±3.14)cm/s,(46.36±3.25)mL/(100 g·min),(3.26±0.34)mg/100 g,respectively,which were higher than those of the control group 1[(50.14±3.26)cm/s,(42.24±2.86)mL/(100 g·min),(2.78±0.26)mg/100 g]and the control group 2[(53.21±3.22)cm/s,(44.15±3.04)mL/(100 g·min),(3.02±0.29)mg/100 g],the differences were statistically significant(P<0.05).After 8 weeks of intervention,TLR2 and TLR4 in the three groups were lower than before intervention,those of the observation group were(0.73±0.12)and(1.01±0.17)μg/L,respectively,which were lower than those of control group 1[(1.02±0.20),(1.47±0.16)μg/L] and control group 2[(0.84±0.18),(1.23±0.15)μg/L],the differences were statistically significant(P<0.05).Conclusion Donepezil hydrochloride combined with tongqiao huoxue decoction and electroacupuncture in the treatment of mild to moderate brain injury with cognitive impairment can improve cerebral perfusion,reduce the expression of TLR,and is conducive to the recovery of cognitive function.