芪参还五胶囊联合富马酸喹硫平片治疗痰瘀互结型血管性痴呆患者认知功能和精神行为异常的疗效分析

Clinical Efficacy of Qishen Huanwu Capsules Combined with Quetiapine on Cognitive Function and Mental Behavior Disorder in Vascular Dementia Patients with Phlegm Combined with Blood Stasis Syndrome

目的 观察芪参还五胶囊联合富马酸喹硫平片治疗痰瘀互结型血管性痴呆(Vascular dementia, VaD)患者认知功能及精神行为异常的临床疗效。方法 选取2020年1月—2021年1月期间河北省沧州中西医结合医院脑病三科收治的VaD患者78例,按随机数字表法分为对照组38例和治疗组40例。对照组予单纯富马酸喹硫平片治疗,治疗组在对照组的给药的基础上增加芪参还五胶囊。治疗3个月后,观察比较两组患者临床疗效、不良反应发生率,治疗前后认知功能评分[简易精神状态量表(Mini-Mental State Examination, MMSE)]、中医证候评分[中医证候积分量表(The scale for the Differentiation of Syndrome of vascular dementia, SDSVD)]、脑血流动力学指标[平均血流速度(Mean velocity, Vm)、收缩期血流速度(Systolic blood flow velocity, Vs)、舒张期血流速度(Diastole blood flow velocity, Vd),阻力指数(Resistance index, RI)]、日常生活活动能力评分[神经精神症状问卷(Neuropsychiatric Inventory, NPI)、日常生活能力(Activities of daily living, ADL)、Hachinski缺血评分(Hachinski Inchemic Score, HIS)]。结果 治疗后两组患者MMSE评分较治疗前升高,SDSVD评分较治疗前降低,差异有统计学意义(P<0.05);且治疗组MMSE评分高于对照组,SDSVD评分低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者脑血流动力学RI、Vs、Vd、Vm指标均较治疗前明显改善,差异有统计学意义(P<0.05);且治疗组脑血流动力学RI、Vs、Vd、Vm指标改善情况明显优于对照组,差异有统计学意义(P<0.05)。治疗后两组患者NPI、HIS、ADL评分均较治疗前明显降低,差异有统计学意义(P<0.05);且治疗组优于对照组,差异有统计学意义(P<0.05)。治疗后治疗组患者治疗总有效率90.00%(36/40)明显高于对照组68.42%(26/38),差异有统计学意义(P<0.05)。治疗后治疗组患者不良反应发生率22.50%(9/40),对照组18.42%(7/38),两组患者不良反应发生率比较,差异无统计学意义(P>0.05)。结论 与单纯的富马酸喹硫平片治疗比较,采用芪参还五胶囊联合富马酸喹硫平片治疗对VaD痰瘀互结型患者认知功能改善效果更加明显,且联合用药并不会明显增加不良反应,安全性好。

Objective To observe the clinical efficacy of Qishen Huawu Capsules combined with Quetiapine in the treatment of cognitive function and abnormal mental behaviors in vascular dementia(VaD)patients with phlegm combined with blood stasis syndrome.Methods Seventy-eight VaD patients admitted to the Third Department of Encephalopathy,Cangzhou Hospital of Integrated Traditional Chinese Medicine and Western Medicine between January 2020 and January 2021 were enrolled and randomly divided into a control group(n=38)and a treatment group(n=40).The control group received treatment with Quetiapine,while the treatment group received Qishen Huawu Capsules in addition to the medication given to the control group.After three months of treatment,the clinical efficacy,occurrence of adverse reactions,pre-and post-treatment cognitive function scores[Mini-Mental State Examination(MMSE)],traditional Chinese medicine(TCM)syndrome scores[Scale for the Differentiation of Syndrome of Vascular Dementia(SDSVD)],cerebral hemodynamic indicators[mean velocity(Vm),systolic blood flow velocity(Vs),diastole blood flow velocity(Vd),and resistance index(RI)],and scores of daily living activities[Neuropsychiatric Inventory(NPI),Activities of Daily Living(ADL),and Hachinski Ischemic Score(HIS)]were observed and compared between the two groups.Results After treatment,the MMSE scores in both groups increased and the SDSVD scores decreased compared with those before treatment(P<0.05).Moreover,the treatment group had a higher MMSE score and a lower SDSVD score than the control group(P<0.05).After treatment,the cerebral hemodynamic indicators(RI,Vs,Vd,and Vm)in both groups showed significant improvement compared with those before treatment(P<0.05).Furthermore,the improvement in cerebral hemodynamic indicators(RI,Vs,Vd,and Vm)in the treatment group was significantly better than that in the control group(P<0.05).After treatment,the NPI,HIS,and ADL scores in both groups decreased compared with those before treatment(P<0.05).Additionally,the treatment group showed better results than the control group in terms of NPI,HIS,and ADL scores(P<0.05).The total effective rate in the treatment group after treatment was 90.00%(36/40),significantly higher than 68.42%(26/38)in the control group(P<0.05).The incidence of adverse reactions in the treatment group after treatment was 22.50%(9/40)and 18.42%(7/38)in the control group(P>0.05).Conclusion Compared with the treatment with Quetiapine alone,the combination of Qishen Huawu Capsules and Quetiapine shows more significant improvement in the cognitive function of VaD patients with phlegm combined with blood stasis syndrome.Additionally,combined therapy does not significantly increase adverse reactions and demonstrates good safety.