丁苯酞联合奥拉西坦、多奈哌齐治疗老年卒中合并血管性痴呆患者的疗效

Effects of butylphthalide combined with oxiracetam and donepezil in the treatment of elderly stroke patients with vascular dementia

目的 探讨丁苯酞联合奥拉西坦、多奈哌齐治疗老年卒中合并血管性痴呆(vascular dementia,VD)患者的效果。方法 选取86例老年卒中合并VD患者作为研究对象,根据随机数字表法分为对照组和联合组,各43例。对照组采用奥拉西坦与多奈哌齐治疗,联合组在对照组治疗的基础上给予丁苯酞治疗。对比2组认知功能和生活能力[简易精神状态检查量表(mini-mental state examination,MMSE)、日常生活能力(activity of daily living,ADL)]、临床治疗效果、痴呆程度[临床痴呆评定量表(clinical dementia rating,CDR)、长谷川痴呆量表(Hasegawa Dementia scale,HDS)]及血清神经细胞因子[神经生长因子(serum nerve cell factor,NGF)、脑源性神经营养因子(brain derived neurotrophic factor,BDNF)和胶质纤维酸性蛋白因子(glial fibrillary acidic protein factor,GFAP)]水平及不良反应。结果 治疗前,2组MMSE、ADL评分、CDR和HDS评分比较差异均无统计学意义;治疗后,2组的MMSE、ADL及HDS评分均升高(P<0.05),且联合组均高于对照组(P<0.05),联合组的CDR低于对照组和治疗前(P<0.05)。联合组的治疗总有效率高于对照组(93.02%vs. 76.74%,P<0.05)。治疗前,2组NGF、BDNF和GFAP水平比较差异均无统计学意义(P>0.05);治疗后,联合组的NGF、BDNF水平高于对照组和治疗前(P<0.05),GFAP低于对照组和治疗前。2组不良反应总发生率比较差异无统计学意义(P>0.05)。结论 丁苯酞联合奥拉西坦、多奈哌齐治疗老年卒中合并VD患者相比奥拉西坦和多奈哌齐治疗效果更优,治疗效果提高,患者认知功能和日常生活能力提高,痴呆程度减轻,血清神经细胞因子表达水平改善。

Objective To investigate the application of butylphthalide combined with oxiracetam and donepezil in elderly stroke patients with vascular dementia(VD).Methods 86 elderly stroke patients with VD were enrolled and divided into control group(n=43)and combined group(n=43)according to random number table method.The control group was treated with oxiracetam and donepezil,while the combined group was treated with butylphthalide on the basis of the control group.The cognitive function and living ability[mini-mental state examination(MMSE)and activity of daily living(ADL)],clinical treatment effect,dementia degree[clinical dementia rating(CDR)and Hasegawa Dementia scale(HDS)],serum nerve cell factor(NGF),brain derived neurotrophic factor(BDNF)and glial fibrillary acidic protein factor(GFAP)levels and adverse reactions were compared between the 2 groups.Results Before treatment,there was no significant difference in MMSE,ADL score,CDR,HDS score between the 2 groups(P>0.05).After treatment,the MMSE,ADL and HDS in the 2 groups increased(P<0.05),and those in the combination group were higher than those in the control group(P<0.05).CDR in the combination group was lower than that in the control group and before treatment(P<0.05).The total effective rate of the combined group was higher than that of the control group(93.02%vs.76.74%,P<0.05).Before treatment,there was no significant difference in the levels of NGF,BDNF and GFAP between the 2 groups(P>0.05);after treatment,the NGF and BDNF in the combined group were higher than those in the control group and before treatment(P<0.05),and the GFAP in the combined group was lower than those in the control group and before treatment(P<0.05).There was no significant difference in the total incidence of adverse reactions between the 2 groups(P>0.05).Conclusion The effect of butylphthalide combined with oxiracetam and donepezil in the treatment of senile stroke patients with VD is better than that of oxiracetam and donepezil,which can improve the therapeutic effect,improve the cognitive function and daily living ability of patients,reduce the degree of dementia,improve the level of serum neurocytokine expression,and do not increase adverse reactions.