丁苯酞联合高压氧治疗老年血管性痴呆的疗效及其对患者Hcy水平的影响

Curative effect of butylphthalide combined with hyperbaric oxygen in the treatment of elderly patients with vascular dementia and its influence on Hcy level

目的观察丁苯酞联合高压氧治疗老年血管性痴呆(VD)的疗效及其对患者同型半胱氨酸(Hcy)水平的影响。方法选择2010年1月至2014年6月在保定市第二中心医院神经内一科治疗的老年VD患者126例,依照简单数字随机表法将所有患者分为观察组和对照组,每组各63例,两组患者均给予降压、调脂以及抗血小板和控制血糖等常规治疗,同时对照组患者还给予高压氧治疗,观察组则在对照组治疗的基础上给予丁苯酞治疗,两组均以3个月作为1个疗程,3个月后比较两组患者的疗效、不同时期的血浆Hcy水平、简易智能量表(MMSE)评分及日常生活的活动能力(Barthel)指数,分析患者血浆Hcy水平与MMSE评分及Barthel指数的相关性。结果观察组患者的总有效率为95.24%,明显高于对照组的84.13%,差异有统计学意义(P<0.05)。观察组患者治疗后1个月及治疗后3个月的血浆Hcy水平分别为(20.48±4.12)μmol/L和(18.39±5.42)μmol/L,均明显低于治疗前的(23.54±5.37)μmol/L以及对照组治疗后对应时间的水平[(22.17±4.94)μmol/L与(20.82±5.21)μmol/L],差异均有统计学意义(P<0.05);观察组患者治疗后3个月的MMSE评分为(22.42±3.52)分,Barthel指数为(55.42±7.71)分,均明显高于对照组的(19.40±2.96)分和(46.32±6.35)分,差异均有显著统计学意义(P<0.01);患者血浆Hcy水平与MMSE评分呈负相关(r=-0.661,P=0.025),与Barthel指数也呈负相关(r=-0.709,P=0.004)。结论利用丁苯酞与以及高压氧联合治疗老年VD患者能够明显改善患者的疗效及认知能力,且可降低血浆Hcy水平,值得临床给予推广应用。

Objective To observe the curative effect of butylphthalide combined with hyperbaric oxygen in the treatment of elderly patients with vascular dementia(VD) and its influence on homocysteine(Hcy) level. Methods A total of 126 elderly patients with VD who were treated in the First Department of Neurology in the Second Central Hospital of Baoding from January 2010 to June 2014 were selected in this study. According to simple digital random table method, all patients were divided into observation group and control group, each group with 63 patients. The patients of two groups were given conventional therapy, such as antihypertensive treatment, lipid modulation, and antiplatelet treatment, blood sugar control. Patients in the control group were treated with hyperbaric oxygen therapy, and the observation group was treated with butylphthalide based on the control group, with 3 months as a course of treatment. The effect, plasma Hcy levels in different periods, mini mental state examination(MMSE) score and activities of daily living(Barthel) index of patients were compared after 3 months between the two groups. The correlations between plasma Hcy level and MMSE score and Barthel index were analyzed. Results The total effective rate in the observation group patients was 95.24%, which was significantly higher than that in the control group of 84.13%, and the difference was statistically significant(P<0.05). The plasma Hcy levels of the observation group 1 month and 3 months after treatment were(20.48±4.12) μmol/L and(18.39±5.42) μmol/L, which were significantly lower than those before treatment of(23.54 ± 5.37) μ mol/L and those in the control group patients after treatment of(22.17 ± 4.94) μ mol/L and(20.82 ±5.21) μ mol/L, and the differences were statistically significant(P<0.05). The MMSE score and and Barthel index 3months after treatment in observation group were respectively(22.42 ± 3.52),(55.42 ± 7.71), which were significantly higher than those in the control group of(19.40±2.96),(46.32±6.35), and the differences were statistically significant(P<0.05). The plasma level of Hcy was negatively correlated with the MMSE score(r=-0.661, P=0.025), and negatively correlated with the Barthel index(r=-0.709, P=0.004). Conclusion Butylphthalide and hyperbaric oxygen combined treatment for elderly patients with VD can significantly improve the efficacy and cognitive function in patients, and can decrease the level of plasma Hcy. It is worth of clinical promotion and application.