脑络通颗粒对老年血管性认知障碍伴失眠患者认知功能、脑血管灌注的影响
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摘要
目的:探讨脑络通颗粒对老年血管性认知障碍伴失眠患者认知功能、脑血管灌注的影响。方法:将174例CRF患者随机分为对照组87例和研究组87例。在常规治疗基础上,对照组予以尼莫地平片30 mg,3次/d,口服;研究组予以脑络通颗粒1袋,3次/d,温水冲服。两组患者均治疗3个月。比较两组间临床疗效、神经心理学指标、脑血管血流灌注速度、血液流变学指标及药物不良反应发生率。结果:对照组有效率(71.27%)低于研究组有效率(86.21%),具有统计学意义(P<0.05)。与对照组比较,研究组治疗后简易智力状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)及工具性日常生活能力量表(ADL)评分较高,老年性痴呆评定量表-认知分量表(ADAS-cog)、匹茨堡睡眠质量指数量表(PSOI)评分较低,治疗后大脑中动脉(MCA)、大脑前动脉(ACA)、大脑后动脉(PCA)及椎动脉(VA)血流速度较高,治疗后血浆黏度、全血高切黏度、全血低切黏度、血细胞比容(Hct)及纤维蛋白原(Fib)水平较低,具有统计学意义(P<0.05)。治疗过程中,对照组药物不良反应为恶心、头痛、心悸,研究组药物不良反应为恶心、头痛、心悸、腹泻。研究组不良反应发生率为8.05%,对照组不良反应发生率为5.75%,两组间差异无统计学意义(P>0.05)。结论:脑络通颗粒治疗老年血管性认知障碍伴失眠患者的临床疗效确切,能明显改善患者认知功能、日常生活能力及睡眠质量,提高脑血管血流灌注,改善血液流变学指标,且安全性较高。
Objective:To investigate the effect of Naoluotong Granule on cognitive function and cerebral vascular perfusion in elderly patients with vascular cognitive impairment and insomnia.Methods:Totally 174 patients with vascular cognitive impairment and insomnia were randomly divided into control group 87 cases and experiment group 87 cases.On the basis of routine treatment,the control group used nimodipine tablets 30 mg,tid,oral.The experiment group received Naoluotong Granule 1 bag,tid,takingwith warm water.Two groups were treated for 3 months.The clinical efficacy,neuropsychological indicators,cerebral blood flow perfusion velocity and hemorheological indexes and incidence of adverse drug reactions were compared between two grops.Results:The effective rate in the control group(71.27%)was lower than that in the experiment group(86.21%)with significant difference(P<0.05).Compared with the control group,the simple mental state checklist(MMSE),montreal cognitive assessment scale(MoCA) and instrumental daily living capacity scale(ADL) scores were higher.The Alzheimer′s disease assessment scale cognitive subscale(ADAS-cog),pittsburgh sleep quality index(PSOI) scores were lower after treatment in the experiment group and the velocity of blood flow in the middle cerebral artery(MCA),the anterior cerebral artery(ACA),the posterior cerebral artery(PCA) and the vertebral artery(VA) were higher after treatment.The levels of plasma viscosity,whole blood viscosity,blood viscosity,hematocrit(Hct) and fibrinogen(Fib) were lower after treatment with significant difference(P<0.05).In the course of treatment,the adverse drug reactions in the control group were nausea,headache and palpitation.The adverse drug reactions in the experiment group were nausea,headache,palpitation and diarrhea.The incidence of adverse reactions in the experiment group was 8.05%,and the incidence of adverse reactions in the control group was 5.75% and there was no significant difference between the two groups(P>0.05).Conclusion:The curative effect of Naoluotong Granule in the treatment of elderly patients with vascular cognitive impairment and insomnia is accurate and it can obviously improve the patients′ cognitive function,daily life ability and sleep quality,improve cerebral blood flow perfusion and the indexes of hemorheology,and the safety is high.
Objective:To investigate the effect of Naoluotong Granule on cognitive function and cerebral vascular perfusion in elderly patients with vascular cognitive impairment and insomnia.Methods:Totally 174 patients with vascular cognitive impairment and insomnia were randomly divided into control group 87 cases and experiment group 87 cases.On the basis of routine treatment,the control group used nimodipine tablets 30 mg,tid,oral.The experiment group received Naoluotong Granule 1 bag,tid,takingwith warm water.Two groups were treated for 3 months.The clinical efficacy,neuropsychological indicators,cerebral blood flow perfusion velocity and hemorheological indexes and incidence of adverse drug reactions were compared between two grops.Results:The effective rate in the control group(71.27%)was lower than that in the experiment group(86.21%)with significant difference(P<0.05).Compared with the control group,the simple mental state checklist(MMSE),montreal cognitive assessment scale(MoCA) and instrumental daily living capacity scale(ADL) scores were higher.The Alzheimer′s disease assessment scale cognitive subscale(ADAS-cog),pittsburgh sleep quality index(PSOI) scores were lower after treatment in the experiment group and the velocity of blood flow in the middle cerebral artery(MCA),the anterior cerebral artery(ACA),the posterior cerebral artery(PCA) and the vertebral artery(VA) were higher after treatment.The levels of plasma viscosity,whole blood viscosity,blood viscosity,hematocrit(Hct) and fibrinogen(Fib) were lower after treatment with significant difference(P<0.05).In the course of treatment,the adverse drug reactions in the control group were nausea,headache and palpitation.The adverse drug reactions in the experiment group were nausea,headache,palpitation and diarrhea.The incidence of adverse reactions in the experiment group was 8.05%,and the incidence of adverse reactions in the control group was 5.75% and there was no significant difference between the two groups(P>0.05).Conclusion:The curative effect of Naoluotong Granule in the treatment of elderly patients with vascular cognitive impairment and insomnia is accurate and it can obviously improve the patients′ cognitive function,daily life ability and sleep quality,improve cerebral blood flow perfusion and the indexes of hemorheology,and the safety is high.
引文
[1] 狄景龙,孙伟.血管性认知障碍的研究进展[J].神经疾病与精神卫生,2017,17(3):225-228.
[2] 唐向东,李桃美,张继辉.失眠症的临床评估与治疗[J].中华精神科杂志,2017,50(1):3-4.
[3] 姜凌,常诚.血管性认知障碍与睡眠障碍中西医研究进展[J].长春中医药大学学报,2014,30(2):365-367.
[4] 罗旺胜,李菊华.脑络通颗粒治疗血管性认知障碍合并失眠症的临床疗效及作用机制探讨[J].中医药信息,2016,33(3):119-122.
[5] 杨德富,常诚.符为民教授运用脑络通颗粒治疗血管性认知障碍新思路[J].陕西中医,2017,38(4):509-510.
[6] Sachdev P,Kalaria R,O′Brien J,et al.Diagnostic criteria for vascular cognitive disorders:a VASCOG statement[J].Alzheimer Disease & Associated Disorders,2014,28(3):206.
[7] 中华医学会神经病学分会睡眠障碍学组.中国成人失眠诊断与治疗指南[J].中华神经科杂志,2012,45(7):534-540.
[8] 郑筱萸.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002:65-67.
[9] 彭丹涛,张占军.神经心理认知量表操作指南[M].北京:人民卫生出版社,2015:10-20.
[10] Peters B R,Sha S J,Yaffe K.Chapter 4 – Sleep and Cognitive Impairment[M]//Sleep & Neurologic Disease.England:Elsevier Science,2017:73-88.
[11] 潘雪,马端鑫,李燕,等.水蛭药理作用的研究进展[J].中国民族民间医药,2015,24(14):24-25.
[12] 杨雪鸥,唐智勇,黄雪梅,等.石菖蒲β-细辛醚研究进展[J].中药材,2016,39(3):686-690.
[13] 朱风俊,贾东佩,蔡春娥.MMSE与MoCA评分在非痴呆型血管性认知障碍的应用[J].江苏医药,2014,40(12):1420-1422.
[14] 孙咏婕,李月春,李锐铭.血管性认知功能障碍早期发现及干预的研究进展[J].中国当代医药,2014,21(4):192-193.
[15] 王庆海,白晶,李宝栋.芪参还五胶囊治疗非痴呆型血管性认知功能障碍的观察[J].中医药学报,2014,42(5):54-57.
[2] 唐向东,李桃美,张继辉.失眠症的临床评估与治疗[J].中华精神科杂志,2017,50(1):3-4.
[3] 姜凌,常诚.血管性认知障碍与睡眠障碍中西医研究进展[J].长春中医药大学学报,2014,30(2):365-367.
[4] 罗旺胜,李菊华.脑络通颗粒治疗血管性认知障碍合并失眠症的临床疗效及作用机制探讨[J].中医药信息,2016,33(3):119-122.
[5] 杨德富,常诚.符为民教授运用脑络通颗粒治疗血管性认知障碍新思路[J].陕西中医,2017,38(4):509-510.
[6] Sachdev P,Kalaria R,O′Brien J,et al.Diagnostic criteria for vascular cognitive disorders:a VASCOG statement[J].Alzheimer Disease & Associated Disorders,2014,28(3):206.
[7] 中华医学会神经病学分会睡眠障碍学组.中国成人失眠诊断与治疗指南[J].中华神经科杂志,2012,45(7):534-540.
[8] 郑筱萸.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002:65-67.
[9] 彭丹涛,张占军.神经心理认知量表操作指南[M].北京:人民卫生出版社,2015:10-20.
[10] Peters B R,Sha S J,Yaffe K.Chapter 4 – Sleep and Cognitive Impairment[M]//Sleep & Neurologic Disease.England:Elsevier Science,2017:73-88.
[11] 潘雪,马端鑫,李燕,等.水蛭药理作用的研究进展[J].中国民族民间医药,2015,24(14):24-25.
[12] 杨雪鸥,唐智勇,黄雪梅,等.石菖蒲β-细辛醚研究进展[J].中药材,2016,39(3):686-690.
[13] 朱风俊,贾东佩,蔡春娥.MMSE与MoCA评分在非痴呆型血管性认知障碍的应用[J].江苏医药,2014,40(12):1420-1422.
[14] 孙咏婕,李月春,李锐铭.血管性认知功能障碍早期发现及干预的研究进展[J].中国当代医药,2014,21(4):192-193.
[15] 王庆海,白晶,李宝栋.芪参还五胶囊治疗非痴呆型血管性认知功能障碍的观察[J].中医药学报,2014,42(5):54-57.