The Effect of Butylphthalide on Cognitive Dysfunction after the Stroke Caused by Cerebral Small Vessel Disease and Its Effect on Cerebral Blood Perfusion
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摘要:
目的 探讨丁苯酞治疗脑小血管病致脑卒中后认知功能障碍的疗效及对脑部血流灌注的影响。 方法 回顾性选取2019年3月至2021年3月石家庄人民医院神经内科收治的脑小血管病所致脑卒中后认知功能障碍患者84例，根据治疗方法不同分为对照组（基础治疗）与研究组（基础治疗+丁苯酞治疗），各42例，观察患者认知功能、日常生活能力、神经功能缺损及脑部血流灌注变化。 结果 治疗3个月后2组MMSE及Barthel指数评分增加，NIHSS评分下降（P < 0.05），组间比较，治疗后研究组MMSE及Barthel指数评分高于对照组，而NIHSS低于对照组，差异有统计学意义（P < 0.05）；研究组临床总有效率为80.95%，明显高于对照组54.76%，组间差异有统计学意义（P < 0.05）；2组患者的平均通过时间降低，脑血流量及血流速度增大，组间比较，治疗后研究组平均通过时间低于对照组，而脑血流量及血流速度明显高于对照组（P < 0.05）。 结论 丁苯酞治疗脑小血管病致脑卒中后认知功能障碍，可改善脑血流灌注，促进患者认知功能与日常生活能力恢复，疗效确切，值得推广应用。 Abstract:Objective To investigate the effect of butylphthalide on cognitive dysfunction after the stroke caused by cerebral small vessel disease and its effect on cerebral blood perfusion. Methods 84 patients with the cognitive impairment after the stroke caused by small vessel disease were retrospectively selected from the Neurology Department of Shijiazhuang People’s Hospital from March 2019 to March 2021. According to the different treatment methods, they were divided into the control group （basic treatment） and the study group （basic treatment+butylphthalide treatment）, with 42 patients in each group. Cognitive function, daily living ability, neurological function deficits, and changes in cerebral blood flow perfusion were observed. Results After 3 months of treatment, MMSE and Barthel index scores increased and NIHSS scores decreased in the two groups （P < 0.05）. After the treatment, MMSE and Barthel index scores in the study group were higher than those in the control group （P < 0.05）. The mean passage time of patients in the two groups decreased, and the CEREBRAL blood flow and blood flow velocity increased. In comparison with the results between the two groups, the mean passage time of patients in the study group was lower than that of the control group after the treatment, while the cerebral blood flow and blood flow velocity were significantly higher than that of the control group （P < 0.05）. Conclusion Butylphthalide can improve the cerebral blood flow perfusion and promote the recovery of patients’ cognitive function and daily living ability in the treatment of cognitive dysfunction after the stroke caused by cerebral small vascular disease. -
Key words:
- Butylphthalide /
- Cerebrovascular disease /
- Stroke /
- Cognitive dysfunction /
- Cerebral perfusion
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表 1 对照组与研究组治疗前后功能恢复情况比较 [（
$\bar{x} \pm s$ ），分]Table 1. Comparison of functional recovery before and after treatment between the control group and the research group [（
$\bar{x} \pm s $ ）， points]组别 n MMSE NIHSS Barthel指数 治疗前 治疗3个月 治疗前 治疗3个月 治疗前 治疗3个月 对照组 42 17.35 ± 3.30 21.45 ± 4.98* 12.19 ± 3.90 6.37 ± 1.71* 25.34 ± 7.23 47.19 ± 8.26* 研究组 42 17.24 ± 3.04 28.82 ± 5.01* 12.41 ± 3.85 4.56 ± 1.30* 25.07 ± 7.15 66.43 ± 10.43* t 0.481 4.627 0.334 3.943 0.561 6.317 P 0.276 0.016* 0.591 0.008* 0.249 P < 0.001* 与本组治疗前比较，*P < 0.05。 
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表 2 对照组与研究组近期临床疗效比较[n（%）]
Table 2. Comparison of recent clinical efficacy between the control group and the study group [n（%）]
组别 n 显效 有效 无效 总有效率 对照组 42 9（21.43） 14（33.33） 19（45.24） 23（54.76） 研究组 42 16（38.10） 18（42.86） 8（19.05） 34（80.95） χ2 6.604 P 0.010* t 3.212 *P < 0.05。
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表 3 对照组与研究组治疗前后脑部血流灌注参数变化比较（
$ \bar{x} \pm s$ ）Table 3. Comparison of changes in cerebral blood flow perfusion parameters before and after treatment between the control group and the research group （
$ \bar{x} \pm s$ ）组别 n 平均通过时间（s） 脑血流量（ mL /100 g） 血流速度[mL /100（ g·min）] 治疗前 治疗3个月 治疗前 治疗3个月 治疗前 治疗3个月 对照组 42 9.52 ± 2.03 7.40 ± 1.00* 1.71 ± 0.34 2.15 ± 0.31* 16.31 ± 1.86 19.62 ± 3.42* 研究组 42 9.56 ± 2.12 6.36 ± 0.82* 1.69 ± 0.30 2.62 ± 0.42* 16.26 ± 1.85 23.27 ± 4.39* t 0.018 3.943 0.461 4.519 0.264 3.167 P 0.307 0.039* 0.276 0.019* 0.251 0.016* 与本组治疗前比较，*P < 0.05。
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