目的 探討尼麥角林聯(lián)合加蘭他敏治療老年卒中后認(rèn)知障礙（PSCI）的臨床療效及其對(duì)血清超氧化物歧化酶（SOD）、丙二醛（MDA）、神經(jīng)元特異性烯醇化酶（NSE）水平的影響。方法 選取2016年6月-2019年12月保定市第一中心醫(yī)院收治的130例老年P(guān)SCI患者作為研究對(duì)象，根據(jù)治療方法將患者隨機(jī)分成對(duì)照組（n=65）和觀察組（n=65）。對(duì)照組口服氫溴酸加蘭他敏片，起始劑量為4 mg/次，2次/d，于早、晚餐后服用；當(dāng)受試者能良好耐受時(shí)，在連用4周后將劑量調(diào)整至8 mg/次，2次/d。觀察組在對(duì)照組的基礎(chǔ)上口服尼麥角林片，20 mg/次，3次/d，餐前溫開(kāi)水送服。連續(xù)治療8周后評(píng)估兩組療效。比較兩組治療前后認(rèn)知功能[蒙特利爾認(rèn)知評(píng)估量表（MoCA）和簡(jiǎn)易精神狀態(tài)檢查表（MMSE）評(píng)分]、日常生活能力[日常生活能力量表（ADL）評(píng)分]、腦血流動(dòng)力學(xué)參數(shù)[雙側(cè)大腦中動(dòng)脈（MCA）及大腦前、后動(dòng)脈（ACA和PCA）的平均血流速度（V_m）]及血清SOD、MDA和NSE水平的變化情況。結(jié)果 治療后，觀察組總有效率為92.3%，顯著高于對(duì)照組的76.9%（P<0.05）。治療后，兩組MoCA、MMSE評(píng)分均顯著增高，ADL評(píng)分則顯著降低（P<0.05）；治療后，觀察組相關(guān)量表（MoCA、MMSE、ADL）評(píng)分的改善效果均顯著優(yōu)于對(duì)照組（P<0.05）。治療后，觀察組治療后顱內(nèi)各動(dòng)脈（MCA、ACA和PCA）的V_m均顯著增快（P<0.05），且顯著快于對(duì)照組（P<0.05）。治療后，兩組血清SOD水平均顯著高于治療前，血清MDA、NSE水平顯著下降（P<0.05）；且治療后，觀察組血清SOD水平較對(duì)照組顯著升高，而血清MDA、NSE水平均顯著降低（P<0.05）。結(jié)論 尼麥角林聯(lián)合加蘭他敏治療老年P(guān)SCI的整體療效確切，可明顯改善老年患者的認(rèn)知功能障礙，提高其日常生活能力，其作用機(jī)制可能是通過(guò)顯著改善老年患者局部腦血流灌注、糾正機(jī)體氧化應(yīng)激狀態(tài)的方式來(lái)實(shí)現(xiàn)的。

Objective To investigate the clinical efficacy of nicergoline combined with galanthamine in treatment of senile cognitive impairment after stroke (PSCI) and its effects on serum levels of SOD, MDA, and NSE. Methods A total of 130 elderly PSCI patients admitted to Baoding NO.1 Center Hospital from June 2016 to December 2019 were selected as the research subjects, and the patients were randomly divided into control group (n=65) and observation group (n=65) according to the treatment methods. Patients in the control group were po administered with Galanthamine Hydrobromide Tablets at breakfast and after dinner with the initial dose of 4 mg/time, twice daily. When well tolerated, the dose was adjusted to 8 mg/time, twice daily after four weeks. Patients in the observation group were po administered with Nicergoline Tablets with warm water before meal, 20 mg/time, three times daily. The efficacy of the two groups was evaluated after 8 weeks of continuous treatment. The cognitive function (MoCA score, MMSE score), daily life ability scale (ADL) score, cerebral hemodynamic parameters (the average blood flow velocity of MCA, ACA, and PCA), and the serum levels of SOD, MDA and NSE in two groups before and after treatment were compared. Results After treatment, the total effective rate of observation group was 92.3%, which was significantly higher than 76.9% of control group (P<0.05). After treatment, MOCA and MMSE scores in two groups were significantly increased, while ADL scores were significantly decreased (P<0.05). After treatment, the improvement effect of related scales (MOCA, MMSE, ADL) scores in observation group was significantly better than those in control group (P<0.05). After treatment, the V_m of intracranial arteries (MCA, ACA and PCA) in the observation group increased significantly (P<0.05), and was significantly faster than that in the control group (P<0.05). After treatment, the serum SOD level was significantly higher than that before treatment, and the serum MDA and NSE levels were significantly decreased (P<0.05). After treatment, the serum SOD level in the observation group was significantly higher than that in the control group, while the serum MDA and NSE levels were significantly lower (P<0.05). Conclusions The overall efficacy of nicergoline combined with galanthamine in treatment of elderly patients with PSCI is definite, which can significantly improve the cognitive dysfunction of elderly patients, and improve their ability of daily living, the mechanism of which may be achieved by significantly improving the local cerebral blood perfusion of elderly patients and correcting the oxidative stress state of the body.

R971

河北省醫(yī)學(xué)科學(xué)研究重點(diǎn)課題計(jì)劃（20191491）