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| 缺血性脑卒中后认知障碍的观察及丁苯酞序贯治疗的作用 |
| Observations on cognitive impairment after ischemic stroke and the role of sequential treatment with Dl-3-n-Butylphthalide |
| 投稿时间：2024-05-18 修订日期：2024-05-18 |
| DOI： |
| 中文关键词: 缺血性卒中、认知障碍、丁苯酞、神经功能、日常生活能力 |
| 英文关键词: ischemic stroke, post-stroke cognitive impairment, butylphthalide, neurological function, ability to perform activities of daily living |
| 基金项目:福建省卫生健康科技计划项目（2017-ZQN-22），福建省自然科学基金（2020J05116，2022J01413） |
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| 中文摘要: |
| 目的：回顾性研究急性缺血性脑卒中后认知障碍的患病情况以及丁苯酞序贯治疗对缺血性卒中后认知功能的影响。
方法：回顾性分析2021年6月—2023年12月福建省立医院以及医联体单位闽清县总医院神经内科收治的急性缺血性脑卒中患者124例，使用丁苯酞序贯治疗作为观察组，性别、年龄和NIHSS评分匹配但无丁苯酞治疗作为对照组。收集所有患者发病时一般人口学及基线的认知功能相关临床资料。使用MMSE、MoCA和画钟试验量表评价两组患者卒中急性期以及治疗12周后的认知功能，采用ADL量表评价患者日常生活能力，采用mRS评估患者的独立生活能力。采用SPSS 22.0软件进行统计分析，GraphPad Prism 8.0绘制图表。
结果：丁苯酞治疗组62例和非丁苯酞治疗组62例患者在基线的性别、年龄、NIHSS评分、受教育程度、高血压病、高脂血症、糖尿病、吸烟、饮酒、头部外伤、听力障碍、心房颤动史等痴呆风险因素方面无统计学差异（P＞0.5），两组基线的MMSE、MoCA和CDT评分亦无显著性差异。治疗 12 周后，观察组的卒中后认知功能障碍发生率低于对照组（P<0.05），观察组 MMSE、MOCA、ADL和CDT评分高于对照组（P＜0.05）。卒中急性期认知损害的比例为48%-60%，卒中后3月时认知损害的比例为35%-61%；相比对照组，观察组3个月时卒中后非痴呆和痴呆的比例明显降低（P＜0.05）。相比MMSE, MoCA对卒中后认知障碍的筛查更敏感，两组患者在不良反应方面未见明显差异。
结论：认知功能障碍是急性缺血性脑卒中后常见的并发症，丁苯酞序贯治疗可以减少轻度认知障碍和痴呆的发生，改善认知评分和日常生活能力，安全性良好。此外，使用MMSE和MoCA量表可用于对卒中后认知障碍的筛查。 |
| 英文摘要: |
| Objective To retrospectively study the prevalence of cognitive impairment after acute ischemic stroke and the effect of sequential treatment with butylphthalide on cognitive function after ischemic stroke.
Methods: 124 patients with acute ischemic stroke admitted to the Department of Neurology of Fujian Provincial Hospital and Minqing County General Hospital, a healthcare consortium unit, were retrospectively analysed from June 2021 to December 2023, and the use of sequential treatment with butylphthalide was used as the observation group, and gender and age-matched but without butylphthalide treatment was used as the control group. General demographic and baseline clinical data related to cognitive function were collected from all patients at the time of onset. The level of cognitive function of the patients in both groups was scored before and after 12 weeks of treatment using the Brief Mental State Evaluation (MMSE), Montreal Cognitive Assessment Scale (MoCA), and the Clock Drawing Test (CDT), and the patients"" ability to perform activities of daily living was assessed using the Activities of Daily Living (ADL) scale after ischemic stroke. The mRS was used to assess the patients"" ability to live independently. Cognitive function and daily living ability were statistically analysed using SPSS 20.0 software, and graphs were drawn using GraphPad Prism 8.0.
Results: No statistical differences were found between 62 patients with the butylphthalide-treated group and 62 patients with the non-butylphthalide-treated group in terms of dementia risk factors such as gender, age, NIHSS score, education level, hypertension disease, hyperlipidaemia, diabetes mellitus, smoking, alcohol consumption, head trauma, hearing impairment, and a history of atrial fibrillation at baseline (P > 0.5), and there were also no MMSE, MoCA, and CDT scores at baseline between the two groups There was also no significant difference in the baseline MMSE, MoCA and CDT scores between the two groups. After 12 weeks of treatment, the incidence of post-stroke cognitive dysfunction in the observation group was lower than that in the control group (P<0.05), and the MMSE, MOCA, ADL, and CDT scores in the observation group were higher than those in the control group (P<0.05). Cognitive impairment ranged from 48%-60% in the acute phase of stroke and 35%-61% at 3 months after stroke. Compared with the control group, the proportion of non-dementia and dementia after stroke was significantly lower in the observation group at 3 months (P < 0.05). Compared with the MMSE, the MoCA was more sensitive in screening for cognitive impairment after stroke. No significant differences in adverse effects were observed between the two groups.
Conclusion: Cognitive dysfunction is a common complication after acute ischaemic stroke, and sequential treatment with butanephthalein can reduce the incidence of mild cognitive impairment and dementia, improve cognitive scores and daily life ability, and has a good safety profile. In addition, the use of the MMSE and MoCA scales can be used to screen for cognitive impairment after stroke. |
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