祁秀丽 邵帅 冯程程

【摘要】 目的：探讨奥拉西坦治疗缺血性脑卒中后认知功能障碍的疗效及对患者血清神经元特异性烯醇化酶（NSE）、同型半胱氨酸（Hcy）和血液流变学的影响。方法：选取2016年3月-2018年5月本院收治的74例缺血性脑卒中后认知功能障碍患者作为研究对象，按照随机数字表法将其分为观察组和对照组，各37例。对照组给予常规神经营养、抗凝治疗，观察组在对照组基础上加用奥拉西坦。比较两组疗效、血清NSE、Hcy、血液流变学指标水平。结果：观察组总有效率为89.19%，高于对照组的67.57%（P<0.05）;治疗后，两组NSE、Hcy水平均低于治疗前，且观察组均低于对照组，差异均有统计学意义（P<0.05）;治疗后，两组血浆纤维蛋白原、血浆黏度、全血黏度均低于治疗前，且观察组均低于对照组，差异均有统计学意义（P<0.05）。結论：奥拉西坦治疗缺血性脑卒中后认知功能障碍有良好疗效，可有效改善患者临床血清NSE、Hcy、血液流变学等临床指标，可推广于临床。

【关键词】 血液流变学; 同型半胱氨酸; 神经元特异性烯醇化酶; 奥拉西坦; 认知功能障碍;缺血性脑卒中

【Abstract】 Objective：To investigate the effect of Oxiracetam on cognitive dysfunction after ischemic stroke and its effect on serum NSE，Hcy and hemorheology.Method：A total of 74 patients with cognitive impairment after ischemic stroke admitted to our hospital from March 2016 to May 2018 were selected as the study subjects.According to the random number table method，they were divided into observation group and control group，37 cases in each group.The control group was given routine neurotrophic and anticoagulant therapy，while the observation group was given Oxiracetam on the basis of the control group.The curative effect，serum NSE，Hcy and hemorheological indexes between two groups were compared.Result：The total effective rate of observation group was 89.19%，which was higher than 67.57% of control group（P<0.05）.After treatment，the levels of NSE and Hcy in two groups were lower than those of before treatment，and observation group were lower than those of control group，the differences were statistically significant（P<0.05）.After treatment，the plasma fibrinogen，plasma specific viscosity and whole blood viscosity of two groups were lower than those of before treatment，and observation group were lower than those of control group，the differences were statistically significant（P<0.05）.

Conclusion：Oxiracetam has a good effect on cognitive impairment after ischemic stroke，it can effectively improve clinical serum NSE，Hcy，hemorheology and other clinical indicators，and can be extended to clinical practice.

【Key words】 Hemorheology; Homocysteine; Neuron-specific enolase; Oxiracetam; Cognitive dysfunction; Ischemic stroke

First-authors address：Liaoyang Central Hospital，Liaoyang 111000，China

doi：10.3969/j.issn.1674-4985.2019.08.010

缺血性脑卒中在老年群体中是多发病、常见病，在临床上，该疾病具有高复发率、高致残率、高死亡率、高发病率，并且可有多种并发症即“四高一多”的特征，严重威胁老年群体的生命健康[1-2]。不论是首发还是复发，缺血性脑卒中均可导致患者出现不同程度的认知障碍，包括中、轻度认知功能障碍、痴呆等认知损害[3-4]。所以，缺血性脑卒中后认知功能障碍的有效治疗和早期识别对保障缺血性脑卒中患者的生活质量有重要意义[5-6]。奥拉西坦在临床上可用于由多种原因造成脑损伤所引起的智能与记忆障碍、神经功能缺失的治疗[7-8]。本研究应用奥拉西坦治疗缺血性脑卒中后认知功能障碍患者，通过比较疗效及血清神经元特异性烯醇化酶（NSE）、同型半胱氨酸（Hcy）、血液流变学指标水平，探究奥拉西坦在治疗缺血性脑卒中后认知功能障碍中的临床意义。……