袁秀萍

摘要：目的  探讨高压氧联合尼莫地平治疗脑小血管病（CSVD）所致认知功能障碍的临床疗效。方法  连续性入组2016年1月～2017年12月于新疆巴州人民医院门急诊就诊符合入排标准的CSVD患者165例，将其隨机分为尼莫地平组、高压氧组和综合治疗组，每组55例。收集其临床资料，完善头颅磁共振检查及神经心理学评估，所有患者均给予基础治疗（包括合并高血压、糖尿病、高血脂者予对症治疗），在此基础上，尼莫地平组给予尼莫地平治疗，高压氧组给予高压氧治疗，综合治疗组给予尼莫地平+高压氧治疗。比较三组患者治疗前后简明精神状态检查（MMSE）评分和蒙特利尔认知功能评估量表（MoCA）总分、各分项评分、各认知领域改善情况及不良反应发生情况。结果  治疗后三组患者MMSE、MoCA评分均优于治疗前，且综合治疗组优于尼莫地平组和高压氧组，差异具有统计学意义（P<0.05），但尼莫地平组与高压氧组患者相比，差异无统计学意义（P>0.05）。三组治疗后MoCA各分项得分较前均有增长，尤其在视空间执行功能、语言能力及延迟回忆方面，差异有统计学意义（P<0.05）。综合治疗组视空间执行功能、计算力、语言能力、延迟回忆分项的得分高于尼莫地平组和高压氧组，差异具有统计学意义（P<0.05）。三组均无严重不良反应发生。结论  高压氧联合尼莫地平可明显改善CSVD患者的认知功能，具有一定的协同作用，可作为CSVD所致认知功能障碍治疗的有效方案。

关键词：高压氧;尼莫地平;脑小血管病;认知功能障碍

Abstract：Objective  To investigate the clinical efficacy of hyperbaric oxygen combined with nimodipine in the treatment of cognitive impairment caused by cerebral small vessel disease （CSVD）.Methods  Continuously enrolled 165 patients with CSBD who met the criteria for admission to the emergency department of Bazhou People's Hospital from January 2016 to December 2017. They were randomly divided into nimodipine group， hyperbaric oxygen group and comprehensive treatment group ， 55 cases in each group. Collecting clinical data， improving the MRI and neuropsychological assessment， all patients were given basic treatment （including symptomatic treatment of hypertension，diabetes， and hyperlipidemia）. On this basis， nimodipine was given to Nemo. In the treatment of pingping， hyperbaric oxygen was given to hyperbaric oxygen therapy， and in the comprehensive treatment group， nimodipine and hyperbaric oxygen were given. The course of treatment was 3 months. The （MMSE） scores and the total scores of the Montreal Cognitive Function Assessment Scale （MoCA），the scores of each sub-item， the improvement of each cognitive field， and the occurrence of adverse reactions were compared between the three groups.Results  After treatment， the MMSE and MoCA scores of the three groups were better than those before treatment， and the comprehensive treatment group was superior to the nimodipine group and the hyperbaric oxygen group，the difference was statistically significant （P<0.05）， but the nimodipine group and the hyperbaric oxygen group. There was no significant difference between the patients （P>0.05）.After three treatments， the scores of MoCA sub-items increased compared with the previous ones， especially in the visual function， language ability and delayed recall the difference was statistically significant（P<0.05）. The scores of spatial executive function， computational power， language ability， and delayed recall were higher in the comprehensive treatment group than in the single treatment group，the difference was statistically significant （P<0.05）.No serious adverse reactions occurred in the three groups.Conclusion  Hyperbaric oxygen combined with nimodipine can significantly improve the cognitive function of patients with CSBD. It has a synergistic effect and can be used as an effective treatment for cognitive dysfunction caused by CSCD.

Key words：Hyperbaric oxygen;Nimodipine;Cerebral small vessel disease;Cognitive dysfunction

随着人口老齡化进程的加速及神经影像技术的发展，脑小血管病（cerebral small vessel disease，CSVD）逐渐被广大医务工作者认识和发现，成为近期的研究热点。CSVD是指各种原因所致的颅内小动脉、微动脉、毛细血管及小静脉病变，进而引起的一系列临床、影像、病理表现综合征[1]。影像学主要表现为脑白质病变（white matter lesions，WMLs）、腔隙性脑梗死（lacunar infarctions，LIs）、脑微出血（cerebral microbleeds，CMBs）等[2]。临床表现多样，以认知功能障碍、缺血或出血性卒中、精神情感障碍、尿便及步态异常为主。……