目的 探讨尼麦角林联合加兰他敏治疗老年卒中后认知障碍（PSCI）的临床疗效及其对血清超氧化物歧化酶（SOD）、丙二醛（MDA）、神经元特异性烯醇化酶（NSE）水平的影响。方法 选取2016年6月-2019年12月保定市第一中心医院收治的130例老年PSCI患者作为研究对象，根据治疗方法将患者随机分成对照组（n=65）和观察组（n=65）。对照组口服氢溴酸加兰他敏片，起始剂量为4 mg/次，2次/d，于早、晚餐后服用；当受试者能良好耐受时，在连用4周后将剂量调整至8 mg/次，2次/d。观察组在对照组的基础上口服尼麦角林片，20 mg/次，3次/d，餐前温开水送服。连续治疗8周后评估两组疗效。比较两组治疗前后认知功能[蒙特利尔认知评估量表（MoCA）和简易精神状态检查表（MMSE）评分]、日常生活能力[日常生活能力量表（ADL）评分]、脑血流动力学参数[双侧大脑中动脉（MCA）及大脑前、后动脉（ACA和PCA）的平均血流速度（V_m）]及血清SOD、MDA和NSE水平的变化情况。结果 治疗后，观察组总有效率为92.3%，显著高于对照组的76.9%（P<0.05）。治疗后，两组MoCA、MMSE评分均显著增高，ADL评分则显著降低（P<0.05）；治疗后，观察组相关量表（MoCA、MMSE、ADL）评分的改善效果均显著优于对照组（P<0.05）。治疗后，观察组治疗后颅内各动脉（MCA、ACA和PCA）的V_m均显著增快（P<0.05），且显著快于对照组（P<0.05）。治疗后，两组血清SOD水平均显著高于治疗前，血清MDA、NSE水平显著下降（P<0.05）；且治疗后，观察组血清SOD水平较对照组显著升高，而血清MDA、NSE水平均显著降低（P<0.05）。结论 尼麦角林联合加兰他敏治疗老年PSCI的整体疗效确切，可明显改善老年患者的认知功能障碍，提高其日常生活能力，其作用机制可能是通过显著改善老年患者局部脑血流灌注、纠正机体氧化应激状态的方式来实现的。

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

河北省医学科学研究重点课题计划（20191491）