目的 探究丁苯酞軟膠囊聯(lián)合鹽酸多奈哌齊片治療血管性癡呆的臨床療效。方法 選取2017年3月-2018年3月中國(guó)人民武裝警察部隊(duì)特色醫(yī)學(xué)中心收治的96例血管性癡呆患者為研究對(duì)象，根據(jù)隨機(jī)數(shù)字表法將所有患者分為對(duì)照組和治療組，每組各48例。對(duì)照組口服鹽酸多奈哌齊片，初始劑量1片/次，1次/d，維持4周，隨后根據(jù)治療效果增至2片/次，1次/d，再持續(xù)治療4周。治療組在對(duì)照組治療的基礎(chǔ)上口服丁苯酞軟膠囊，2粒/次，3次/d。兩組患者均持續(xù)治療8周。觀察兩組的臨床療效，比較兩組的蒙特利爾認(rèn)知評(píng)估量表（MoCA）評(píng)分、血清因子水平、血液流變學(xué)指標(biāo)、阿爾茨海默病生活質(zhì)量測(cè)評(píng)量表（QOL-AD）評(píng)分。結(jié)果 治療后，對(duì)照組和治療組的總有效率分別為77.08%、93.75%，兩組比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后，兩組患者視空間執(zhí)行力評(píng)分、注意力評(píng)分、延遲回憶評(píng)分、定向力評(píng)分和MoCA總分均較治療前升高（P<0.05）；且治療組MoCA評(píng)分指標(biāo)均明顯高于對(duì)照組（P<0.05）。治療后，兩組患者血清膠質(zhì)細(xì)胞源神經(jīng)營(yíng)養(yǎng)因子（GDNF）水平升高，白細(xì)胞介素-6（IL-6）、腫瘤壞死因子-α（TNF-α）水平降低，同組治療前后比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）；且治療組患者GDNF較對(duì)照組高，而IL-6、TNF-α均明顯低于對(duì)照組，兩組比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后，兩組患者全血低切黏度、全血中切黏度、全血高切黏度均較治療前降低，同組治療前后比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）；且治療組患者血液流變學(xué)指標(biāo)均明顯低于對(duì)照組，兩組比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后，治療組患者QOL-AD評(píng)分明顯升高，同組治療前后比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）；并且治療組患者QOL-AD評(píng)分明顯高于對(duì)照組，兩組比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。結(jié)論 丁苯酞軟膠囊聯(lián)合鹽酸多奈哌齊片治療血管性癡呆具有較好的臨床效果，可改善患者認(rèn)知功能，調(diào)節(jié)血清因子和血液流變學(xué)指標(biāo)，改善生活質(zhì)量，具有一定的臨床推廣應(yīng)用價(jià)值。

Objective To explore the effect of Butylphthalide Soft Capsules combined with Donepezil Hydrochloride Tablets in treatment of vascular dementia. Methods Patients (96 cases) with vascular dementia in Special Medical Center of the People's Armed Police from March 2017 to March 2018 were randomly divided into control and treatment groups, and each group had 48 cases. Patients in the control group were po administered with Donepezil Hydrochloride Tablets, starting dosage 1 tablet/time, once daily, after treated for 4 weeks, then according to the treatment effect, increased to 2 tablets/time, once daily. Patients in the treatment group were po administered with Butylphthalide Soft Capsules on the basis of the control group, 2 grains/time, three times daily. Patients in two groups were treated for 8 weeks. After treatment, the clinical efficacies were evaluated, and MOCA scores, serum factors level, hemorheology indexes, and QOL-AD scores in two groups were compared. Results After treatment, the clinical efficacies in the control and treatment groups were 77.08% and 93.75%, respectively, and there was difference between two groups (P < 0.05). After treatment, visual space and executive score, attention score, delayed recall score, orientation score and MOCA total score in two groups were significantly increased (P < 0.05). And the MOCA score indexes in the treatment group were significantly higher than those in the control group (P < 0.05). After treatment, the levels of GDNF in two groups were significantly increased, but the levels of IL-6 and TNF-α in two groups were significantly decreased, and the difference was statistically significant in the same group (P < 0.05). And the serum factors levels in the treatment group were significantly better than those in the control group, with significant difference between two groups (P < 0.05). After treatment, whole blood low shear viscosity, whole blood medium shear viscosity, and whole blood high shear viscosity in two groups were significantly decreased, and the difference was statistically significant in the same group (P < 0.05). And the hemorheology indexes in the treatment group were significantly lower than those in the control group (P < 0.05). After treatment, QOL-AD scores in two groups were significantly increased, and the difference was statistically significant in the same group (P < 0.05). And QOL-AD scores in the treatment group were significantly better than those in the control group (P < 0.05). Conclusion Butylphthalide Soft Capsules combined with Donepezil Hydrochloride Tablets has clinical curative effect in treatment of vascular dementia, can improve the cognitive function of patients, regulate serum factors and hemorheology indexes, and improve the quality of life, which has a certain clinical application value.

R971