Strelnikova I A, Svetkina A A, Androfagina O V
Seredavin Samara Regional Clinical Hospital, Samara, Russia.
Seredavin Samara Regional Clinical Hospital, Samara, Russia; Samara State Medical University, Samara, Russia.
Zh Nevrol Psikhiatr Im S S Korsakova. 2020;120(3. Vyp. 2):54-58. doi: 10.17116/jnevro202012003254.
To evaluate an effect of long-term sequential therapy with mexidol and mexidol forte on the functional outcome of patients with carotid ischemic stroke.
The study included 50 patients with newly developed carotid stroke, hospitalized in the stroke unit on the first day from the onset of the disease. Patients of the main group (n=25) received mexidol in a dose of 500 mg intravenously once a day for 14 days, then mexidol forte 250 in tabs 250 mg 3 times a day for 60 days. Patients of the comparison group (n=25) received standard basic therapy. The significance of intergroup differences was assessed using the Mann-Whitney test, Fisher's exact test, and relative risk (OR) calculation. Differences were considered significant at a level of p<0,05.
After 14 days of therapy, both groups of patients showed a positive trend compared to baseline. At the same time, patients of the mexidol group had a higher MoCA score (U=173,5, p=0,006), a lower score when performing tasks on dynamic praxis (U=214,0, p=0,028) and optical spatial disturbances (U=170,5, p=0,003), better memorization strength (181,5, p = 0,006) and better performance on abstraction MOCA subtest (U=200,5, p=0,014). By the 74th day, the absence of moderate cognitive impairment (MoCA> 26 points) was diagnosed in 17 patients (68%) of the main group and 14 patients (56%) of the comparison group. No significant differences were found. Moreover, patients of the main group had a significantly lower NIHSS score (U=124,0, p<0,001) and a lower degree of disability: a total mRS score 0-2 was achieved in 19 (76%) patients of the main group and only in 12 (48%) patients of the comparison group (OR=3,34, F=0,07, p<0,05). Also, patients receiving long-term sequential therapy with mexidol and mexidol forte 250 had milder spatial disorders than patients of the comparison group.
Consecutive treatment with mexidol and mexidol forte 250 in the acute and early recovery periods of ischemic stroke positively affects the regression of local neurological symptoms, increases the likelihood of achieving independence in everyday life by 3,34 times, and reduces the severity of optical-spatial, neurodynamic and memory impairments.
评估美西律与强力美西律长期序贯疗法对颈动脉缺血性脑卒中患者功能转归的影响。
本研究纳入50例新发颈动脉脑卒中患者，发病首日收住卒中单元。主要组（n=25）患者静脉滴注美西律，剂量为500mg，每日1次，共14天，随后口服强力美西律，250mg片剂，每次250mg，每日3次，共60天。对照组（n=25）患者接受标准基础治疗。采用曼-惠特尼检验、费舍尔精确检验及相对危险度（OR）计算评估组间差异的显著性。p<0.05为差异有统计学意义。
治疗14天后，两组患者与基线相比均呈积极趋势。同时，美西律组患者蒙特利尔认知评估量表（MoCA）评分较高（U=173.5，p=0.006），动态实践任务执行评分较低（U=214.0，p=0.028），视空间障碍评分较低（U=170.5，p=0.003），记忆强度较好（181.5，p = 0.006），抽象MoCA子测试表现较好（U=200.5，p=0.014）。到第74天时，主要组17例患者（68%）和对照组14例患者（56%）被诊断无中度认知障碍（MoCA>26分）。未发现显著差异。此外，主要组患者美国国立卫生研究院卒中量表（NIHSS）评分显著较低（U=124.0，p<0.001），残疾程度较低：主要组19例患者（76%）总改良Rankin量表（mRS）评分为0-2分，而对照组仅12例患者（48%）达到该评分（OR=3.34，F=0.07，p<0.05）。此外，接受美西律与强力美西律250长期序贯治疗的患者视空间障碍比对照组患者更轻。
在缺血性脑卒中急性期和早期恢复期，连续使用美西律与强力美西律250对局部神经症状的消退有积极影响，使日常生活中实现独立的可能性增加3.34倍，并减轻视空间、神经动力学和记忆障碍的严重程度。
