Clinical Study Of Enhanced External Counterpulsation In The Treatment Of Subcortical Ischemic Vascular Dementia

Background: With continuous progress of society and continuous development of medical technology,the average life expectancy in my country has increased significantly,and the aging process of the population has been intensified,and the health problems of the elderly have received more and more attention.Subcortical ischemic vascular dementia（SIVD）is the most common type of vascular dementia（VAD）.The main pathogenesis and pathological changes are subcortical small vessel disease,lacunar infarction caused by ischemia-reperfusion and white matter lesions.The cognitive impairment of SIVD is prominent in the impairment of attention and executive function.The patients with SIVD bring a heavy burden to the family and society.At present,treatment research mostly focuses on drugs,and has not achieved ideal results.Exploring new treatment methods has important research value.Enhanced external counterpulsation（EECP）is a non-invasive auxiliary circulatory device.Studies have confirmed that EECP can improve organ ischemia through a variety of mechanisms and is used in the treatment of ischemic cardiovascular and cerebrovascular diseases.This study evaluated the clinical effect of EECP treatment by evaluating the comprehensive cognitive function of patients with SIVD before and after EECP treatment;The results will provide a scientific basis for the use of EECP in the treatment of SIVD patients.Objective: This topic is devoted to the study of the effect and mechanism of EECP on the improvement of cognitive function in patients with SIVD,so as to provide a scientific basis for the treatment of SIVD patients with EECP.Methods: 60 patients with SIVD diagnosed in the Department of Neurology,outpatient department of geriatrics and inpatient department of Taihe Hospital Affiliated to Hubei Medical College from January 2021 to December 2021 were recruited.They were divided into control group（n = 30）and EECP treatment group（n = 30）randomly.On the basis of routine antihypertensive,hypoglycemic,antiplatelet therapy and lipid regulating and stabilizing plaque therapy,the control group was treated with Donepezil 5mg qd,and the EECP treatment group was treated with EECP on the basis of Donepezil 5mgqd oral treatment（once a day,60 minutes each time,6 times a week,for6 weeks,36 times in total）.Before treatment and after 6 weeks of treatment,the patients’cognitive function and activities of daily living were evaluated,and fasting venous blood was collected in the morning,and serum vascular endothelial growth factor（VEGF）was determined by double-antibody two-step sandwich enzyme-linked immunosorbent assay.Before and 6 weeks after treatment,CT perfusion（CTP）was perfected in both groups.The center of semiovale was selected as the region of interest,and the cerebral blood flow（CBF）and cerebral blood volume（CBV）were measured by software.The general data of the patients were collected,including gender,age,education level,and the proportion of common chronic diseases such as hypertension,coronary heart disease,hyperlipidemia and diabetes.All data were statistically analyzed by SPSS24.0.Results:1.There were 60 eligible patients in the study,30 patients in the EECP therapy group and 30 patients in the control group.There was no significant difference in the general data between the two groups.There was no significant difference in the scores of overall cognitive function and self-care ability scale between the two groups before treatment（P>0.05）.After 6 weeks of treatment,the scores of MoCA and MMSE in the EECP treatment group were higher than those in the control group significantly,while the scores of ADL in the treatment group were lower than those in the control group.And the differences were statistically significant（P<0.05）.2.There was no significant difference in serum VEGF level between the two groups before treatment.After 6 weeks of treatment,the level of serum VEGF in EECP treatment group had a significant increase,and the difference was statistically significant（P < 0.05）.3.There was no significant difference in CBF and CBV in the center of semiovale between the two groups before treatment.But the center CBF of the right semioval is slightly faster than that of the left,and the CBV is slightly more than that of the left.After 6 weeks of treatment,the CBF and CBV of bilateral semioval center in EECP group were significantly higher than those before treatment（P < 0.05）.4.In the EECP treatment group,2 patients had adverse reactions,including dizziness and rash,with a total adverse reaction rate of 6.7%.In the control group,1patient had an adverse reaction,manifested as drowsiness,with a total adverse reaction rate of 3.3%.There was no significant difference in the overall adverse reaction rate between the two groups（P>0.05）.Conclusion: EECP can improve the overall cognitive function and activities of daily living in patients with SIVD.Its mechanism of action involves that EECP can improve cerebral blood flow and cerebral perfusion,and increase the expression of serum VEGF,which may promote the formation of microangiogenesis in chronic ischemic brain tissue.EECP is safe and effective in the treatment of vascular dementia,and may be an effective intervention in addition to conventional drug therapy,and is expected to be popularized and applied in clinic in the future.