工娱治疗在脑卒中后认知障碍的临床价值

Clinical value discussion of recreation therapy in cognitive disorder after stroke

目的：探讨工娱治在脑卒中后认知障碍的临床价值。方法：选取脑卒中后认知障碍患者78例，按照随机数字表法分为对照组和观察组各39例。对照组给予针灸、尼莫地平联合肢体康复治疗；观察组在对照组的基础上实施工娱治疗。分别于治疗前，治疗后4、8、12周采用简明精神状态检查表（ MMSE）及神经行为认知状况检查表（ NCSE）评估患者病情及临床疗效。结果：2组患者治疗后4~12周MMSE评分均较治疗前增加（P〈0.05~P〈0.01）；且观察组MMSE均高于对照组（P〈0.05）。治疗后对照组患者的神经行为认知状况除4周与8周时定向力、专注力、语言命名和语言复述评分均无显著变化外（P〉0.05），其他各项评分均较治疗前改善（P〈0.05~P〈0.01）；与治疗前比较，观察组患者除4周时专注力评分与治疗前差异无统计学意义（P〉0.05）外，其他各个时间点的神经行为认知状况评分均得到改善（P〈0.05~P〈0.01）；观察组除4周时专注力、语言理解、语言命名、语言复述及8周时推理判断能力评分与对照组差异均无统计学意义（P〉0.05）外，其余各个单项评分均高于对照组（P〈0.05~P〈0.01）。结论：工娱治疗联合传统治疗可明显改善脑卒中后认知障碍患者的各项认知功能。

Objective：To discuss the clinical value of using recreation therapy in cognitive disorder after stroke. Methods：From March 2010 to April 2014 in our hospital 78 cases of patients with cognitive impairment after stroke were chosen and divided into the control group and the observation group using random number method （ 39 cases in each group ）;The control group were given acupuncture,nimodipine in joint with limb rehabilitation treatment,while on basis of that the observation group were given recreation therapy;And respectively before treatment,4 weeks,8 weeks,12 weeks after treatment with concise mental state check table（ MMSE） and neurobehavioral cognitive status checklist（ NCSE） of all patients were investigated to evaluate the clinical curative effects. Results：Two groups patients after 4~12 weeks MMSE rates all increased compared with before treatment increased（P〈0. 05 to P〈0. 01）;MMSE in the observation group were higher（P 〈 0. 05）. Neurobehavioral cognitive status of patients in the control group after treatment,except when 4 weeks and 8 weeks orientation,concentration and language name and language negative ratings than before treatment improved（P〈0. 05 to P 〈0. 01）;compared with before treatment,the observation group in addition to patients was not statistically significant when mindfulness 4 weeks score before treatment difference（P 〉 0. 05）,the other at each time point of neurobehavioral cognitive status score were improved （ P 〈0. 05 to P 〈0. 01 ）;4 weeks when the observation group concentration, language comprehension,language name,reasoning ability to judge scores the control group showed no significant difference（P〉0. 05） when the language repeat and 8 weeks,the rest of each individual scores were higher（P〈0. 05 to P〈0. 01 ）. Conclusions：Using recreation therapy combined with traditional therapy could obviously improve the cognitive function in patients with cognitive impairment after stroke.