经皮穴位电刺激治疗脑卒中后认知功能障碍的临床随机对照研究

Effects of Transcutaneous Electrical Acupoint Stimulation in the Treatment of Post-stroke Cognitive Impairment: a Randomized Controlled Clinical Trial

目的观察经皮穴位电刺激(TEAS)对脑卒中后认知功能障碍(PSCI)患者认知功能和日常生活能力的影响。方法选取2015年1月—2016年6月赣南医学院附属康复医院老年康复科及神经康复科住院的PSCI患者90例,按照患者意愿及就诊顺序分为TEAS组、电针组和对照组,每组30例。3组患者均行常规治疗,TEAS组和电针组在此基础上给予电刺激神庭、百会等穴位。于治疗前、治疗2周、4周后采用洛文斯顿作业治疗用认知评定量表(LOTCA)、北京版蒙特利尔认知功能评估量表(MoCA)和改良版Barthel指数(MBI)进行评价。结果治疗前,3组患者LOTCA、MoCA、MBI评分比较,差异无统计学意义(P>0.05);治疗2周、4周后,3组患者LOTCA、MoCA、MBI评分比较,差异均有统计学意义(P<0.05);其中,治疗2周,电针组及TEAS组LOTCA、MoCA、MBI评分高于对照组(P<0.05);治疗4周,电针组LOTCA、MoCA、MBI评分高于对照组,TEAS组LOTCA、MoCA、MBI评分高于对照组及电针组(P<0.05)。对照组治疗前后LOTCA、MoCA、MBI评分比较,差异无统计学意义(P>0.05);电针组及TEAS组治疗前后LOTCA、MoCA、MBI评分比较,差异均有统计学意义(P<0.05);其中电针组及TEAS组治疗2周、4周后LOTCA、MoCA、MBI评分较治疗前升高(P<0.05)。结论 TEAS与电针一样,刺激神庭、百会等穴位可以改善PSCI,且提高患者的日常生活能力;同时在一定时间阶段TEAS治疗效果与疗程呈正比,但电针治疗不具有时间依赖性。

Objective To observe the effects of transcutaneous electrical acupoint stimulation（ TEAS） on cognitive function and daily living ability of patients with post-stroke cognitive impairment（ PSCI）. Methods 90 PSCI patients in Department of Neurological Rehabilitation and Geriatric Rehabilitation in Rehabilitation Hospital Affiliated to Gannan Medical University from January 2015 to June 2016 were selected,divided into TEAS group,electroacupuncture group and control group according to the patients’ desire and the order of treatment,30 cases in each group. The patients in control group were given conventional treatment only,and the patients in electroacupuncture group were given electroacupuncture stimulation treatment at ＂ Shenting ＂ and ＂ Baihui ＂ and conventional treatment, the patients in TEAS group were given transcutaneous electrical accupoint stimulation treatment at ＂ Shenting＂ and ＂ Baihui＂ and conventional treatment. Before treatment,2 weeks and 4 weeks after treatment, the Loewenstein Occupational Therapy Cognitive Assessment（ LOTCA）, Montreal Cognitive Function Assessment Scale（ Mo CA） and Modified Barthel Index（ MBI） were evaluated. Results Before treatment, there was no significant difference in LOTCA,Mo CA and MBI scores among the 3 groups（ P 〉 0. 05）. 2 weeks and 4 weeks after treatment,the differences of the scores of LOTCA,Mo CA and MBI were statistically significant among the 3 groups（ P 〈 0. 05）; 2 weeks after treatment,the scores of LOTCA,Mo CA and MBI in the electroacupuncture group and TEAS group were higher than those in the control group（ P 〈 0. 05）; 4 weeks after treatment,the scores of LOTCA,Mo CA and MBI in the electroacupuncture group were higher than those in the control group,the scores of LOTCA,Mo CA and MBI in the TEAS group were higher than those in the control group and electroacupuncture group（ P 〈 0. 05）. The scores of LOTCA,Mo CA and MBI in the control group before and after treatment were not statistically significant（ P 〉 0. 05）; the scores of LOTCA, Mo CA and MBI in the electroacupuncture group and TEAS group before and after treatment were statistically significant（ P 〈 0. 05）. The scores of LOTCA,Mo CA and MBI in the electroacupuncture group and TEAS group 2 weeks and 4 weeks after treatment were higher than those before treatment（ P 〈 0. 05）. Conclusion AS both TEAS and EA at ＂ Shenting＂ and ＂ Baihui＂ can improve cognitive function in patients with PSCI and improve the ability of daily life of patients with PSCI,at the same time,we discovered that the therapeutic effect of TEAS is related to the course of treatment. In a certain period of time,the longer the course of treatment,the better the effect,but the electroacupuncture treatment has no time dependence.