头皮针联合重复经颅磁刺激治疗脑卒中后认知功能障碍的疗效观察

Therapeutic effect of combined scalp acupuncture and repeated transcranial magnetic stimulation on post-stroke cognitive dysfunction

目的探讨头皮针联合重复经颅磁刺激(rTMS)治疗脑卒中后认知功能障碍的临床疗效。方法选择我院康复医学科2015年1月~2016年12月收治的45例脑卒中后认知功能障碍患者,随机分为头皮针组、rTMS组及联合治疗组,每组15例。三组均接受基础治疗及认知功能训练,头皮针组接受头皮针治疗,rTMS组接受rTMS治疗,联合治疗组接受头皮针联合rTMS治疗。分别于治疗前、治疗后2个月进行MMSE、记忆力(AVLT)、执行及注意力(TMT、CWT、SDMT、DST)、语言及结构能力(VFT、BNT、CDT)、日常生活活动能力(Barthel指数)评定。结果三组治疗后MMSE、AVLT123、AVLT5、AVLT再认、TMT-A、CWT-时间、CWT-正确数、SDMT、DST顺、DST逆、VFT、BNT、CDT、Barthel指数较治疗前均有显著性提高,差异具有统计学意义(P<0.05);联合治疗组在治疗后MMSE、AVLT123、TMT-A、CWT-时间、DST顺、VFT、BNT、CDT改善优于另外两组,差异具有统计学意义(P<0.05)。结论头皮针联合重复经颅磁刺激具有协同作用,可进一步改善脑卒中后认知功能。

Objective To investigate the clinical efficacy of scalp acupuncture combined with repeated transcranial magnetic stimulation（rTMS） in the treatment of cognitive dysfunction after stroke. Methods Forty-five patients with poststroke cognitive impairment who were admitted to our department from January 2015 to December 2016 were randomly divided into scalp acupuncture group, rTMS group and combination therapy group with 15 cases in each group. All three groups received basic treatment and cognitive function training. The scalp acupuncture group received scalp acupuncture, the rTMS group received rTMS and the combined treatment group received scalp acupuncture combined with rTMS. MMSE, memory （AVLT）, performance and attention （TMT, CWT, SDMT, DST）, language and structural ability （VFT, BNT, CDT）, activity of daily living （Barthel Index） before and 2 months after treatment were rated. Results After treatment, MMSE, AVLT123, AVLTS, AVLT recognition, TMT-A, CWT-time, CWT-correct number, SDMT, DST cis, DST inverse, VFT, BNT, CDT, Barthel index were all significantly higher than before treatment in all three groups. The difference was statistically significant （P〈0.05）. The improvement of MMSE, AVLT123, TMT-A, CWT-time, DST-cis, VFT, BNT, and CDT was better in the combined treatment group than in the other two groups after treatment. The dif- ference was statistically significant （P〈0.05）. Conclusion Scalp acupuncture combined with repeated transcranial magnetic stimulation has a synergistic effect that can further improve cognitive function after stroke.