卒中单元综合治疗对血管性认知功能损害患者认知功能、生活质量以及照料者心理状态的影响

Comprehensive treatment in stroke unit can improve the cognitive function and the life quality of stroke survivors with vascular cognitive impairment as well as the mental state of their caregivers

目的观察卒中单元综合治疗对血管性认知功能损害(VCI)患者认知功能、生活质量及照料者心理状态的影响.方法将符合入组标准的93例VCI患者按随机数字表法分为对照组44例,治疗组49例,其照料者对应分为照料对照组44例和照料治疗组49例.2组患者均采用常规药物治疗(基础药物,加上石杉碱甲和尼麦角林片),对照组照料者不作任何其它干预,治疗组在上述治疗的基础上增加卒中单元综合康复治疗(肢体运动训练、社交训练、认知训练、健康教育等),同时治疗组照料者给予系统的VCI及脑卒中相关健康教育、康复知识、技能培训及适当的抗抑郁抗焦虑药物治疗.2组患者均于治疗前、治疗后3个月和6个月后进行简易精神状态检查(MMSE)、蒙特利尔认知评估量表(MoCA)、日常生活能力量表(ADL)、Spitzer生活质量指数(QLI)评定;2组患者的照料者均于治疗前、治疗后3个月和6个月后进行汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)评定.结果治疗3个月和6个月后,治疗组患者的MMSE、MoCA、ADL和QLI评分较组内治疗前和对照组同时间点比较,均显著改善,差异均有统计学意义(P<0.05).治疗3个月和6个月后,照料治疗组的HAMD评分分别为(7.58±3.28)分和(7.73±3.61)分,与组内治疗前和对照组同时间点比较,差异均有统计学意义(P<0.05),且治疗3个月和6个月后,照料治疗组的HAMA评分与组内治疗前和对照组同时间点比较,差异亦均有统计学意义(P<0.05).结论卒中单元综合治疗可显著改善VCI患者的认知功能、生活质量以及照料者的心理状态.

Objective To study the effect of comprehensive treatment in stroke unit on the cognition and life quality of patients with vascular cognitive impairment (VCI) and also its effects on the mental state of their caregivers. Methods Ninety-three persons with VCI were randomly divided into a control group (n=44) and a comprehensive treatment group (n=49) after being admitted into the stroke unit. Both groups took routine basic drugs (such as anti-platelet drugs, lipid lowering drugs, anti-hypertension drugs, huperzine-A tablets and Nicergoline tablets). The treatment group was additionally provided with limb movement rehabilitation training, social practice, cognitive training and health education. During the treatment, the treatment group′s caregivers were also given health education about VCI and stroke, systematic rehabilitation knowledge and skills training and appropriate anti-depressant and anxiety medication if need. Before the treatment, as well as 3 and 6 months after the treatment, the patients of both groups were evaluated using the mini-mental state examination (MMSE), the Montreal cognitive assessment (MoCA), their ability in the activities of daily living (ADL) was rated and Spitzer quality of life (QLI) values were assigned. The caregivers were evaluated using the Hamilton depression scale (HAMD) and the Hamilton anxiety scale (HAMA). Results After 3 and 6 months of treatment, the average MMSE, MoCA, ADL and QLI scores of the treatment group had improved significantly and were then significantly better than those of the control group at the same time points. The average HAMD score of the treatment group was also significantly better. Conclusion Comprehensive stroke unit therapy can improve the cognition and life quality of patients with vascular cognitive impairment. It can also improve the mental state of their caregivers.