灯盏生脉胶囊联合SCT、mCIMT三联疗法治疗脑卒中患者的康复疗效及对氧化应激的影响

Effects of Dengzhan Shengmai Capsules Combined with SCT and mCIMT on Rehabilitation and Oxidative Stress Response of Stroke Patients

目的观察灯盏生脉胶囊联合感知提醒疗法(Sensory cueing treatment,SCT)、改良限制-诱导运动疗法(Modified constraint-induced movement therapy,mCIMT)三联疗法对脑卒中患者认知功能和肢体功能的康复效果,并观察其对氧化应激指标的影响。方法选取2018年5月—2020年5月期间于中国矿业大学附属医院行康复治疗的脑卒中患者158例,按随机数字表法分为对照组和治疗组,每组各79例。所有患者均接受常规治疗,对照组给予SCT与mCIMT训练,3 h/d,每周治疗5 d,治疗组在对照组基础上给予灯盏生脉胶囊口服,3次/d。治疗4周后,观察比较两组患者临床疗效[美国国立卫生研究院脑卒中量表(NIHSS)评分]、认知功能恢复情况[简易智能精神状态检查量表(Mini-mental state examination,MMSE)、蒙特利尔认知评估量表(Montreal cognitive assessment,MoCA)]、肢体功能康复情况[Fugl-Meyer运动功能(Fugl-Meyer assessment-upper extremity,FMA)、上肢动作研究量表(Action research arm test,ARAT)、Berg平衡量表(Berg balance scale,BBS)],并观察超氧化物歧化酶(Superoxide dismutase,SOD)、血清丙二醛(Malondialdehyde,MDA)、总抗氧化能力(Total antioxidative capability,TAOC)水平变化。结果治疗后治疗组总有效率92.21%(71/77)明显高于对照组80.77%(63/78),差异有统计学意义(P<0.05)。治疗后两组患者MMSE、MoCA评分均高于治疗前,差异有统计学意义(P<0.05);且治疗组MMSE、MoCA评分均明显高于对照组,差异有统计学意义(P<0.05)。治疗后两组患者FMA、ARAT、BBS评分均高于治疗前,差异有统计学意义(P<0.05);且治疗组FMA、ARAT、BBS评分均明显高于对照组,差异有统计学意义(P<0.05)。治疗后两组患者血清SOD、TAOC水平均高于治疗前,MDA水平均低于治疗前,差异有统计学意义(P<0.05);且治疗组血清SOD、TAOC水平高于对照组,MDA水平低于对照组,差异有统计学意义(P<0.05)。结论灯盏生脉胶囊联合SCT、mCIMT三联疗法对脑卒中患者的康复效果明显优于只采用运动训练手段治疗,可显著促进患者认知功能、肢体功能的康复,并能减轻脑卒中后机体氧化应激损伤,值得临床推广应用。

Objective To observe the effects of Dengzhan Shengmai Capsules combined with sensory cueing treatment(SCT)and modified constraint-induced movement therapy(mCIMT)on the rehabilitation of cognitive function and limb function and the oxidative stress indicators of stroke patients.Methods A total of 158 stroke patients who underwent rehabilitation in the Affiliated Hospital of China University of Mining and Technology from May 2018 to May 2020 were included and assigned into a control group(n=79)and an observation group(n=79)according to a random number table method.All the patients received conventional treatment.Additionally,the control group received SCT and mCIMT for 3 h per day,5 days per week and the observation group was orally administrated with Dengzhan Shengmai Capsules 3 times per day on the basis of the control group.Both groups were treated for 4 weeks.Before and after treatment,the National Institutes of Health Stroke Scale(NIHSS)scoring was performed to determine the efficacy and the Mini-Mental State Examination(MMSE)and the Montreal Cognitive Assessment(MoCA)scoring was performed to evaluate the recovery of cognitive function.Fugl-Meyer Assessment-Upper Extremity(FMA),Action Research Arm Test(ARAT),Berg Balance Scale(BBS)scoring was conducted to evaluate the rehabilitation of limb function.Furthermore,the levels of superoxide dismutase(SOD),serum malondialdehyde(MDA),and total antioxidant capacity(TAOC)were determined.Results After treatment,the observation group had higher total effective rate than the control group[92.21%(71/77)vs.80.77%(63/78),P<0.05].The treatment in both groups elevated the MMSE,MoCA,FMA,ARAT,and BBS scores(P<0.05)and the observation group had higher scores than the control group after treatment(P<0.05).The treatment in both groups elevated the serum SOD and TAOC levels and lowered the serum MDA level(P<0.05).Moreover,the observation group had higher serum SOD and TAOC levels and lower MDA level than the control group after treatment(P<0.05).Conclusion Dengzhan Shengmai Capsules combined with SCT and mCIMT out performs exercise training alone in the rehabilitation of stroke patients.This triple therapy can significantly promote the rehabilitation of patients′cognitive function and limb function and reduce oxidative stress after stroke,being worthy of promotion in clinical practice.