通窍益智汤联合认知训练治疗脑梗死后认知功能障碍临床研究

Clinical Study on Tongqiao Yizhi Tang Combined with Cognitive Training for Cognitive Dysfunction After Cerebral Infarction

目的:观察通窍益智汤联合认知训练治疗脑梗死后认知功能障碍的临床疗效。方法:选取100例脑梗死后认知功能障碍患者,根据随机数字表法分为对照组和观察组各50例。2组均给予常规治疗,在此基础上对照组进行认知训练,观察组在对照组基础上给予通窍益智汤治疗,2组均治疗8周。比较2组临床疗效、认知功能、神经功能、日常生活活动能力和神经递质水平。结果:观察组总有效率94.00%,高于对照组78.00%(P<0.05)。治疗后,2组视空间与执行能力、语言功能、注意和计算功能、抽象、定向、延迟回忆评分及蒙特利尔认知评估量表(MoCA)总分均较治疗前升高(P<0.05),观察组视空间与执行能力、语言功能、注意和计算功能、抽象、定向、延迟回忆评分及MoCA总分均高于对照组(P<0.05)。治疗后,2组美国国立卫生研究院卒中量表(NIHSS)评分均较治疗前降低(P<0.05),功能独立性评定量表(FIM)评分均较治疗前升高(P<0.05);观察组NIHSS评分低于对照组(P<0.05),FIM评分高于对照组(P<0.05)。治疗后,2组乙酰胆碱(ACh)、去甲肾上腺素(NE)水平均较治疗前升高(P<0.05),观察组ACh、NE水平均高于对照组(P<0.05)。结论:通窍益智汤联合认知训练治疗脑梗死后认知功能障碍,可有效改善患者的认知功能、减轻神经功能缺损,提高其日常生活活动能力,作用机制可能与提高神经递质水平有关。

Objective: To observe the clinical effect of Tongqiao Yizhi Tang combined with cognitive training for cognitive dysfunction after cerebral infarction. Methods:A total of 100 cases of patients with cognitive dysfunction after cerebral infarction were selected and divided into the control group and the observation group according to the random number table method, with 50 cases in each group. Both groups were given routine treatment;the control group was additionally given cognitive training,and the observation group was additionally treated with Tongqiao Yizhi Tang based on the treatment of the control group. Both groups were treated for eight weeks. The clinical effects, cognitive function, neurological function,activities of daily living and neurotransmitter levels in the two groups were compared. Results:The total effective rate was 94.00% in the observation group,higher than that of 78.00% in the control group(P<0.05). After treatment, the scores of visual space and executive ability, language function,attention and calculation function,abstraction,orientation and delayed recall as well as the total scores of Montreal Cognitive Assessment(MoCA) in the two groups were significantly higher than those before treatment(P<0.05);the above scores in the observation group were higher than those in the control group(P<0.05). After treatment, the scores of National Institutes of Health Stroke Scale(NIHSS) in the two groups were decreased when compared with those before treatment(P<0.05), and the scores of Functional Independence Measure(FIM) were increased(P<0.05);the NIHSS score in the observation group was lower than that in the control group(P<0.05), and the FIM score was higher(P<0.05). After treatment,the levels of acetylcholine(ACh) and norepinephrine(NE) in the two groups were increased when compared with those before treatment(P<0.05),and the levels of ACh and NE in the observation group were higher than those in the control group(P<0.05). Conclusion: The therapy of Tongqiao Yizhi Tang combined with cognitive training for cognitive dysfunction after cerebral infarction can effectively improve the cognitive function of patients,relieve their neurologic impairment,and enhance their activities of daily living,and its action mechanism is related to the improvement of the levels of neurotransmitters.