孙氏调神针刺法联合认知训练治疗卒中后认知功能障碍患者34例临床观察

Clinical Observation on SUN’s Mind-regulating Acupuncture Method Combined with Cognitive Training for Post-stroke Cognitive Impairment in 134 Cases

目的 观察孙氏调神针刺法联合认知训练治疗卒中后认知功能障碍(PSCI)的临床疗效及可能机制。方法 将74例PSCI患者随机分为对照组和观察组各37例。两组均给予脑卒中基础治疗(包括控制血压、血糖、血脂,抗血小板聚集,改善循环)及常规针刺治疗、康复训练、认知训练,观察组在此基础上再予孙氏调神针刺法治疗。取穴百会、情感区(额区)及孙氏腹针疗法中腹一区,每日1次,每周5次,共治疗4周。治疗前后采用简易精神状态评价量表(MMSE)、阿尔茨海默病评定量表-认知量表(ADAS-Cog)进行评分,并进行画钟试验(CDT)、连线测验[TMT,包括A、B两部分的耗时数(TMT-A)和(TMT-B),干扰量=(TMT-B)-(TMT-A)]、改良Bathel指数量表(MBI)评分,并检测血清C反应蛋白(CRP)、同型半胱氨酸(Hcy)水平。结果 最终观察组34例、对照组36例进行统计分析。与本组治疗前比较,治疗后两组患者的MMSE评分、CDT评分、MBI评分均升高,ADAS-Cog评分、TMT-A、TMT-B均下降,血清CRP、Hcy水平明显降低(P<0.01),且观察组各项指标改善明显优于对照组(P<0.01)。观察组治疗后干扰量较治疗前降低(P<0.05),而对照组治疗前后干扰量差异无统计学意义(P>0.05)。结论 孙氏调神针刺法联合认知训练可显著改善PSCI患者的认知功能、日常生活自理能力,优于单纯的认知训练,其可能通过降低血清CRP、Hcy水平发挥治疗作用。

Objective To observe the clinical efficacy of SUN’s mind-regulating acupuncture method combined with cognitive training in the treatment of post-stroke cognitive impairment(PSCI) and the possible mechanism.Methods A total of 74 patients with PSCI were randomly divided into control group(37 cases) and observation group(37 cases). Both groups were given routine treatment for stroke including management of blood pressure, blood sugar, blood lipid, antiplatelet aggregation, regular acupuncture, rehabilitation and cognitive training. The observation group was additionally given SUN’s mind-regulating acupuncture at Baihui(GV 20), emotional area(frontal area), and the first abdominal area of SUN’s abdominal acupuncture therapy. All patients were treated once a day, 5 times a week for 4 weeks. Before and after treatment, the mini-mental state examination scale(MMSE), Alzheimer’s disease assessment scale cognition part(ADAS-Cog), clock drawing test(CDT), trail making test(TMT) including time taken to complete part A(TMT-A) and part B(TMT-B), and the time completion difference that equals to(TMT-B) minus(TMT-A), Modified Bathel Index(MBI), and serological indexes including serum C-reactive protein(CRP) and homocysteine(Hcy) of both groups were observed. Results Finally, 34 cases in the observation group and 36 cases in the control group were analyzed. After treatment, the MMSE score, CDT score and BMI score of both groups were improved, while the ADAS-Cog score, TMT-A and TMT-B completion time, the levels of serum CRP and Hcy in both groups significantly decreased(P<0. 01), with more changes found in the observation group than in the control group(P<0. 01). After treatment, the time completion difference of TMT-A and TMT-B in the observation group significantly decreased(P<0. 05), while that in the control group was not statistically different(P>0. 05).Conclusion Superior to cognitive training alone, SUN’s mind-regulating acupuncture combined with cognitive training can significantly improve the cognitive function and self-care ability of patients with PSCI, possibly by regulating serum CRP and Hcy levels.