益气聪明汤加减联合经颅直流电刺激辅助治疗脑卒中后认知障碍患者临床观察

Clinical Observation on Modified Yiqi Congming Decoction Combined with Transcranial Direct Current Stimulation in Treating Patients with Post-stroke Cognitive Impairment

目的:观察益气聪明汤加减联合经颅直流电刺激辅助治疗对脑卒中后认知障碍(post-stroke cognitive impairment,PSCI)患者氧化应激指标的影响。方法:选取PSCI患者68例,以随机数字表法分为对照组和观察组,每组34例。其中对照组在常规治疗的基础上联合经颅直流电刺激治疗,观察组在对照组治疗的基础上加用益气聪明汤治疗,两组均连续治疗90天。对比两组临床疗效、抗血小板聚集率、认知功能和日常生活能力及氧化应激指标。结果:观察组总有效率[94.12%(32/34)]明显高于对照组[73.53%(25/34)](P<0.05)。治疗后,两组简易精神状态量表、Barthel指数评分较治疗前升高,美国国立卫生院脑卒中量表评分降低(P<0.05),且观察组上述指标改善优于对照组(P<0.05);治疗后,两组中医证候积分各项目均下降(P<0.05),且观察组显著低于对照组(P<0.05);治疗后,两组谷胱甘肽过氧化酶、超氧化物歧化酶较治疗前升高,丙二醛降低(P<0.05),且观察组上述指标改善优于对照组(P<0.05);治疗后,两组中医血小板聚集率均较治疗前显著降低(P<0.05),且治疗后观察组血小板聚集率远低于对照组(P<0.05);两组不良反应发生率无明显差异(P>0.05)。结论:直流电刺激辅助治疗下以益气聪明汤加减治疗PSCI患者,能减轻临床症状,改善认知功能和氧化应激状态,有利于患者神经功能恢复及抗血小板聚集作用,并能增强日常生活能力水平,且安全性较好。

Objective:To observe the influence of Yiqi Congming decoction combined with transcranial direct current stimulation(tDCS)on the indicators of oxidative stress in patients with post-stroke cognitive impairment(PSCI).Methods:All 68 PSCI patients were allocated to the control group and the observation group using random number table method,with 34 cases in each group.The control group was treated by tDCS on the foundation of conventional therapy,and the observation group took Yiqi Congming decoction based on the therapy the control group accepted,both groups were treated for 90 days consecutively.To compare clinical effects,antiplatelet aggregation,cognitive function,activity of daily living(ADL),and the indicators of oxidative stress between both groups.Results:Total effective rate of the observation group was[94.12%(32/34)],obviously higher than[73.53%(25/34)]of the control group(P<0.05).After the treatment,the scores of minimum mental state examination(MMSE)and Barthel index(BI)increased in both groups than before the treatment,the scores of National Institute of Health stroke scale(NIHSS)lowered(P<0.05),and the improvements of the indexes above in the observation group were better than these of the control group(P<0.05);after the treatment,syndrome integrals of different items in both groups lowered(P<0.05),and the observation group was lower than the control group significantly(P<0.05);after the treatment,the levels of glutathione peroxidase and SOD increased than before the treatment in both groups,malonaldehyde decreased(P<0.05),and the improvements of the indexes above of the observation group were better than these of the control group(P<0.05);after the treatment,platelet aggregation rates of both groups lowered significantly than before the treatment(P<0.05),and after the treatment,platelet aggregation rate of the observation group was far below than that of the control group(P<0.05);the incidences of adverse reaction between both groups showed no obvious difference(P>0.05).Conclusion:tDCS as an adjunctive therapy com-bined with oral administration of Yiqi Congming decoction in the treatment of PSCI patients could alleviate clinical symptoms,improve cognitive function and oxidative stress state,it could help the recovery of neurological function,resist platelet aggregation and enhance ADL with better safety.