电针后留针联合认知训练治疗脑卒中后认知功能障碍:多中心随机对照试验

Needle retaining after electroacupuncture combined with cognitive training for post-stroke cognitive impairment:a multi-center randomized controlled trial

目的:比较电针后留针联合认知训练与电针联合认知训练治疗脑卒中后认知功能障碍(PSCI)的临床疗效。方法:将206例PSCI患者随机分为留针组(103例,脱落9例)和电针组(103例,脱落6例)。两组患者均接受常规内科基础治疗及康复治疗,留针组予神庭、百会电针治疗(前15 min连续波,频率50 Hz,后15 min疏密波,频率2 Hz/50 Hz)后继续留针1 h,留针期间行认知训练;电针组予相同电针治疗30 min后(不留针)行认知训练。两组均每天1次,每周5次,共治疗8周。分别于治疗前及治疗8周后观察两组患者中医证候积分;于治疗前及治疗4、8周后观察两组患者简易精神状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)、日常生活能力评分;并于治疗8周后评定两组临床疗效。结果:治疗8周后,两组患者中医证候积分高于治疗前(P<0.05);留针组患者中医证候积分高于电针组(P<0.05)。治疗4、8周后,两组患者MMSE、MoCA、日常生活能力评分均高于治疗前(P<0.05);留针组患者治疗4、8周后MMSE、MoCA评分及治疗8周后日常生活能力评分高于电针组(P<0.05)。留针组总有效率为90.4%(85/94),高于电针组的82.5%(80/97,P<0.05)。结论:电针后留针联合认知训练和电针联合认知训练均可有效治疗PSCI,改善患者临床症状、认知功能和日常生活能力,电针后留针联合认知训练疗效更优。

Objective To compare the efficacy of needle retaining after electroacupuncture combined with cognitive training and electroacupuncture combined with cognitive training in the treatment of post-stroke cognitive impairment(PSCI).Methods A total of 206 patients with PSCI were randomized into a needle retaining group(103 cases,9 cases dropped out)and an electroacupuncture group(103 cases,6 cases dropped out).In addition to the conventional basic medical treatment and the rehabilitation treatment,in the needle retaining group,electroacupuncture at Shenting(GV 24)and Baihui(GV 20)was applied,with continuous wave of 50 Hz in the first 15 min and with disperse-dense wave of 2 Hz/50 Hz in the last 15 min,the needles were continuously retained for 1 h after electroacupuncture,during which cognitive training was adopted;in the electroacupuncture group,cognitive training was performed after the same electric stimulation exerted for 30 min,without additional needles retaining.The treatment was given once a day,5 times a week for totally 8 weeks in the two groups.Before and after 8-week treatment,the TCM syndrome score was observed;before and after 4,8-week treatment,the scores of minimental state examination(MMSE),Montreal cognitive assessment(MoCA)and ability of daily living were observed in the two groups.The clinical efficacy of the two groups was evaluated after 8-week treatment.Results After 8-week treatment,the TCM syndrome scores were increased compared with those before treatment in both groups(P<0.05);the TCM syndrome score in the needle retaining group was higher than that in the electroacupuncture group(P<0.05).After 4,8-week treatment,the scores of MMSE,Mo CA and ability of daily living were increased compared with those before treatment in both groups(P<0.05);MMSE,Mo CA scores after 4,8-week treatment and ability of daily living score after 8-week treatment in the needle retaining group were higher than those in the electroacupuncture group(P<0.05).The total effective rate was 90.4%(85/94)in the needle retaining group,which was superior to 82.5%(80/97)in the electroacupuncture group(P<0.05).Conclusion Both needle retaining after electroacupuncture combined with cognitive training and electroacupuncture combined with cognitive training can effectively treat PSCI,improve the clinical symptom,cognitive function and ability of daily living in PSCI patients.Needle retaining after electroacupuncture combined with cognitive training has a better therapeutic effect.