针刺联合重复经颅磁刺激治疗卒中后认知障碍的疗效观察及对记忆力和P300波幅的影响

Observation of the therapeutic effect of acupuncture combined with repetitive transcranial magnetic stimulation on cognitive impairment after stroke and its effect on memory and P300 amplitude

目的观察通督醒神针刺法联合重复经颅磁刺激治疗卒中后认知障碍的临床疗效及对患者认知功能、记忆力及P300波幅的影响。方法将80例卒中后认知障碍的患者作为研究对象,随机分为对照组(39例)和观察组(41例)。两组均行认知功能康复训练,对照组予重复经颅磁刺激治疗,观察组予通督醒神法针刺联合重复经颅磁刺激治疗。比较两组临床疗效,观察两组治疗前后蒙特利尔认知评估(Montreal cognitive assessment,MoCA)评分、Rivermead行为记忆测验-Ⅱ(Rivermead behavioral memory test-Ⅱ,RBMT-Ⅱ)评分、改良Barthel指数(modified Barthel index,MBI)评分及头部P300波幅和潜伏期的变化。结果观察组总有效率高于对照组(P<0.05)。治疗后,两组MoCA、RBMT-Ⅱ和MBI评分及头部P300波幅均较同组治疗前升高(P<0.05),且观察组均高于对照组(P<0.05);两组P300潜伏期均较同组治疗前降低(P<0.05),且观察组低于对照组(P<0.05)。结论在认知功能康复训练基础上,针刺联合重复经颅磁刺激可有效改善卒中后认知障碍患者的认知功能,增强记忆力,提高日常生活能力,升高P300波幅,疗效优于重复经颅磁刺激治疗。

Objective To observe the clinical efficacy of Tong Du Xing Shen acupuncture combined with repetitive transcranial magnetic stimulation in the treatment of cognitive impairment after stroke and its effect on cognitive function,memory and P300 amplitude.Method Eighty patients with post-stroke cognitive impairment were studied and randomly divided into a control group(39 patients)and an observation group(41 patients).Both groups were treated with cognitive function rehabilitation training.The control group was treated with repetitive transcranial magnetic stimulation,and the observation group was treated with Tong Du Xing Shen acupuncture combined with repetitive transcranial magnetic stimulation.The clinical efficacy of the two groups was compared,and the changes of Montreal cognitive assessment(MoCA)score,Rivermead behavioral memory test-Ⅱ(RBMT-Ⅱ)score,modified Barthel index(MBI)score,and head P300 amplitude and latency were observed before and after treatment.Result The total effective rate of the observation group was higher than that of the control group(P<0.05).After treatment,the scores of MoCA,RBMT-and MBI and the amplitude of head P300Ⅱin the two groups were higher than those before treatment(P<0.05),and they were higher in the observation group than in the control group(P<0.05).The P300 latency of the two groups was lower than that before treatment(P<0.05),and that of the observation group was lower than that of the control group(P<0.05).Conclusion In addition to the cognitive function rehabilitation training,acupuncture combined with repetitive transcranial magnetic stimulation can effectively improve the cognitive function of patients with post-stroke cognitive impairment,enhance memory,improve the ability of daily living,and increase the amplitude of P300,and the curative effect is better than the treatment of repetitive transcranial magnetic stimulation alone.