基于事件相关电位P300及脑血流动力学探讨通督醒脑针法改善卒中后认知功能障碍

Exploration of Needling Method of Dredging Du Meridian and Refreshing Brain on Post-Stroke Cognitive Impairment Based on Event-Related Electric Potential P300 and Cerebral Hemodynamics

目的:探讨通督醒脑针法对卒中后认知功能障碍患者的临床疗效。方法:将60例脑卒中患者随机分为观察组30例和对照组30例。对照组采用常规基础治疗、认知康复训练和盐酸多奈哌齐片,观察组在对照组基础上采用通督醒脑针法,疗程8周。比较两组MoCA评分、MMSE评分、ADL评分、脑部血管血流最大峰值(Vs)、平均流速(Vm)和血管阻力指数(RI)水平及事件相关电位P300的差异。采用MoCA评分、MMSE评分与P300潜伏期、波幅高低的关联分析,分析不同病灶卒中患者的MoCA和P300水平比较。结果:两组治疗后MoCA评分、MMSE评分和ADL评分与同组治疗前比较均有所提高,差异具有统计学意义(P<0.05);观察组治疗后MoCA评分、MMSE评分、ADL评分与对照组比较均有所提高,差异具有统计学意义(P<0.05);观察组脑动脉Vs及Vm值水平高于对照组(P<0.05),脑动脉RI值水平低于对照组(P<0.05)。观察组治疗后P300潜伏期短于对照组,波幅长于对照组(P<0.05);P300潜伏期与MoCA评分、MMSE评分呈负相关,P300波幅与MoCA评分、MMSE评分则呈正相关。MoCA评分与MMSE评分呈正相关;额叶卒中组、颞叶卒中组、顶叶卒中组与基底节区卒中组、枕叶卒中组比较,治疗前MoCA评分低,P300潜伏期延长,波幅减低(P<0.05);与顶叶卒中组比较,额叶组和颞叶组水平差异具有统计学意义(P<0.05)。结论:通督醒脑针法可有效改善认知功能,有效调节大脑血流动力学水平和事件相关电位P300。脑卒中患者以额叶、颞叶卒中后认知功能下降最明显。

Objective:To observe the clinical efficacy of needling method of dredging Du meridian and refreshing brain in treatment of post-stroke cognitive impairment.Methods:60 patients with post-stroke cognitive impairment were randomly divided into the observation group and the control group,with 30 patients in each group.The control group was treated with conventional basic treatment,cognitive rehabilitation and Donepezil Hydrochloride Tablet;on which basis,the observation group was also treated with needling method of dredging Du meridian and refreshing brain.Both groups were treated for 8 weeks.The scores of MoCA,MMSE and ADL,cerebral vascular blood flow(Vs,Vm,RI),and event-related electric potential P300 were compared between the two groups after the treatment.The association of the scores of MoCA and MMSE with the incubation period and the amplitude of P300 was analyzed in the two groups.MoCA score and P300 were compared in patients with different focal lesions.Results:The scores of MoCA,MMSE and ADL were increased after the treatment compared with those before the treatment in the two groups(P<0.05);of which the increases in the observation group were more significant than those in the control group(P<0.05).The levels of Vs,Vm and RI were higher(P<0.05),and the level of RI was lower in the observation group than those in the control group(P<0.05).The incubation period was shorter(P<0.05),and the amplitude was longer in the observation than those in the control group(P<0.05).The incubation of P300 was negatively correlated with the scores of MoCA and MMSE,and the amplitude of P300 was positively correlated with the scores of MoCA and MMSE.The MoCA score was positively correlated with the score of MMSE.The score of MoCA was decreased,the incubation of P300 was prolonged and the amplitude of P300 was lowered in the frontal lobe stroke group,the temporal lobe stroke group and the parietal lobe stroke group than those in the basal ganglia stroke group and the occipital lobe stroke group(P<0.05);in which there were statistical differences in the frontal lobe stroke group and the temporal lobe stroke group compared with those in the parietal lobe group(P<0.05).Conclusion:Needling method of dredging Du meridian and refreshing brain can improve cognitive function,regulate cerebral vascular blood flow and event-related electric potential P300.Cognitive decline was most pronounced in frontal lobe and temporal lobe.