早期认知训练对脑梗死后康复训练效果的疗效观察

发布时间：2018-03-29 07:06

本文选题：认知训练　切入点：脑梗死　出处：《承德医学院》2017年硕士论文

【摘要】：随着现代人们生活节奏及饮食结构、方式的改变,使得卒中发病率提高,卒中是一种高致残的疾病,卒中后遗留的功能障碍给患者家庭、社会带来严重负担,使得人们不得不关注,改善患者的功能障碍已成为神经康复的日常工作。然而脑卒中后认知功能的恢复一直是康复治疗的重点及难点,其持续时间长、症状严重成为影响患者功能康复的瓶颈,神经康复工作者们一直致力于寻找切实可行的措施来促进认知功能的改善。近年来关于认知训练对卒中后肢体功能改善的研究成为热点,关于影响脑卒中后认知功能的因素的研究也已经深入到细胞分子生物水平,值得一提的是血液中同型半胱氨酸水平被证明是影响认知功能的独立危险因素,影响认知功能的恢复。目的:探讨早期认知训练对脑梗死后认知障碍患者的康复疗效。方法:将60例初次发作脑梗死合并认知障碍的患者按随机数字表法分为治疗组(30例)和对照组(30例)。对照组进行常规药物治疗及康复训练。治疗组在接受同对照组相同的药物及常规训练外辅以强化集中认知训练,每次30-45min/次,1次/日,5日/周。于治疗前、治疗4周后分别采用洛文斯顿作业疗法认知评定量表(LOCTA)、Fugle-Meyer(FMA)运动功能评分、改良Bathel指数(MBI)及Berg平衡功能量表(BBS)对2组患者的认知及肢体功能进行疗效评定,同时于上述时间点检测各组患者血浆同型半胱氨酸水平并进行对比。并进行治疗前后比较。结果:LOCTA评分情况:治疗前,治疗组及对照组中LOCTA各认知领域受损情况的分布经非参数检验大体相同。治疗4周后,治疗组总分由最初的43.57±17.38分增加到69.23±17.92分,对照组总分由最初44.83±16.69分增加到65.83±19.51分。FMA肢体功能评分:治疗前,治疗组33.67±25.43分,对照组27.30±23.29分,治疗4周后,治疗组增加到51.63±27.11分,对照组增加到38.13±24.80分。MBI评分:治疗前,治疗组37.60±21.33分,对照组34.53±24.39分,治疗4周后,治疗组增加到65.37±21.06分,对照组增加到53.07±23.95分。BBS平衡能力评分:治疗前,治疗组11.57±11.54分,对照组8.80±8.79分,治疗4周后,治疗组增加到30.00±14.95分,对照组增加到20.50±14.05分。血中同型半胱氨酸(Hcy)水平测定:治疗4周后,治疗组由最初的18.40±6.34umol/L,降低到10.38±2.67umol/L。对照组由最初的18.85±7.43umol/L降低到14.62±5.73umol/L。治疗前,两组患者认知的LOCTA评分情况、肢体功能的FMA评分、日常生活活动能力的MBI评分、平衡能力的BBS评分、血浆中Hcy的水平组间进行统计学分析,差异均无统计学意义(P0.05)。治疗4周后,两组患者LOCTA评分情况、FMA肢体功能评分、MBI评分、BBS平衡能力评分、血浆中Hcy水平组间比较与组内治疗前比较均有明显改善(P0.05)。治疗组患者的LOCTA评分情况、FMA肢体功能评分、MBI评分、BBS平衡能力评分、血浆中Hcy水平的改善程度显著高于对照组(P0.05)。血浆中Hcy水平下降程度与LOCTA评定认知改善程度无明显线性相关关系。结论:1本研究中,治疗4周以后,治疗组在LOCTA评分、FMA肢体功能评分、MBI评分、BBS平衡能力评分上,都明显优于对照组,由此看出,认知训练疗法配合常规康复治疗,对推进脑卒中认知障碍患者肢体功能及日常生活活动能力的改善是行之有效的。2本研究中,治疗4周后,治疗组血浆中Hcy水平下降程度较对照组明显,因此,认知程度的改善与血浆同型半胱氨酸水平相关。3本研究中,认知训练疗法是拟定30-45min/次,日1次,每周5天的方案并规范实施的。该方案的有效性在实验过程中得到了证实。4本研究中,没有观察到认知下降程度与血浆同型半胱氨酸水平呈明显的线性相关关系。就该结果而言,影响血中同型半胱氨酸下降程度因素较多,实验中对于饮食、遗传因素及其他合并疾病集体控制欠佳,尚需规范实验入组条件,进行多元线性分析,最终得到相关结果。
[Abstract]:With modern life rhythm and diet structure, changes in the way, the incidence of stroke, stroke is a highly disabling disease, stroke left after the impairment to the patient's family and society brings the serious burden, which make people have to pay attention, improve the patient's dysfunction has become routine. However, neural rehabilitation of cognitive function after stroke recovery has been the focus and difficulty of rehabilitation treatment, which lasted for a long time, the symptoms become a bottleneck affecting the patient rehabilitation, rehabilitation workers have been trying to find feasible measures to promote the improvement of cognitive function. In recent years has become a hot research on cognitive training to improve limb function after stroke. Study on factors affecting the cognitive function after stroke has been deep into the molecular biology level, it is worth mentioning that the blood homocysteine Amino acid levels were shown to be independent risk factors affecting cognitive function, cognitive function recovery. Objective: To investigate the early cognitive training on the rehabilitation effect of patients with cognitive impairment after cerebral infarction. Methods: 60 cases of initial onset of cognitive impairment in patients with cerebral infarction according to the random number table method is divided into the treatment group (30 cases) and the control group (30 cases). The control group was given routine drug treatment and rehabilitation training. The treatment group in the control group underwent the same drugs and routine training and strengthen the focus of cognitive training, 30-45min/ each time, 1 times / day, 5 days / week. Before treatment, 4 weeks after treatment respectively using Loewenstein Occupational Therapy Cognitive Rating Scale (LOCTA), Fugle-Meyer (FMA) motor function score, modified Bathel index (MBI) and Berg balance scale (BBS) was used to evaluate the curative effect of cognitive and limb function in the patients of the 2 groups, while at the same time point were detected with Comparison of plasma homocysteine levels and. And comparing before and after treatment. Results: the LOCTA score: before treatment, the treatment group and control group LOCTA in each cognitive domain damage distribution by nonparametric test is largely the same. After 4 weeks of treatment, the treatment group total score from 43.57 + 17.38 to 69.23 + 17.92, control group total score from 44.83 + 16.69 to 65.83 + 19.51 increase.FMA limb function score: before treatment, the treatment group of 33.67 + 25.43, 27.30 + 23.29 in control group, after 4 weeks of treatment, the treatment group increased to 51.63 + 27.11, the control group increased to 38.13 in 24.80..MBI score: before treatment, the treatment group of 37.60 + 21.33, 34.53 + 24.39 in control group, after 4 weeks of treatment, the treatment group increased to 65.37 + 21.06, the control group increased to 53.07 + 23.95.BBS balance score: before treatment, the treatment group of 11.57 + 11.54, 8.80 + 8.79 in control group, After 4 weeks of treatment, the treatment group increased to 30 + 14.95, the control group increased to 20.50 + 14.05. Serum homocysteine (Hcy) levels were measured after 4 weeks of treatment, the treatment group from the initial 18.40 + 6.34umol/L, 10.38 + 2.67umol/L. group decreased to 18.85 from the initial L to + 7.43umol/ 14.62 + 5.73umol/L. before treatment, LOCTA score of two groups of patients with cognitive, limb function FMA score, ADL score of MBI, the balance ability of BBS score, statistical analysis of the level of plasma Hcy, there were no significant differences (P0.05). After 4 weeks of treatment, scores of two groups LOCTA patients, FMA limb function score, MBI score, BBS balance score, plasma Hcy level between groups compared with the group before treatment were significantly improved (P0.05). The LOCTA score of the patients in the treatment group, FMA limb function score, MBI score, BBS can balance Stress score, improve the degree of the plasma level of Hcy was significantly higher than the control group (P0.05). The plasma level of Hcy decreased and LOCTA to evaluate the cognitive degree of improvement without obvious linear correlation. Conclusion: 1 in this study, after 4 weeks of treatment, the treatment group in the LOCTA score, FMA limb function score, MBI score, BBS balance the ability to score, were significantly better than the control group, which shows that the cognitive therapy combined with routine rehabilitation training, and to promote the activities of daily living brain stroke patients with cognitive disorder limb function improvement is effective for.2 in this study, after 4 weeks of treatment, the treatment group in plasma Hcy level decreased significantly compared with the control group, so.3, and improve the plasma homocysteine level of cognitive level in this study, cognitive training therapy is proposed for 30-45min/ times, 1 times a day, 5 days a week and the implementation of the norms. The effectiveness of the proposed scheme in the experiment In the process of.4 was confirmed in the present study, no observed cognition showed a linear correlation significantly decreased and the level of plasma homocysteine level. This result, effect of homocysteine decreased by many factors, the experiment for diet, genetic factors and other diseases associated with poor control of the collective, still need to standardize the test group conditions, multiple linear analysis, finally obtained the relevant results.

【学位授予单位】：承德医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3;R493

【参考文献】