天王补心丹结合认知康复训练治疗脑卒中后轻度认知功能障碍的临床观察

发布时间：2018-06-05 16:29

本文选题：脑卒中后认知功能障碍 + 天王补心丹　；参考：《湖北中医药大学》2017年硕士论文

【摘要】：目的本研究通过观察天王补心丹结合认知功能训练治疗在脑卒中后出现的认知功能障碍临床治疗效果,探究天王补心丹在治疗脑卒中后认知功能障碍(post-stroke cognitive impairment,PSCI)的理论依据以及作用机理,探索出一种简洁、高效的中西医综合康复方法,并为其广泛推广提供客观依据。方法将国家中医药管理局所发表的《老年呆病的诊断,辨证分型及疗效评定标准》与《中风病诊断以及疗效评定标准》(二代标准)作为本研究中医诊断的纳入标准,以中华医学会2011年颁布的《血管性认知障碍诊疗计划》作为本研究的西医诊断标准。本实验共有符合要求的患者42例,均为湖北省中医院推拿科/康复医学科/疼痛科花园山住院部2015年5月至2016年10月期间入院的患者。将42例符合纳入标准的卒中后认知功能障碍患者随机分成2组,其中治疗组21例,对照组21例。治疗组予以天王补心丹配合认知康复训练进行治疗,对照组只予以认知康复训练治疗。运用简易智力状态的检查(MMSE)、蒙特利尔认知的评估量表(Mo CA)以及日常生活的活动能力(ADL)量表为评价指标,所有入选患者均于治疗前以及治疗后进行量表评价,以量表的评分情况来评价天王补心丹结合认知康复训练治疗脑卒中后轻度认知功能障碍的临床疗效。结果本研究共有符合其诊断标准的患者44例,但在治疗过程中先后有2人由于其它原因退出本研究,最终进入统计的患者在治疗组为21例,对照组为21例。研究结果显示:在年龄以及性别,病程以及受教育的程度等方面,两组患者治疗前后的差异无统计学的意义(P0.05),这表示两组患者这些项目达到了基本均衡,其结果受到上述因素的影响可能性较小。治疗之前统计结果显示:两组患者治疗前分别进行MMSE量表以及Mo CA量表以及ADL量表这三个量表进行评分,结果显示两组患者在四个量表评分的总分及相应量表的子项评分差异均无统计学意义(P0.05),提示这两组患者在接受治疗前病情大致相同,具有了可比性。治疗结束之后统计结果显示:(1)MMSE量表的评分结果表明两组患者治疗结束之后MMSE评分在总分以及即刻记忆,回忆以及计算力、注意以及绘图四个子项差异明显(P0.01);且治疗组结果优于对照组。(2)Mo CA量表评分结果表明两组患者治疗结束之后在总分及注意,视空间和执行能力,延迟记忆以及命名四个子项方面差异有统计学意义(P0.01),且治疗组优于对照组。(3)ADL量表评分可显示两组患者在治疗结束之后在总分以及两个子项目均较治疗前显著改善(PO.01),治疗组较对照组在总分和子项目工具性日常生活能力方面改善更加明显(P0.01)。在安全性的方面,两组患者均未曾发现有着明显跟治疗相关的不良反应。结论天王补心丹结合认知康复训练的治疗方法对脑卒中后认知障碍有明显的改善,安全且无明显不良反应,具有临床推广意义。
[Abstract]:Objective to observe the clinical effect of Tianwang Bu Xin Dan combined with cognitive function training in the treatment of cognitive dysfunction after stroke. To explore the theoretical basis and mechanism of Tianwang Buxin Dan in the treatment of post-stroke cognitive impairment of cerebral apoplexy, to explore a simple and efficient comprehensive rehabilitation method of traditional Chinese and western medicine, and to provide an objective basis for its extensive popularization. Methods the criteria of diagnosis, Syndrome differentiation and Therapeutic Evaluation of senile Demphis, published by the State Administration of traditional Chinese Medicine, and the criteria for diagnosis and Evaluation of curative effect of Stroke (second Generation Standard) were used as the inclusion criteria of TCM diagnosis in this study. The diagnosis and treatment Plan of Vascular Cognitive Disorder issued by the Chinese Medical Association in 2011 was used as the diagnostic standard of western medicine. A total of 42 patients were admitted to the hospital from May 2015 to October 2016. 42 patients with post-stroke cognitive dysfunction were randomly divided into two groups: treatment group (n = 21) and control group (n = 21). The treatment group was treated with Tianwang Buxin Dan combined with cognitive rehabilitation training, while the control group was only treated with cognitive rehabilitation training. The simple mental state (MMSE), the Montreal Cognitive Assessment scale (MOA) and the activity of Daily living (ADL) scale were used as the evaluation index. All the patients were evaluated before and after treatment. To evaluate the clinical efficacy of Tianwang Buxin Dan combined with cognitive rehabilitation training in the treatment of mild cognitive dysfunction after stroke. Results there were 44 patients who met the diagnostic criteria in this study, but in the course of treatment, 2 patients withdrew from the study for other reasons, and 21 patients in the treatment group and 21 in the control group. The results showed that there was no significant difference between the two groups in terms of age and sex, course of disease and education level before and after treatment. The results are less likely to be affected by the above factors. The statistical results before treatment showed that the patients in the two groups were evaluated with MMSE scale, Mo CA scale and ADL scale before treatment. The results showed that there was no significant difference in the total scores of the four scales and the sub-items of the corresponding scales between the two groups, suggesting that the patients in the two groups had the same condition before the treatment and were comparable. At the end of the treatment, the statistical results showed that the MMSE score of the two groups showed the total score, immediate memory, memory and computational power after the treatment. There were significant differences among the four subitems in attention and drawing, and the results of the treatment group were better than those of the control group (P < 0.01). The results of the treatment group were superior to those of the control group (P < 0.05). The results showed that the total score, attention, visual space and executive ability of the two groups were higher after the treatment. The difference of delayed memory and naming of four subitems was statistically significant (P 0.01), and the ADL score of the treatment group was better than that of the control group. The ADL scores of the two groups showed significant improvement in the total score and the two sub-items after the treatment. Compared with the control group, the improvement of total score and instrumental ability of daily life in the treatment group was more obvious than that in the control group (P 0.01). In terms of safety, no significant treatment-related adverse reactions were found in either group. Conclusion the treatment of Tianwang Bu Xin Dan combined with cognitive rehabilitation training can obviously improve the cognitive impairment after stroke, and it is safe and has no obvious adverse reactions. It is of clinical significance.
【学位授予单位】：湖北中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R277.7

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