针刺联合认知训练治疗缺血性卒中后认知功能障碍疗效观察  

Efficacy Observation of Acupuncture Combined with Cognitive Training for Cognitive Impairment After Ischemic Stroke

作　　者：王飞[1] 高珊[1] 杨林[1] WANG Fei;GAO Shan;YANG Lin(Wuhan No.1 Hospital,Wuhan 430022,China)

机构地区：[1]武汉市第一医院,武汉430022

出　　处：《上海针灸杂志》2021年第7期795-800,共6页Shanghai Journal of Acupuncture and Moxibustion

基　　金：湖北省自然科学基金项目(HBWH201801210)。

摘　　要：目的观察针刺联合认知训练治疗缺血性卒中后认知功能障碍的临床疗效。方法将80例缺血性卒中后认知功能障碍患者,随机分为观察组和对照组,每组40例,对照组患者给予个性化认知训练方案治疗,观察组在对照组的基础上选取百会、神门穴进行针刺治疗。治疗前后对观察组患者进行静息态核磁共振扫描(rs-fMRI)检查,比较两组治疗前后美国国立卫生研究院卒中量表(NIHSS)、简易精神状态量表(MMSE)、蒙特利尔认知评估量表(MoCA量表)、Fugl-Meyer评估法(FMA)、改良Barthel指数(MBI)评分变化,并比较两组临床疗效以及观察组双侧海马区功能连接变化情况。结果观察组患者的总有效率为95.0%,高于对照组的77.5%(P<0.05)。与治疗前比较,两组治疗后的NIHSS评分降低,MMSE、MoCA、FMA、MBI评分升高,且观察组上述指标优于对照组,差异有统计学意义(P<0.05)。与治疗前比较,观察组患者fMRI表现为左侧海马与右侧额下回、右侧额中回,右侧海马与左侧额中回、左侧额下回、左侧额上回及左侧顶叶的功能连接增强,差异有统计学意义(P<0.05)。结论针刺联合认知训练可有效改善缺血性卒中后认知功能障碍患者的神经认知损伤,并能提高运动功能及日常生活自理能力,作用机制可能与改善海马脑区与额叶、顶叶之间的功能连接有关。Objective To observe the clinical efficacy of acupuncture plus cognitive training in treating cognitive impairment after ischemic stroke.Method Eighty patients with cognitive impairment after ischemic stroke were randomized into an observation group and a control group,with 40 cases in each group.Patients in the control group were given individualized cognitive training plan,while the observation group was given additional acupuncture treatment by selecting Baihui(GV20)and Shenmen(HT7).Before and after treatment,patients in the observation group were examined using resting-state functional magnetic resonance imaging(rs-fMRI).The scores of National Institute of Health stroke scale(NIHSS),mini-mental state examination(MMSE),Montreal cognitive assessment(MoCA),Fugl-Meyer assessment(FMA)and modified Barthel index(MBI)in the two groups were compared before and after treatment.Clinical efficacy was also compared in the two groups,as well as the changes of functional connections in bilateral hippocampus in the observation group.Result The total effective rate was 95.0%in the observation group,higher than 77.5%in the control group(P<0.05).After treatment,the NIHSS score decreased,and the scores of MMSE,MoCA,FMA and MBI increased in both groups,and the observation group was superior to the control group comparing the above indexes,with statistical significance(P<0.05).After intervention,the fMRI findings in the observation group showed that the functional connections between the left hippocampus and the inferior and middle frontal gyrus of the right side,and the connections between the right hippocampus and the middle,inferior and superior frontal gyrus as well as the parietal lobe of the left side were strengthened,presenting statistical significance(P<0.05).Conclusion Acupuncture plus cognitive training can effectively improve the neurological and cognitive impairments and improve motor function and daily living abilities in patients with cognitive impairment after ischemic stroke.The mechanism may be associated with th

关 键 词：针刺疗法 中风后遗症 认知功能障碍 核磁共振成像 美国国立卫生研究院卒中量表 

分 类 号：R246.6[医药卫生—针灸推拿学]