本文選題：認(rèn)知訓(xùn)練　切入點(diǎn)：腦梗死　出處：《承德醫(yī)學(xué)院》2017年碩士論文

【摘要】：隨著現(xiàn)代人們生活節(jié)奏及飲食結(jié)構(gòu)、方式的改變,使得卒中發(fā)病率提高,卒中是一種高致殘的疾病,卒中后遺留的功能障礙給患者家庭、社會帶來嚴(yán)重負(fù)擔(dān),使得人們不得不關(guān)注,改善患者的功能障礙已成為神經(jīng)康復(fù)的日常工作。然而腦卒中后認(rèn)知功能的恢復(fù)一直是康復(fù)治療的重點(diǎn)及難點(diǎn),其持續(xù)時(shí)間長、癥狀嚴(yán)重成為影響患者功能康復(fù)的瓶頸,神經(jīng)康復(fù)工作者們一直致力于尋找切實(shí)可行的措施來促進(jìn)認(rèn)知功能的改善。近年來關(guān)于認(rèn)知訓(xùn)練對卒中后肢體功能改善的研究成為熱點(diǎn),關(guān)于影響腦卒中后認(rèn)知功能的因素的研究也已經(jīng)深入到細(xì)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證明是影響認(rèn)知功能的獨(dú)立危險(xiǎn)因素,影響認(rèn)知功能的恢復(fù)。目的:探討早期認(rèn)知訓(xùn)練對腦梗死后認(rèn)知障礙患者的康復(fù)療效。方法:將60例初次發(fā)作腦梗死合并認(rèn)知障礙的患者按隨機(jī)數(shù)字表法分為治療組(30例)和對照組(30例)。對照組進(jìn)行常規(guī)藥物治療及康復(fù)訓(xùn)練。治療組在接受同對照組相同的藥物及常規(guī)訓(xùn)練外輔以強(qiáng)化集中認(rèn)知訓(xùn)練,每次30-45min/次,1次/日,5日/周。于治療前、治療4周后分別采用洛文斯頓作業(yè)療法認(rèn)知評定量表(LOCTA)、Fugle-Meyer(FMA)運(yùn)動功能評分、改良Bathel指數(shù)(MBI)及Berg平衡功能量表(BBS)對2組患者的認(rèn)知及肢體功能進(jìn)行療效評定,同時(shí)于上述時(shí)間點(diǎn)檢測各組患者血漿同型半胱氨酸水平并進(jìn)行對比。并進(jìn)行治療前后比較。結(jié)果:LOCTA評分情況:治療前,治療組及對照組中LOCTA各認(rèn)知領(lǐng)域受損情況的分布經(jīng)非參數(shù)檢驗(yàn)大體相同。治療4周后,治療組總分由最初的43.57±17.38分增加到69.23±17.92分,對照組總分由最初44.83±16.69分增加到65.83±19.51分。FMA肢體功能評分:治療前,治療組33.67±25.43分,對照組27.30±23.29分,治療4周后,治療組增加到51.63±27.11分,對照組增加到38.13±24.80分。MBI評分:治療前,治療組37.60±21.33分,對照組34.53±24.39分,治療4周后,治療組增加到65.37±21.06分,對照組增加到53.07±23.95分。BBS平衡能力評分:治療前,治療組11.57±11.54分,對照組8.80±8.79分,治療4周后,治療組增加到30.00±14.95分,對照組增加到20.50±14.05分。血中同型半胱氨酸(Hcy)水平測定:治療4周后,治療組由最初的18.40±6.34umol/L,降低到10.38±2.67umol/L。對照組由最初的18.85±7.43umol/L降低到14.62±5.73umol/L。治療前,兩組患者認(rèn)知的LOCTA評分情況、肢體功能的FMA評分、日常生活活動能力的MBI評分、平衡能力的BBS評分、血漿中Hcy的水平組間進(jìn)行統(tǒng)計(jì)學(xué)分析,差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。治療4周后,兩組患者LOCTA評分情況、FMA肢體功能評分、MBI評分、BBS平衡能力評分、血漿中Hcy水平組間比較與組內(nèi)治療前比較均有明顯改善(P0.05)。治療組患者的LOCTA評分情況、FMA肢體功能評分、MBI評分、BBS平衡能力評分、血漿中Hcy水平的改善程度顯著高于對照組(P0.05)。血漿中Hcy水平下降程度與LOCTA評定認(rèn)知改善程度無明顯線性相關(guān)關(guān)系。結(jié)論:1本研究中,治療4周以后,治療組在LOCTA評分、FMA肢體功能評分、MBI評分、BBS平衡能力評分上,都明顯優(yōu)于對照組,由此看出,認(rèn)知訓(xùn)練療法配合常規(guī)康復(fù)治療,對推進(jìn)腦卒中認(rèn)知障礙患者肢體功能及日常生活活動能力的改善是行之有效的。2本研究中,治療4周后,治療組血漿中Hcy水平下降程度較對照組明顯,因此,認(rèn)知程度的改善與血漿同型半胱氨酸水平相關(guān)。3本研究中,認(rèn)知訓(xùn)練療法是擬定30-45min/次,日1次,每周5天的方案并規(guī)范實(shí)施的。該方案的有效性在實(shí)驗(yàn)過程中得到了證實(shí)。4本研究中,沒有觀察到認(rèn)知下降程度與血漿同型半胱氨酸水平呈明顯的線性相關(guān)關(guān)系。就該結(jié)果而言,影響血中同型半胱氨酸下降程度因素較多,實(shí)驗(yàn)中對于飲食、遺傳因素及其他合并疾病集體控制欠佳,尚需規(guī)范實(shí)驗(yàn)入組條件,進(jìn)行多元線性分析,最終得到相關(guān)結(jié)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.

【學(xué)位授予單位】：承德醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R743.3;R493

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