本文選題：腦卒中后認(rèn)知功能障礙 + 天王補(bǔ)心丹��； 參考：《湖北中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的本研究通過(guò)觀(guān)察天王補(bǔ)心丹結(jié)合認(rèn)知功能訓(xùn)練治療在腦卒中后出現(xiàn)的認(rèn)知功能障礙臨床治療效果,探究天王補(bǔ)心丹在治療腦卒中后認(rèn)知功能障礙(post-stroke cognitive impairment,PSCI)的理論依據(jù)以及作用機(jī)理,探索出一種簡(jiǎn)潔、高效的中西醫(yī)綜合康復(fù)方法,并為其廣泛推廣提供客觀(guān)依據(jù)。方法將國(guó)家中醫(yī)藥管理局所發(fā)表的《老年呆病的診斷,辨證分型及療效評(píng)定標(biāo)準(zhǔn)》與《中風(fēng)病診斷以及療效評(píng)定標(biāo)準(zhǔn)》(二代標(biāo)準(zhǔn))作為本研究中醫(yī)診斷的納入標(biāo)準(zhǔn),以中華醫(yī)學(xué)會(huì)2011年頒布的《血管性認(rèn)知障礙診療計(jì)劃》作為本研究的西醫(yī)診斷標(biāo)準(zhǔn)。本實(shí)驗(yàn)共有符合要求的患者42例,均為湖北省中醫(yī)院推拿科/康復(fù)醫(yī)學(xué)科/疼痛科花園山住院部2015年5月至2016年10月期間入院的患者。將42例符合納入標(biāo)準(zhǔn)的卒中后認(rèn)知功能障礙患者隨機(jī)分成2組,其中治療組21例,對(duì)照組21例。治療組予以天王補(bǔ)心丹配合認(rèn)知康復(fù)訓(xùn)練進(jìn)行治療,對(duì)照組只予以認(rèn)知康復(fù)訓(xùn)練治療。運(yùn)用簡(jiǎn)易智力狀態(tài)的檢查(MMSE)、蒙特利爾認(rèn)知的評(píng)估量表(Mo CA)以及日常生活的活動(dòng)能力(ADL)量表為評(píng)價(jià)指標(biāo),所有入選患者均于治療前以及治療后進(jìn)行量表評(píng)價(jià),以量表的評(píng)分情況來(lái)評(píng)價(jià)天王補(bǔ)心丹結(jié)合認(rèn)知康復(fù)訓(xùn)練治療腦卒中后輕度認(rèn)知功能障礙的臨床療效。結(jié)果本研究共有符合其診斷標(biāo)準(zhǔn)的患者44例,但在治療過(guò)程中先后有2人由于其它原因退出本研究,最終進(jìn)入統(tǒng)計(jì)的患者在治療組為21例,對(duì)照組為21例。研究結(jié)果顯示:在年齡以及性別,病程以及受教育的程度等方面,兩組患者治療前后的差異無(wú)統(tǒng)計(jì)學(xué)的意義(P0.05),這表示兩組患者這些項(xiàng)目達(dá)到了基本均衡,其結(jié)果受到上述因素的影響可能性較小。治療之前統(tǒng)計(jì)結(jié)果顯示:兩組患者治療前分別進(jìn)行MMSE量表以及Mo CA量表以及ADL量表這三個(gè)量表進(jìn)行評(píng)分,結(jié)果顯示兩組患者在四個(gè)量表評(píng)分的總分及相應(yīng)量表的子項(xiàng)評(píng)分差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),提示這兩組患者在接受治療前病情大致相同,具有了可比性。治療結(jié)束之后統(tǒng)計(jì)結(jié)果顯示:(1)MMSE量表的評(píng)分結(jié)果表明兩組患者治療結(jié)束之后MMSE評(píng)分在總分以及即刻記憶,回憶以及計(jì)算力、注意以及繪圖四個(gè)子項(xiàng)差異明顯(P0.01);且治療組結(jié)果優(yōu)于對(duì)照組。(2)Mo CA量表評(píng)分結(jié)果表明兩組患者治療結(jié)束之后在總分及注意,視空間和執(zhí)行能力,延遲記憶以及命名四個(gè)子項(xiàng)方面差異有統(tǒng)計(jì)學(xué)意義(P0.01),且治療組優(yōu)于對(duì)照組。(3)ADL量表評(píng)分可顯示兩組患者在治療結(jié)束之后在總分以及兩個(gè)子項(xiàng)目均較治療前顯著改善(PO.01),治療組較對(duì)照組在總分和子項(xiàng)目工具性日常生活能力方面改善更加明顯(P0.01)。在安全性的方面,兩組患者均未曾發(fā)現(xiàn)有著明顯跟治療相關(guān)的不良反應(yīng)。結(jié)論天王補(bǔ)心丹結(jié)合認(rèn)知康復(fù)訓(xùn)練的治療方法對(duì)腦卒中后認(rèn)知障礙有明顯的改善,安全且無(wú)明顯不良反應(yīng),具有臨床推廣意義。
[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.
【學(xué)位授予單位】：湖北中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R277.7

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