贾云哲 吕晓宇

[摘要] 目的 探讨针灸联合活血通络汤治疗脑卒中后认知功能障碍的临床效果。 方法 选择2015年1月～2016年12月武汉市第十一医院收治的79例脑卒中后认知功能障碍患者，随机分为对照组（39例）和治疗组（40例）。对照组患者给予活血通络汤治疗，治疗组患者给予针灸联合活血通络汤治疗，两组患者均连续治疗30 d。评价并比较两组患者临床疗效。应用简易精神状态检查量表（MMSE）评价认知功能，检测治疗前后血清皮质醇（Cor）、热休克蛋白70（HSP70）水平，觀察患者在治疗过程中的不良反应。 结果 治疗组总有效率明显高于对照组（P < 0.05）。治疗后，两组患者MMSE评分明显高于治疗前，且治疗组MMSE评分明显高于对照组，差异有统计学意义（P < 0.05）。两组患者血清Cor水平明显低于治疗前，血清HSP70水平明显高于治疗前，且治疗组治疗后血清Cor、HSP70水平变化均明显优于对照组，差异均有统计学意义（P < 0.05）。两组在治疗过程中均未见明显的不良反应。 结论 针灸联合活血通络汤治疗脑卒中后认知功能障碍临床效果显著，能够明显改善患者认知功能和神经功能预后，且安全性较好，值得在临床上推广应用。

[关键词] 针灸；活血通络汤；脑卒中后认知功能障碍；疗效

[中图分类号] R749.1 [文献标识码] A [文章编号] 1673-7210（2018）02（a）-0113-04

Clinical study of acupuncture combined with Huoxue Tongluo Decoction in the treatment of post-stroke cognitive impairment

JIA Yunzhe1 LYU Xiaoyu2

1.Department of Rehabilitation， Wuhan Eleventh Hospital， Hubei Province， Wuhan 430015， China； 2.Department of Rehabilitation， Guangzhou General Hospital of Southern Theater Command， Guangdong Province， Guangzhou 950010， China

[Abstract] Objective To investigate the effects of acupuncture combined with Huoxue Tongluo Decoction in the treatment of post-stroke cognitive impairment. Methods A total of 79 patients with post-stroke cognitive impairment in Wuhan Eleventh Hospital from January 2015 to December 2016 were enrolled in this study. The subjects were randomly divided into the control group （39 cases） and the treatment group （40 cases）. The control group was treated with Huoxue Tongluo Decoction， the treatment group was treated with acupuncture combined with Huoxue Tongluo Decoction. The two groups were treated for 30 days. The clinical effects of the two groups after treatment were compared. The cognitive function by mini-mental state examination （MMSE） was evaluated， the levels of serum cortisol （Cor） and heat shock protein 70 （heat shock protein 70， HSP70） were detected before and after treatment， the adverse reactions of the two groups during treatment were observed. Results The total effective rate of the treatment group was significantly higher than that of control group （P < 0.05）. After treatment， the MMSE score of the two groups was significantly higher than that before treatment， the MMSE score of the treatment group was significantly higher than that of control group （P < 0.05）. After treatment， the levels of serum Cor in the two groups were significantly lower than those before treatment， the levels of serum HSP70 in the two groups were significantly higher than those before treatment， and the changes of serum Cor and HSP70 levels after treatment in the treatment group were significantly better than those in the control group， the differences were statistically significant （P < 0.05）. There were no significant adverse reactions in the two groups during the treatment. Conclusion Acupuncture combined with Huoxue Tongluo Decoction for patients with post-stroke cognitive impairment has a good efficacy， which can improve the cognitive function and neurologic prognosis， with good safety， and it is worthy of clinical promotion and application.

[Key words] Acupuncture； Huoxue Tongluo Decoction； Post-stroke cognitive impairment； Efficacy

脑卒中，又称脑血管意外，是指脑部供血动脉粥样硬化或血栓形成导致脑动脉堵塞、狭窄或破裂，从而引起的急性脑血液循环功能障碍，可分为缺血性脑卒中和出血性脑卒中两种类型，其中缺血性脑卒中占70%以上[1]。脑卒中好发于中老年人群，大多数患者在抢救治疗后会有不同程度的认知功能障碍，常有焦虑、抑郁等心理状态，多伴有失认、失语、视觉障碍、记忆障碍等，严重影响患者的身体健康和日常生活[2]。认知功能是人在认识客观事物的过程中对所感觉到的信息进行获取、提取、编码、操作及使用的过程，包括注意、知觉、思维、记忆、语言、执行能力等，是目前康复医学研究的一项重点[3]。脑卒中后认知功能障碍是发展为血管性痴呆的早期阶段，早期及时有效的治疗还存在逆转的可能性，故脑卒中后认知功能障碍受到医学界的关注[4]。……